Inspection on 18/12/06 for Tree Tops Nursing Home

This inspection was carried out on 18th December 2006.

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

Tree Tops Nursing Home 22/05/07

Tree Tops Nursing Home 20/06/06

Tree Tops Nursing Home 13/10/05

Tree Tops Nursing Home 27/04/05

Tree Tops Nursing Home 11/11/04

Tree Tops Nursing Home 22/04/04

Tree Tops Nursing Home 21/01/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOMES FOR OLDER PEOPLE Tree Tops Nursing Home 12 Ryndleside Northstead Manor Drive Scarborough North Yorkshire YO12 6AD Lead Inspector Mrs Rosalind Sanderson Key Unannounced Inspection 18th December 2006 09:30 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.V324713.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. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tree Tops Nursing Home Address 12 Ryndleside Northstead Manor Drive Scarborough North Yorkshire YO12 6AD 01723 372729 F/P 01723 372729 treetops.nh@tiscali.co.uk 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 *** Post Vacant *** 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.V324713.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users in category (DE) must be aged 55 years upwards Date of last inspection 16th October 2006 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 with easy access to local transport. 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. Parking is available on the road at the front of the home. The home has an information pack that is given to prospective service users and their families. This gives information about the services the home has to offer. At the date of our visit the fees that the home charges are £492 per week. Additional charges are made for hairdressing and chiropody. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a pre inspection questionnaire; Comment cards returned from 14 relatives, 7 staff. Information from a review meeting held with North Yorkshire County Council Adult and Community Services and the providers from Tree Tops. A visit to the home carried out by two inspectors. Evidence gained from the use of an observational tool developed to help inspectors during inspections of services providing care for people with a dementia. A site visit was carried out and lasted for eight hours. Two relatives and eight staff were spoken with. Records relating to service users, staff and the management activities of the home were inspected. The nature of service user’s illnesses at this home means that they are unable to give their written views and in some cases verbal comments. During the visit the Short Observational Framework for Inspectors (SOFI) tool was used where the wellbeing, engagement and interaction of service users was observed and recorded. This helped the inspector to gain an insight of what life is like at Tree Tops for the people that live there. The acting manager assisted the inspectors during the day. They were available, along with two representatives from the company, to receive feedback from the inspection at the end of the day. What the service does well: When a person expresses a wish to live at Treetops they receive a visit from somebody at the home. Discussions take place around care and social needs. This means that the service user has met somebody from the home before they go there to live and that the staff are aware of the service users needs before they arrive. The cook is aware of service users needs in relation to their diet and the meals were well presented and looked appetising. Additional staff are available at mealtimes so that those service users that require assistance receive it on an individual basis. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Tree Tops nursing home aims to provide a specialist service for people with a dementia or a mental disorder. However many service users at the home have physical needs greater than those that the home aims to provide for. This means that staff are fully occupied meeting these physical needs and so have less time and resources available to meet the specialist needs and therapeutic care that people within this group require. The registered person could identify when a persons physical needs greatly outweigh their mental healthcare needs and ensure that that they are appropriately placed to receive the best care. This will allow the staff to have more time to work towards meeting individual’s needs. The registered person must appoint a person to manage the home who is suitably qualified and competent to manage a home for this service user group. The registered person must ensure that care plans are working documents and when a review indicates further care input this is actioned. Similarly risk assessments should be used appropriately and where a risk is identified measures should be put in place to reduce these. The registered person must make sure that staff are fully trained and aware of their roles in relation to service users medication, moving and handling and assisting service users to take their diet. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 7 Service users independence could be further promoted by the use of signage and pictorial aids in the home. 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. Tree Tops Nursing Home DS0000028018.V324713.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 Tree Tops Nursing Home DS0000028018.V324713.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 Quality in this outcome area is good. Service user’s needs are fully assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People that come to live at Treetops are not always able to make a choice about where to live. The service users next of kin or their representative usually makes this decision for them so the discussion around the persons needs involves the relatives or representatives wherever possible. People wishing to come and live at Treetops are visited by somebody from the home before the move to the home takes place. A discussion is had about the person’s care, social and mental health needs and a decision is made as to whether the needs of the person would be met at this home. Information from hospitals, social services and other relevant sources is also taken into account when making this decision. