Inspection on 20/06/06 for Tree Tops Nursing Home

This inspection was carried out on 20th June 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 18/12/06

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 20th June 2006 08.45 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.V301196.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.V301196.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 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.V301196.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 13th October 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 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 at the back of the house and on the road at the front. 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 time of our visit the fees that the home charges are between £432 and £532 per week. Additional charges are made for hairdressing (£5) and chiropody (£10). Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process on this occasion involved sending letters out to relatives so that their comments about the service could be taken into account. 20 comment cards were sent out to relatives and 75 were returned. Comments received will be included in this report. The inspector completed an ‘Inspection Record’ with information that had been supplied by the home. The record helped the inspector with the planning of the inspection. A visit to the home took place. This lasted for seven and a half hours and was carried out by one inspector. During the site visit 6 staff, 1 relative and 3 members of the management team were spoken with. A care manager visiting a client was also spoken with and a further two care managers gave their views following the inspection. 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 care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Treetops for the people that live there. Discussions took place with the Responsible individual around the details of the Registration Certificate. It was agreed to amend the registration categories and to remove the named registered manager as she has resigned her position. A new certificate will be issued when written confirmation is received that the company agrees to the changes. 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 recently appointed 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.V301196.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The registered person must use the information that is gathered about service users needs to develop individual care plans. This would ensure that all service users needs are met. Once developed the plans must be kept under review and issues discussed and agreed at reviews must be implemented so that the needs continue to be met. So that service users are protected the registered person must follow the homes recruitment policy. This will ensure all relevant checks are in place before staff start work at the home. A notice was given to make sure that this is completed. Staff training in adult protection and caring for people suffering with a dementia would further protect service users. In order that measures are taken to safeguard service user’s safety, the registered person must carry out risk assessments for the use of bed rails and also arrange for the weekly fire alarm and emergency lighting tests to be re instated. An official letter was sent to require the registered person to do this. In addition to this there was no evidence that the fixed wiring had been tested and was safe, although the manager said that it had. The registered person was required to forward a copy of the current certificate. The registered person must make arrangements for all staff to be supervised. This would enable the philosophy of the home to be discussed, and individual staff issues that would need addressing such as attitudes and communication. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 7 The home is currently without a registered manager and this has led to shortfalls highlighted in this report. In order that improvements can be made, the registered person must make progress in appointing a person that is qualified and competent to take up this role. The registered person has been requested to complete an action plan to show how improvements to the home are to be made. 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.V301196.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.V301196.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 is not applicable Quality in this outcome area is good. Service users are assured their needs will be met at Treetops. This judgement has been made using available evidence including a site visit. 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.V301196.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. Inconsistencies in care planning may lead to service users not receiving the full care that they require. This judgement has been made using available evidence including a site visit. EVIDENCE: Staff were seen speaking kindly to service users, some of whom presented with challenging behaviour. Staff were aware of individual service users preferences in relation to bed time, activities and food preferences and said that these were met. Medications procedures ensure that service users receive their medications safely. Comments received from relatives were very positive about the staff. These included, ‘Staff are very friendly and when I visit (always unannounced) they can be seen sitting with residents and chatting to them.’ Another said, ‘Please shower them with praise, the staff always keep me updated and informed’. