Inspection on 22/05/07 for Tree Tops Nursing Home

This inspection was carried out on 22nd May 2007.

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

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

Other inspections for this house

Tree Tops Nursing Home 18/12/06

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 Pauline O`Rourke Key Unannounced Inspection 22nd May 2007 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 DS0000028018.V335126.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. DS0000028018.V335126.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 vacant post 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) DS0000028018.V335126.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 18th December 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 and there is 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 people 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 residents and their families. This gives information about the services the home has to offer. On the 22nd May 2007 the weekly fees that the home charges are £492. Additional charges are made for hairdressing and chiropody. DS0000028018.V335126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered from the provider, relative, health and social care professionals. A site visit by two inspectors to the home was carried out on 22nd May 2007. It focused on the key standards. An inspection of some of the premises was undertaken. A number of records were also examined. Discussions were held with the manager who is in the process of being registered with the Commission for Social Care Inspection. Seven members of staff on duty, and two visiting professionals and three relatives were also spoke with. Interactions between the staff and the residents were observed for about two hours. Feedback was also received from two residents, two health professionals, fourteen relatives, and five GPs’ in response to questionnaires sent prior to the visit. An inspector spent at least two hours observing residents to assess the well being of people who live at the home, and also how staff interact with them. The results of this are incorporated into the main body of the report. Treetops Nursing Home was last visited on the 18th December 2006 and was found to be performing poorly at that time. This visit was undertaken to check what improvements had been made. The home was found to be improving the service provided to residents. What the service does well: At this visit it was noticed that the staff had time to sit with the residents and engage them in activities or just talking to them. They assisted the residents in a sensitive and respectful way and allowed them to wander where they wanted. One resident was able to walk around pushing a chair and no one stopped them. They just kept an eye on them to ensure they were safe. The staff were working in a positive way and the home was not noisy. The cleaners in the home should be commended as there were no unpleasant odours anywhere in the building and it was clean everywhere. The residents were dressed an their own clothes and some of the gentlemen wore a tie. These were only a part of what was happening in the home and the next section describes more accurately the positives in the home. DS0000028018.V335126.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? A new manager has been appointed and this has helped pull the staff team together. All the staff spoken with said that she was firm but fair, easy to approach, and she looked to them for ideas as well as implementing her own changes. Everyone felt that they were working more as a team now, including the new manager who said she could not have done as much without the support of all the staff. At this inspection it was clear that many improvements to the service have been made. On arrival it was noted that the altered layout of the ground floor had made a difference to the residents. They now have a dining room that overlooks the front garden. This room also doubles up as a quiet area and craft room. The lighting in these areas has also improved and this has led to a more homely environment. The furnishings have also been replaced and the décor is calm with muted colours and tones. Staff and visitors commented during the visit how they felt this had helped to promote a calmer environment: • Improved décor likes the move and feels the home is much calmer. They are using pictures to tell the residents where they. An example of this is using a picture of a toilet on the toilet door. They have also put picture frames on their bedroom doors and are in the process of obtaining pictures of the residents when they were younger to help them identify their bedroom. The staff now have a regular routine within the home and whilst this is not set in stone it does free up time so that they can sit with the residents more during the day. The staff are now receiving training in health and safety issues as well as Dementia Awareness. There is an activities organiser in place and he is developing a range of activities the residents can take part in either oneto-one or in a group. They are also organising monthly events where an entertainer comes in for a couple of hours. The residents are now going out on trips to places of local interest. The staff are working with the relatives to try and ensure that the personal information they have about residents lives can be used to help the staff understand the them better. The manager has obtained specialist equipment for the residents to ensure they are safe and the staff can help support them safely. Overall the impression left from the visit was one of a calm bright environment where the residents are supported by staff who are developing a better understanding of dementia. What they could do better: There are still areas where improvements can be made. The care plans need attention. They appeared disorganised and had a lot of historical information DS0000028018.V335126.R01.S.doc Version 5.2 Page 7 in them. The care plans also need to reflect fully what actually happens in the home. This applies to the level of help someone needs. This can change because of the nature of dementia and these variations need to be identified in the plan. The information in the plan needs to written in plain English so that all carers can understand what is going on. This especially applies to the medical notes. The care plans should also be signed by either the resident or their representative to ensure everyone knows what is happening. The staff should always assist residents at the right level. If a resident is sitting down so should the staff, if they are standing up so should the staff. This allows the residents to be helped appropriately and promote their privacy and dignity. The manager should look in to the possibility of using a pictorial questionnaire with the residents to see if they like their home. Staff might find a pocket version useful as well. Several recommendations were made in the report. Using simple English in the care plans so everyone can understand them. When staff are helping residents they do so in a way that maintains their dignity. 