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Inconsistencies in planning care may lead to service users not receiving appropriate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care planning has shown some improvement since the last inspection. Each person has a care plan in place. Attention is given to reviewing the plans on a regular basis. Risk assessments are in place where needed and are also reviewed. Attention is given to service user’s nutritional needs and the monthly weights recorded showed that generally people’s weights were stable or increasing. Staff ensure that service user’s receive an adequate diet and sufficient fluids. However there still remains some serious shortfalls in care provision. This is where the care needs have been identified through the initial assessment or where the reviews indicate that additional care is required. A service user’s care plan stated that they should be in a sitting position of 90° when they are assisted to take their diet and there should be resting periods between Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 11 spoonfuls. They were observed to be fed in a reclining position with insufficient resting period. There are not always plans in place to direct staff to the best possible care and where special equipment is needed. An example of this is when service users are at risk of developing pressure sores. Special pressure relieving mattresses are not always in place when required. One service user that was recovering from some pressure damage had been sat out in a chair following a period spent in bed. The nurse in charge stated that this would be for a short period only. Four and a half hours later they were still sat out and in some discomfort. A request was made by the inspector that they be put back to bed. The acting manager stated that only one person was suffering from pressure damage although the care plans indicated that the number was much higher. A relative commented, ‘On a recent short admission to hospital they (hospital staff) were very concerned about ………very sore bottom’. The use of bed rails is not carefully considered. In one example the service user had been identified as being at risk of entrapment from their use but still had them on the bed. There had been at least two reports of the person in question being found in a dangerous position in relation to these rails. A member of care staff had expressed some concern about this and this had been documented. The same resident was seen to be at risk of falling from the chair in which they were sitting. The inspector had to request assistance from staff to reposition them. One service user had bed rails in place that were not high enough or the correct type of bedrail for that bed. Moving and handling assessments were in place for each service user. However when it was identified that equipment was needed it did not always identify what equipment. Staff were observed using a hoist for a service user in the lounge. Once in the hoist the service user was allowed to ‘swing’. An entry in their care plan showed that they had recently sustained a bruise to their forehead from the hoist. A service user had slipped from their chair to the floor. Initially staff were going to leave them there, other service users were wandering around at the time. They then decided to put him back in his chair and lifted him from the floor using an underarm lift. Service users were left in the lounge area for long periods of time without any supervision from staff. The trained nurse stated, ‘There should be two staff in here at all times.’ Some service users were agitated and distressed during the day. A relative had commented ‘ Patients are often in the lounge area and with no member of staff present’. Another commented, ‘I get concerned that there are no staff in the lounge area for long periods of time’. Relatives have reported that there is a problem with clothing. One said, ‘….has their own clothing that is clearly labelled(with name tags) but it is used by others.’ Another reported, ‘Slippers should be named so they do not get used by others’. The laundry assistant said that it could be a problem that clothes Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 12 get mixed up as the night staff put them in the wrong baskets despite the fact that they are labelled. In addition to this they stated that service users might wander into others bedrooms and take items of clothing. One service user was seen to have taken the slippers from another service user and was wearing them. This was pointed out to the acting manager who replied, ‘Oh we bought a job lot of those for service users’. This indicated that these did in fact belong to the person wearing them, however this was not the case. Medications were seen to be given to service users in the correct way. The medicines were stored and where necessary disposed of correctly. One service user had had their medication reviewed by the GP and it was recommended that they have regular analgesia and medication to keep their bowels regular. There were some omissions on their medication administration record for these drugs. Another service user was receiving medication via a nebuliser. The nurse asked a member of staff to supervise them but this did not happen. Two service users whose care was reviewed had not been assessed for pain relief where this was indicated due to health problems. Tree Tops Nursing Home DS0000028018.V324713.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): Quality in this outcome area is adequate. Service users are able to maintain contact with their families and friends but are provided with very little therapeutic activity. Service users receive a nutritious, well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the providers have arranged a meeting with the relatives of the service users. This was well attended and appreciated by the relatives. The provider stated that these are to be a regular event. A relative said, ‘The meetings are a good idea. It is nice to know what is going on at the home and what plans they have’. Comment cards reflected that communication between the staff at the home and relatives was satisfactory. An activities organiser that has been in post full time since the last inspection. He has introduced more activities in the home and liaised with the service user’s families to obtain more in depth life histories. This could assist staff to understand service users behaviour and have more meaningful interactions with them. The records are kept separately from the care records and staff reported that the activities organiser records any activities in them after getting this information from staff. The post is to be reduced to part time. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 14 During the site visit no activities were observed and staff had very little interaction with the service users. When staff spoke with service users and received a negative response, no further conversation took place. An example of this is when a member of staff came into the lounge a service user called, ‘help’. The staff member asked what they wanted and then left the room. Service users appeared to be unsettled during the day. They were also agitated at times. Although they were able to walk along the corridor at times, bedroom doors were locked so they could not get access. Staff reported that often service users went to a particular bedroom to use the commode. When the door to this bedroom was open the commode was clearly visible. However toilets were not easily identified and there was no use of signage in the home to assist service users find their way around or identify particular areas in the home. The food provided is nutritious and the cook was able to describe how diets are enriched for service users when they are unwell. She was aware of individual service users dietary needs. Staff are available at mealtimes to assist those service users that need help to take their meals. Unfortunately this is a high number and so the mealtime is staggered. A member of staff commented, ‘mealtimes are like a conveyer belt’. Those who are able to eat ‘finger food’ are encouraged to do so. Tree Tops Nursing Home DS0000028018.V324713.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): Quality in this outcome area is good. Service users are protected by the homes policies and procedures and staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure that is clearly displayed in the entrance of the home. Complaint forms are left for relatives to complete if they need to make a complaint. The majority of relatives (72 ) that completed comment cards knew about the procedure. Two relatives spoken with were aware of the procedure and felt confident that if they complained things would be attended to. The Commission for Social Care Inspection had received a complaint. The complainant wished to remain anonymous. The complaint was that service users had been woken early to get dressed and then put back to bed. An early morning visit had been made and it was found that this was the case. The provider has now spoken with all the staff concerned and is confident that this does not happen now. The acting manager stated that he makes visits to the home outside of normal working hours to monitor the situation. Staff have received training in adult protection and those spoken with were clear about reporting procedures. Since the last inspection the provider has made one referral to the Protection of Vulnerable Adults list. This followed a provisional listing that had also been made by the provider. Tree Tops Nursing Home DS0000028018.V324713.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): Quality in this outcome area is adequate. Service users live in a clean and safe environment but would benefit from changes to the physical environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements have been made to the environment with the addition of new carpets and floor coverings. Decoration of communal areas has been undertaken. This has made the home a more pleasant place to live. Fire checks and staff training is now completed as required. As previously mentioned there is no signage or other considerations given to the physical environment that would make it easier for service users to find their way around. The use of signage and pictorial aids would benefit service users and help them to find their way around the home. Some service users bedroom doors are kept locked and so even if they could find their way there they could not get into their bedrooms. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 17 A set of fire doors had had their handles removed to allow for some flooring to be covered. The acting manager stated that this had been done to prevent the service users from accessing the area while the floor covering had been allowed to dry. A small hook device had been placed at the top of the doors and a notice placed there stating, ‘temporary handle’. The doors are fitted with magnetic closers but had been closed at this time. It was extremely difficult to open the doors. The acting manager was asked to replace the handles immediately, which he did. He said that the doors must have closed when the fire alarm had been activated during a test that morning. However this was early afternoon and the doors had been open at lunchtime. It was more likely that the doors had been closed to keep service users in one area while staff were otherwise occupied. Tree Tops Nursing Home DS0000028018.V324713.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): Quality in this outcome area is adequate. Service users would benefit from more contact and interaction with staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas show that there are sufficient staff on duty at all times. On the day of the visit there were sufficient staff on duty. Relatives have commented that there appears to be more staff in recent months. Recruitment records showed that staff are now recruited safely and have the necessary checks in place before they are employed. However one member of staff had a reference from a colleague in place. Training is now more rigorous and staff report that they have received training in all mandatory areas and in addition to this training in areas relevant to this client group. 