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 11 However comments received from care managers did not give the same picture. They reported that staff, including the acting manager, are not always aware of service user needs and give inaccurate reports about their condition. An example of this is when a service users condition was reported to be improving. This service user was admitted to hospital very shortly after this report in an extremely poorly condition. They also reported that aspects of care that are discussed and agreed at care review meetings are not always implemented. Staff do not speak respectfully to service users and in one instance a member of staff was heard calling a service user a ‘monster’. Information that carers have appears to be what they had learnt from their conversations with relatives and observations. The care records of the service users showed that the detailed information gathered before admission had not been used to develop care plans or to carry out risk assessments. Care plans were not always complete or accurate. Carers do not refer or contribute to care planning. Examples of this are as follows: • Information received before admission showed that a prospective service user had been identified as ‘high risk’ of developing pressure sores and was at risk of falls. No care plan or risk assessment had been put in place at the home so that staff were not aware of what help/ assistance that this person required. The person’s private room was looked at and it was noted that there was no pressure relieving equipment in place. Bed rails were in place on the bed although there was no risk assessment for these and no indication that the use of these had been fully considered. The person had been living at the home for a while. Another showed a service user as ‘high risk’ of developing pressure sores. In this case appropriate equipment was available. However sores had developed. There was no evidence that the Tissue Viability nurse had been consulted about the best treatment for this person. Where risk assessments were in place they had not been reviewed. A service user that had a number of falls recorded in his care plan had not had a falls risk assessment carried out and did not have a care plan in place. These may have helped staff identify when, how and why the falls were happening and assist them in trying to reduce the number of falls this person had. • • • These inconsistencies in important record keeping may mean that staff are not always fully informed of all service users needs and this in turn may lead to omissions in their care. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Service users social needs are addressed, to ensure they are fully met the current systems that are in place must be built upon and further developed. This judgement has been made using available evidence including a site visit. EVIDENCE: A member of care staff has been appointed as the activities organiser. He is extremely enthusiastic about this role and has put into place a tailored programme of activities for each service user based on their previous likes and dislikes. Information has been gained from relatives and other visitors and is available for all staff to access. The member of staff is encouraging all other carers to participate in the programme and making staff aware that activities are important and part of the whole care package and therefore the responsibility of the whole care team. He is arranging fund raising activities for the service users amenity fund. It is important that the manager encourages and develops this area of care. There is no provision for service users to wander safely outside the building and so allowing them freedom of movement. There is an area to the front of Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 13 the home where service users may sit under supervision. It is important to minimise any reduction in service users freedom that may lead to frustration and in some cases challenging behaviour. There are systems in place to ensure that all service users receive sufficient drinks and food throughout the day. Additional staff are on duty at meal times to ensure that those service users requiring individual attention and assistance receive it. Mealtimes were observed to be unhurried and service users were given sufficient time. Food provided was in good amounts that looked appetising. Discussions with the cook showed that she was knowledgeable about current service users dietary needs and about the needs of this service user group. Although there is no choice at mealtimes, alternatives are always available to cope with individuals likes and dislikes that are recorded. Observation of daily routines showed that at times staff are extremely busy and service users can become very frustrated at the lack of stimulation. They are sat in chairs in the lounge area and at busy times there are no staff around. Comments from relatives bear this out. ‘There is a general lack of stimulation at the home’, ‘At times patients are very noisy and this is upsetting’. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 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 the following standard(s): 16&18 Quality in this outcome area is poor. Service users are not protected. This judgement has been made using available evidence including a site visit. EVIDENCE: There is a complaints procedure available within the service users guide. 53 of relatives that returned comment cards were aware of the procedure. The procedure is clear and easy to understand. A relative spoken with said that they were aware of the procedure and had followed this. However this was late last year and she was had not been informed of the outcome of the complaint so was unable to say if she was satisfied with the process. They did, however, feel confident that they would be listened to in the future. The acting manager was unable to show a complaints log. A care manager had recently visited the home and the manager had asked her to try to persuade a relative to withdraw their complaint reportedly saying, ‘It is affecting my health’ and ‘that person received more care than any other’. This complaint is currently being investigated. Care staff spoken with were very clear about what constituted action should be taken should this occur. The adult protection clear. A recent incident at the home had been reported to the at the time. This was in turn reported to the acting manager. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc abuse and what policy is also nurse in charge An entry in the Page 15 Version 5.2 care plan stated, ‘Relatives not informed as this was a minor incident.’ The incident however should have been referred to Social Services for consideration under the adult protection procedures. This was eventually reported four weeks later. This is very serious, as service users have been placed at possible risk of further harm due to lack of robust reporting procedures. Staff recruitment procedures have not been followed leading to staff that have not had the necessary checks completed caring for vulnerable people. Tree Tops Nursing Home DS0000028018.V301196.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26 Quality in this outcome area is poor. Service users live in a pleasant home however the failure to ensure necessary fire checks are completed means that service users and staff are not fully protected from risk of fire. This judgement has been made using available evidence including a site visit. EVIDENCE: The home is situated in a quiet area and offers pleasant views to the front of the house where there is a seating area where service users may sit with members of staff. Service users would be able to wander more freely if the safe area to the back of the house was developed. The entrance hall and dining area has recently had new floor covering fitted. This is impermeable and has been fitted to reduce any odours within the home. The home is pleasantly decorated and service users private rooms Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 17 have been personalised with small items that they wished to bring in. There is an ongoing programme of decoration to ensure that the home remains pleasantly decorated for service users. A fire risk assessment is in place that details amongst other things when staff should receive fire training. Staff confirmed that this happens. The weekly programme for testing of the fire equipment had not been carried out regularly since March 06. This is dangerous and should be re instated. An official notice was left that this be addressed immediately. Tree Tops Nursing Home DS0000028018.V301196.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. Recruitment procedures are not sufficiently robust to fully protect service users. This judgement has been made using available evidence including a site visit. EVIDENCE: Comments received from relatives were complimentary about the staff. A visitor said, ‘All the staff are very good’. Staff were observed to treat service users with respect and allow them time to express themselves for example, at mealtimes when they were seen to be encouraged to express their wishes. However comments received from a care manager detailed in this report indicates that this is not always the case. Staff confirmed that they have received some training to help them to carry out their roles effectively. A third of relatives commented that they do not believe there is always sufficient staff on duty at all times. One said, ‘Staffing levels appear to be low on weekends’. The duty rotas show that this has been the case on occasions. Staff reported, ‘Usually enough staff are on duty’. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 19 One member of staff reported that she had undertaken a course in dementia awareness that she had found helpful. Only two care staff have completed this course although a further member of staff held a foundation NVQ level 2 in Mental Health Care. Staff have yet to receive Protection of Vulnerable Adults training although all care staff spoken with were clear about what constitutes abuse and reporting procedures. One trained member of staff said she would expect a written report before taking action. Recruitment records showed that there are currently fifteen staff working at the home without a current Criminal record check. Some staff had only one written reference, some had none and others only had verbal references. This is not acceptable and places service users at unnecessary risk. A notice was left with the person in charge requiring them to rectify the situation. This had been a requirement at the previous inspection also. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. The home is not well managed. This judgement has been made using available evidence including a site visit. EVIDENCE: The acting manager has been in post since 1/5/06. He is a registered general nurse who was previously employed at the home as a staff nurse. He has yet to make application to the CSCI to become registered manager of the service. Staff felt that he is approachable and that he would ‘Make his mark in time’. Discussions took place around his experience of caring for people with a dementia or with mental health needs. He does not yet hold a management Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 21 qualification. He understands the necessity of undertaking further training in order that he is equipped to carry out the role of Registered Manager. We spoke about the reporting of accidents and adverse incidents. Although accidents had been reported in the accident book, only two regulation 37 notices had been received at the Commission for Social Care Inspection since January. The recent serious allegation had only just been reported, six weeks following the incident and the detail on the form was not accurate. An entry in the care plan had stated that this had not been reported to the relatives as he had not viewed it as a ‘serious incident’. Care managers have expressed concerns about the managers understanding of Protection of Vulnerable Adults and also the delay in reporting the recent incident. Another care manager expressed concern about the attitude of the acting manager and