CARE HOMES FOR OLDER PEOPLE
Tree Tops Nursing Home 12 Ryndleside Northstead Manor Drive Scarborough North Yorkshire YO12 6AD Lead Inspector
Mary Slattery Unannounced Inspection 13th October 2005 10:15 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 Tree Tops Nursing Home DS0000028018.V256738.R01.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. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tree Tops Nursing Home Address 12 Ryndleside Northstead Manor Drive Scarborough North Yorkshire YO12 6AD 01723 372729 01723 372729 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) Complete Care Homes Limited Mrs Mavis Patricia Garner Care Home 24 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (24) Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users in category (DE) must be aged 55 years upwards Date of last inspection 27th April 2005 Brief Description of the Service: Tree Tops is a care home providing nursing care and accommodation for up to 24 service users with dementia and mental disorder from the age of 55 years upwards. Tree Tops is a detached house located in a residential area of the seaside town of Scarborough. The amenities and the facilities of the town centre are a short distance from the home. There are single and double bedrooms over three floors and access to the upper floors is by either the stairs or a passenger lift. There is ramped and level access to the home and level access around the home. There is a garden area at the front which service users use in the good weather and parking is available at the back of the house and on the road at the front. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report related to an unannounced inspection carried out on the 13th October 2005. The inspection took five hours plus 2 hours preparation time. A tour of the premises was carried out, which included the service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users and staff. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The registered manager was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
Tree Tops provides nursing care and accommodation for people from the age of 55 years who have dementia and mental health problems. There was good information in the statement of purpose and service user guide about the facilities and service provided, the accommodation and how to make a complaint against any aspect of life in the home. The staff carry out assessments and collect useful information about the service users’ nursing and personal care needs. They talk to relatives and the service user about their past lives and produce a social history which enables appropriate leisure activities to be arranged for them to take part in. Have good meaningful care plans in place, which gives information about all their needs with clear actions plans in place to assist the staff in delivering the appropriate care and to minimise risks to the service users yet enabling the service users to remain as independent both physically and mentally as far as they are able. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 6 The staff have training opportunities to gain the necessary skills and knowledge they need to provide care to service users who have dementia, mental illness and behaviour problems. Good nutritional assessments were in place a good selection of food for their health, welfare and enjoyment was provided. There was plenty of equipment available for pressure relief and for the safe moving and handling of service users. Good relationships were kept with external health care professions including general practitioners and mental health services on behalf of the service users and relatives are kept informed of any changes in their conditions. Lunchtime was observed and the staff’s performance was streamlined making sure that the service users were given all the support and attention they needed to have their lunch in a pleasant and peaceful way. What has improved since the last inspection? What they could do better:
Serious attention must be given to the current practice where service users are denied the right of choice about what time they go to bed each night. Every service user has a nighttime care plan and the staff must make sure that they are working in accordance with these care plans.
Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 7 The majority of the service users are not able due to the nature of their condition to always make an informed verbal choice about when they wish to go to bed. Some do however indicate in some way that this is what they want to do or not. No service user should be assisted to bed for the convenience of the night staff. The registered proprietor and the registered manager need to work together to implement appropriate management systems that makes sure that there is enough staff on duty, that service users receive their correct medication and that the required checks are made on staff before they are employed. The hall and stairs carpet needs to be replaced and the required safety certificates need to be in place to show that all equipment is in good order and the service users and staff are safe. 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. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4,and 5. People are provided with information about what the home offers and information is gathered about people before they are admitted to the home to make sure that their needs can be met in a safe way. EVIDENCE: The statement of purpose and the service user guide provides people with the information about what the home offers. There is information about the accommodation, the facilities, specialist equipment, the staff that are employed in the home and the details of how to make a complaint against the service. Service users and/or their representatives have written contracts/terms and conditions document and copies are held on each individual file. Prospective service users and their representatives are invited to visit the home to look and the facilities and services to see if they are suitable to their needs. Arrangements are made for all prospective service users to have their needs assessed prior to any admission being agreed. This information is recorded and
Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 10 The outcomes of the assessments are discussed to ensure that their needs can be met and that any equipment necessary is made available before admission. The home provides care for people with dementia and mental disorder who are not always able to make an informed choice about their future care and accommodation and in light of this the decision to move into the home is usually made by the service users next of kin or their representative. The home does not provide intermediate care. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. There are systems in place to assist the staff in meeting the needs of the service users. EVIDENCE: All of the service users care plans have been reviewed and those inspected gave good information about the service users personal, nursing, social and mental health needs. Their was clear guidance in place to assist staff in meeting individual needs, information about the contact with external health care professionals and the outcomes of any treatments and interventions by health care professionals and the arrangements in the event of their death. Risk assessments had been carried out and plans were in place to reduce the risk in relation to falls and freedom of movement around the home. There was information about the prevention and treatment of pressure sores and the pressure relieving equipment that was in use and the management and promotion of continence. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 12 There was guidance in place to help the staff manage difficult and challenging behaviour and a nighttime profile for each service users that gave details of service users sleeping patterns. The daily records detailed the care given and any changes in the service users condition. The arrangements for assisting service users to go to bed at night and to get up each morning were discussed. The following concerns were raised: The night staff’s expectations were that the majority of service users would be in bed when they came on duty. Although the policy of the home is that service users will be assisted to bed according to their care needs and wherever possible their wishes. The night staff start duty at 8pm each evening and the majority of staff feel that it is unreasonable that any service user should be assisted to bed against their wishes at this time of the evening. These concerns have been raised with the manager and discussed at staff meetings. It has been made clear to all staff that service users will not be assisted to bed to suit the staff but the practice continues. One member of staff was said to have walked out of the home shortly after commencing duty because the majority of service users were still up. This practice must stop and any staff working against the homes philosophy of care and its and policies should be disciplined. Whilst staff were seen to be respectful towards the service users during the inspection the above practice shows that the service users are not always treated with respect and they are denied the opportunity to exercise their right to choose when they go to bed. There are no service users who administer their own medication. The qualified nursing staff are responsible for the procedure. The system and facilities were inspected and a number of gaps were found in the administration records. The nursing staff have failed on a number of occasions to keep accurate records to confirm that service users have received their medication. An official notice has preciously been served regarding this matter. A robust monitoring system, to provide all qualified nursing staff with medication training and to take appropriate action against the nursing staff that fail to follow the required medication recording procedures. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Visitors are welcome in the home and the arrangements are flexible allowing service users regular contact with their family and friends. EVIDENCE: Because of the service users conditions it id difficult to confirm with any certainty that their experiences of life in the home match their expectations. Information is gathered about the service users and a social history is available for staff to refer to. This helps when social activities are being organised and when staff spend one to one time with them. One member of staff is responsible to develop and implement an appropriate social activities programme. Lots of new equipment has been purchased including a music centre, paints and light exercise equipment. A number of paintings that were done by the service users were displayed in the home. Visitors are made welcome and time is spent with them discussion the welfare of their relative and arrangements made for service users to visit their family where possible. There was evidence that service users were asked about what they would like to do and they were given support from the staff to choose what they wear each day and what they would like to eat and drink but they were not helped
Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 14 to decide the time they get up in the morning or at what time they go to bed each night. The minutes of the staff meeting refer to the discussion about changes that need to be made to the current menu to ensure that all that is offered meets the nutritional needs of the service users and their likes and dislikes. The care plan records showed that the nutritional assessments have been updated and gave information about what is required to maintain good health, there was information about the type and level of support each person needed and any equipment necessary to for them feed themselves. Lunch time was observed and this was carried out in the best interest of the service users, The atmosphere was calm, everyone was attended to as needed ensuring they were satisfied and enjoyed the food provided. The staffing levels increase over this period to enable this to happen. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The service users are not always able to tell the staff when they are unhappy about the care they receive and rely on their relatives and to staff to advocate on their behalf. EVIDENCE: Service users and their representatives are informed about how to make a complaint against the service and records of all complaints and their outcomes are recorded. Many of the staff showed great concern about the service users choices being restricted and were focused on making sure changes were made allowing people choice about what they do each day. The staff demonstrated a good understanding of the adult protection policy and procedure and a number have had abuse awareness training. A recent incident has occurred in the home and this was dealt with effectively and in line with the adult protection policy and procedure ensuring that service users were safe. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 and 26. The standard of the environment continues to improve providing service users with a clean and more homely place to live in. EVIDENCE: There is a programme of redecoration and refurbishment to continually upgrade the furnishings fixtures and fittings. One of the sitting rooms has been repainted and new furniture is on order. The sluice room and the laundry have been cleaned and tidied up; shelves and a sink have been fitted in the laundry. The service users bedrooms are furnished to meet their needs and relatives are encouraged to bring personal items to help personalise the bedrooms. There is a wide range of equipment available to assist with moving and handling and for pressure relief.
Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 17 There are sufficient assisted bathing and toilet facilities and the home was clean and free from offensive odours. The carpet on the hallways and stairs is looking shabby and worn in places and needs to be replaced. Rubbish is still being stored at the side of the building and this needs to be removed to reduce the risk of fire and improve the exterior environment. The following safety certificates were not available for inspection. Fixed wiring certificate. Gas safety certificate. Water testing certificate for Legionella. Nurse call bell inspection certificate. Small appliance testing certificate. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The registered proprietors actions towards changing the staff rota poor staff recruitment may place service users at risk. EVIDENCE: The home employs qualified nursing staff with mental health qualifications and general nursing qualifications and care staff who have completed NVQ training and other staff are working towards completing NVQ. Training planned to take place includes the required first aid and fire safety training. Staff would benefit from infection control and HIV AIDS awareness training. The staff records were inspected and those that were inspected were in good order and there was evidence that the required checks had taken place. The CRB checks that were carried out on 2 members of staff had been done by their previous employer and the registered person is required to carryout further CRB checks on these 2 members of staff. 2 staff that have recently commenced working in the home both transferred from another home previously owned by the registered proprietor. There were no records in place for these staff. It was established that due to a staff shortage on night duty attempts were made to secure the services of one member of the existing staff group.
Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 19 This was not possible and the registered proprietor made arrangements for a person not employed in the home to work on duty overnight alongside 2 other members of staff. None of the required checks had been carried out to establish if this person was suitable to work in a care home with vulnerable people. This arrangement is totally unacceptable and compromises the safety of service users. The home employs one cook and a kitchen assistant. The cook is currently on sick leave and care staff that have the required food handling certificate are working in the kitchen. The staff are on the care staff rota and are taken off the floor, which resulted in the staffing levels being reduced by one. This is not acceptable and proper arrangement must be made to cover kitchen duties. There is no domestic staff on duty over the weekend period and care staff carryout the required cleaning tasks. Arrangements must be made to have sufficient staff available to carryout all the required domestic tasks over 7 days. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37 and 38. The registered proprietor and the registered manager need to get together to produce a clear plan to show how they are to work together to manage the service effectively and efficiently. EVIDENCE: The registered manager is a qualified nurse and has managed the service for a number of years. Some duties and responsibilities are delegated to other qualified nurses. The registered manager has not completed a management training course. Staff meetings take place providing them with an opportunity to discuss all aspects of the day-to-day activity in the home. There are some care practices that need to be changed to enable the registered manger to demonstrate fully that the home is run in the best interests of the service users.
Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 21 A formal system of staff supervision needs to be in place and the outcomes recorded. Arrangements need to be made for structured meeting with the registered proprietor to take place to discuss the activity in the home to ensure that it is run effectively, efficiently and in the best interests of the service users. All the records are kept secure and staff have access to the homes policies and procedures. There is a health and safety policy in place and staff attend health and safety training. A number of the required safety certificates were not available for inspection as detailed in standards 19-26. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 3 3 3 3 X 3 STAFFING Standard No Score 27 1 28 1 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X X X 3 1 Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 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 OP9 Regulation 13(2) Requirement The registered person is required to keep accurate records of all medication administered to service users. Requirement outstanding from the previous inspection. The registered person is required to make arrangements to enable service users to choose when they retire to bed each night. The registered person is required to replace carpet on the hall and stairs. The registered person is required to have up to date safety certificates to evidence that all equipment and the water supply are safe. The registered person is required to have sufficient numbers of staff working in the home to undertake catering and domestic duties. The number of care staff must not be reduced to cover catering duties. The registered person must have the required staff records in place including CRB checks. To have robust recruitment and
DS0000028018.V256738.R01.S.doc Timescale for action 13/10/05 2. OP10 12(3) 30/10/02 3. 4. OP19 OP25 16 (c) 13 (4) (a) 30/11/05 30/10/05 5 OP27 18 (a) 30/10/05 6 OP29 19 1.2.3.4.5. 6. 30/10/05 Tree Tops Nursing Home Version 5.0 Page 24 selection procedures in place to make sure that no staff are working in the home prior to all the required checks being undertaken. 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 OP30 OP31 OP32 Good Practice Recommendations It is recommended that arrangements be made for staff to have infection control training and HIV and Aids awareness training. It is recommended that the registered manager undertakes management training. It is recommended that the registered proprietor and the registered manager arrange structured meetings to ensure that the home is run effectively and efficiently and in the best interests of the service users. Tree Tops Nursing Home DS0000028018.V256738.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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