90 of staff have a qualification in care at NVQ level 2 or above. Staff are not always deployed effectively and tended to stay together. This meant that service users were left for long periods of time without a staff member present and when they were present they did not always communicate with service users. For example, one member of staff passed a person that was crying without any comment. Another member of staff asked a service user if they felt sick. When they replied ‘yes’ the staff member walked away. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This home is not well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has been in post since 1/5/06. He is a registered general nurse. He has yet to make application to the CSCI to become registered manager of the service. He has recently started some training in Dementia Care through the distancelearning route. He has also completed additional training in adult protection, fire training and various health related courses. Most accidents are now recorded correctly and regulation 37 notifications are received. However an incident where a service user had got her head and feet Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 20 stuck between bed rails and the bottom of the bed had not been recorded. Documentation has improved and records are now easily accessible. The acting manager was not able to demonstrate understanding and knowledge of service user’s day-to-day needs. He was unaware that there had been an incident where the service user had been in an unsafe position with the bed rails. He was asked to arrange an urgent review of this persons care and was about to wait until the following day to do this. He was then asked to make immediate contact with the care manager, which he then did. Staff were not supervised or deployed effectively and this led to service user’s being left alone for long periods. One service user had been identified as needing one to one supervision for eight hours of the day but was left alone for long periods of time and did not get this supervision at all at weekends. He did say that the care plans were audited and yet there were numerous occasions when additional care had been needed or changes to care had been identified but not acted upon. These are detailed within this report but had not been identified through the audits. The manager must take a more proactive approach to the issues that have been raised within this report to ensure that service users health, safety and welfare are paramount. Staff now receive formal supervision. However the acting manager said that his supervision was sporadic. Safety certificates were up to date. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 21 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 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 22 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 OP7 OP8 OP38 Regulation 12,13,15, 17 Requirement The registered person must ensure that service users care needs are planned for and met by addressing the following issues: • Care plans must be reviewed and updated as needed to ensure that they address the current care needs of service users. • When care needs change the necessary changes to care must be implemented in line with the appropriate clinical guidelines. This is in particular relation to prevention of pressure damage. The registered person must ensure that risk assessments are in place for the use of bed rails. Where these indicate that there is a risk to service users measures to reduce this risk must be taken. Until a longer term solution can be agreed and actioned the registered person must put in place immediate and urgent measures in order that there is DS0000028018.V324713.R01.S.doc Timescale for action 19/01/07 2. OP8 OP38 13(4) 18/12/06 3. OP8 OP38 13 18/12/06 Tree Tops Nursing Home Version 5.2 Page 23 4. OP9 13(2) 5. 6. OP10 OP12 12(4) 16(n) 7. OP30 13(4) 8. OP31 OP36 18(2) no further risk of entrapment to the service user identified at the site visit. The registered person must make sure that service users receive their prescribed medication and when they require supervision, this is put in place. Service users must be fully assessed for pain relief where this is indicated. Service users must wear their own clothes and footwear at all times. The registered person must make arrangements to ensure that service users have access to and the opportunity to take part in meaningful activities that are suitable for their needs and abilities. The registered person must make arrangements for all staff to receive updated training for moving and handling of service users. The registered person must arrange for senior staff, to be formally supervised and within this supervision the following must be addressed: The philosophy of the home. • Conduct of staff to ensure that service users are safe and treated with dignity and respect at all times. • Training needs. • Communication. Where an assessment of a service user indicates that they should be fed in a certain position then this is carried out to ensure that they receive food safely. DS0000028018.V324713.R01.S.doc 29/12/06 19/01/07 19/01/07 31/01/07 19/01/07 • 9. OP15 OP38 13(4) 19/01/07 Tree Tops Nursing Home Version 5.2 Page 24 10. OP19 23(1&2) The registered person must arrange for signage and pictorial aids to be used within the home in order that the environment will be better placed to meet the needs and abilities of the service user group. The registered person must ensure that fire doors are used correctly and that all door handles are in place The registered person must make sure that staff are deployed in the home efficiently and to ensure the safety, dignity and respect of service users at all times. The registered person must appoint a person to manage the home who is competent and trained to manage a home for this service user group. Previous timescale of 20/9/06 not met 31/01/07 11. OP19 OP38 23(4) 29/12/06 12. OP27 OP38 12 29/12/07 13. OP31 8,9 31/03/07 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 OP29 Good Practice Recommendations It is recommended that references are sought from previous employers and not other staff members. Tree Tops Nursing Home DS0000028018.V324713.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Tree Tops Nursing Home DS0000028018.V324713.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. 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