failure to implement agreed care actions for service users following reviews. We were unable to discuss the last report and action plan in detail as the manager had not seen it. Previous requirements were discussed. The manager said that he does not always have supernumerary hours in order to carry out his role. The general manager of the group carries out visits to the home as required under regulation 26 and indicated that she offers her full support in order that the acting manager may carry out his role effectively. Copies of the visit reports are not sent in to the Commission. The organisation has a quality assurance system and surveys stakeholders ad hoc in order that their views are taken into account. However, a more formal and structured approach would better inform the management where improvements are needed and assure people that their views matter and are taken into account. Staff have yet to receive formal supervision and the manager was unclear about the process. Staff supervision would enable the manager to have one to one discussions with staff to address their work performance in relation to the aims and objectives of the home and identify individuals training needs. This will ensure that appropriate, well-trained staff that are aware of the philosophy of the home are caring for the service users. Safety certificates were seen and were up to date. The only certificate that was not available was the fixed wiring certificate. The manager was asked to forward this to the Commission for Social Care Inspection as soon as possible. The call bell inspection record indicated that some call bells were not in working order. The manager indicated that this was an ongoing problem. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X 1 X X 1 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 OP8 Regulation 12,13,14, 15,17. Requirement Timescale for action 07/07/06 2 OP8 13 The registered person must ensure that service users care needs are planned for and met by addressing the following issues: • Care plans must be in place for each service user. • These plans must be reviewed and updated as needed to ensure that they address the current care needs of service users. • Where indicated the registered person must make referrals to healthcare professionals to ensure the service users have access to these people when needed. Arrange for reviews of the care with relatives and commissioners and carry out agreed changes to the care plans. The registered person must 20/06/06 ensure that risk assessments are in place for the use of bed rails. DS0000028018.V301196.R01.S.doc Version 5.2 Tree Tops Nursing Home Page 24 3. OP10 OP36 12(4(a)) The registered person must arrange for all staff, including 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 treated with dignity and respect at all times. • Individual and collective training needs of staff. • Communication. To ensure that service users are fully protected the registered person must: • Ensure that induction training includes reference to the particular health care needs of this client group and also refers to dignity and respect of service users. • Arrange for all staff to receive training in the Protection of Vulnerable Adults • Arrange for staff to receive training in the care of people who suffer from a dementia and have mental health needs. The registered person must: make sure that before any person is employed at the home the following are in place: Two written references in respect of each employee. • A CRB check for this employment. This requirement is outstanding from 30/10/05 • • 20/07/06 4 OP18 OP27 OP30 12,13,18 14/07/06 5. OP18 OP29 19 20/06/06 Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 25 6 OP29 19 The registered person must ensure that for those employees identified at the inspection without the necessary checks in place the following applies: • • A CRB is applied for. Two written references are obtained. 05/07/06 • Evidence that this has been completed must be forwarded to the Commission for Social Care Inspection 7 OP22 12,13 The registered person must make arrangements to ensure that service users have access to working call bells at all times. The registered person must: • Have up to date safety certificates to evidence that all equipment is safe. 05/07/06 8. OP25 OP38 13(4(a)) 05/07/06 This is outstanding from 30/10/06 The registered person must also: • Forward a copy of the current fixed wiring certificate to the Commission for Social Care Inspection. 9. OP31 8,9 The registered person must make arrangements to have in place a registered manager who is competent and trained to manage a home for this service user group.. The registered person must: • Make arrangements for the weekly testing of the fire alarm and emergency lighting to be reinstated and continued DS0000028018.V301196.R01.S.doc 20/09/06 10. OP38 13,23 20/06/06 Tree Tops Nursing Home Version 5.2 Page 26 11 *RQN CSA section 31 The registered person must provide to the Commission an action plan showing how the above requirements will be actioned and how the home will be improved. 02/08/06 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 OP12 OP28 OP33 Good Practice Recommendations The registered person should consider developing the area at the back of the building to provide a secure grassed area where service users may wander freely. The registered person should continue to encourage staff to achieve a qualification in care at NVQ level 2 or above. The current quality assurance system should be further developed to ensure that all stakeholders views are sought and used to formulate a development plan. Tree Tops Nursing Home DS0000028018.V301196.R01.S.doc Version 5.2 Page 27 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 © 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.V301196.R01.S.doc Version 5.2 Page 28 - 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. 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