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. DS0000028018.V335126.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 DS0000028018.V335126.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. Standard 6 does not apply. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be sure that their individual needs will be assessed prior to moving in to the home. EVIDENCE: Since the last inspection only one person has been admitted to the home. The case file seen contained detailed assessment information about their needs. The clinical lead and the manager had visited the potential resident in hospital to carry this out. A member of staff spoken with said that the information they had received on the admission of this resident had been detailed enough to allow them to provide appropriate support. This information is seen as a starting point and more detailed care plans are developed as residents become more settled in. The Statement of Purpose also carries information about the admissions process. Information received through the surveys indicated that DS0000028018.V335126.R01.S.doc Version 5.2 Page 10 information is given out to potential residents and their relatives. Some of the comments included: “Asked by relative if I wanted to move into this home” and “was given leaflets” DS0000028018.V335126.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents receive the care and support they need although this is not always reflected in the care plan. The staff provide support in a sensitive way that promotes the residents independence and dignity. EVIDENCE: Three care plans were seen and all of them were set out in the same order. They had a detailed personal and social history, and contained information pertinent to their individual dementia and any other health issue they had. They also had risk assessments including one requested by the Fire Officer for a resident who insisted on moving the fire equipment. Unfortunately there was also a lot of out of date information in the file and this should be archived elsewhere. There was evidence that the care plans were reviewed regularly but there was no evidence that any relative or significant other had any knowledge of the support provided by staff. As many of the residents are DS0000028018.V335126.R01.S.doc Version 5.2 Page 12 unable to express themselves through verbal communication it is important their representatives are aware of what happens when they are not there. The care plans of people who require nursing intervention their plans contained information about how their needs will be met. An example of this was wound care on a weekly basis. In the care plans seen it was difficult to evidence that this was being carried out as only monthly care had been recorded. The information was such that an unfamiliar nurse would not be able to workout what type of wound care was required. Also one resident required ‘thick n’ easy’ in drinks to assist their swallowing. The care plan did not state what consistency was required. The manager said this was written in the records in the persons’ room where there was a food and fluid chart. The plan also said this person was to be fed using a teaspoon however on the day of the visit a carer was using a dessertspoon. The manager said that this person was assisted according to their alertness. This was not reflected in their notes. There was no evidence in the care plans to show how often people who can’t ask for help should be checked through the night. . The manager is aware of the failings of the care plans and has discussed with the clinical lead the logistics of sorting them out. She said that when she started there was so much to do that she had prioritise her work. The care plans will need time and attention to ensure they are right hence she chose to leave them until she had tome to do them properly. The residents can retain their own GP unless they are admitted out of area and many of them had continued to do so. There was also evidence that where necessary referrals had been made to other health care professionals. These included a psychologist, psychiatrist, dietician, speech and language workers, chiropodist, continence advisor and occupational therapists. There are good links with the local Community Psychiatric nurse and there are two residents currently being reviewed by them. One specialist bed has been provided for 1 person with specialist needs. The home had also bought two electric beds and are hoping to purchase another. People were using soft cushions and air mattresses according to their pressure sore risk assessment. During the visit it was noticed that the carers are more alert, following dementia training, to the importance of distraction and diversion when addressing challenging behaviour. This was demonstrated when one man became very noisy and agitated when he was being moved. The administration and storage of the medicines was appropriate and up to date. The staff keep a record of the fridge temperature. The items stored in the fridge were appropriate and dressings were stored for named individuals. The controlled drugs storage and administration records were accurate and up to date. There has been a recent inspection by a pharmacist and the manager said that this had been a positive inspection. Both staff spoken with about medication were knowledgeable about procedures and saw sedation as a last DS0000028018.V335126.R01.S.doc Version 5.2 Page 13 resort. They have started to consistently record ‘as necessary’ drugs and in discussion with the manager it was suggested they audit these drugs on a weekly basis so that if there were any errors they could be quickly picked up. Movical and Lactulose were being dispensed from one carton or bottle for a number of people. The lead nurse said at least many of the residents were on the same medication and whilst they recognised it was bad practice to do this there was not the space on the medicine trolley for all the cartons and bottles. The Commission for Social Care Inspection pharmacy inspector has advised us that this is poor practice and should be a recommendation in the report. During the visit it was noticed that residents were appropriately dressed in their own clothes. Several events were witnessed during the visit that showed staff respecting the residents’ individuality, dignity and privacy. The residents were addressed by their name, and staff allowed people to answer at their own pace. Several carers comforted one resident who was upset. She did not want her dinner and this was respected. Another resident was taken to their room so that a dressing could be done. Another had been incontinent and the carer gently suggested that they went to his room. The incident was not discussed in the communal area. In the care plans seen there was no evidence of a resident’s preference for a male or female carer providing their personal care in the care plans and this should be checked. DS0000028018.V335126.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are able to make choices on a daily basis and are supported to do this by the staff. They enjoy a good and varied diet and a social and recreational programme continues to be developed. EVIDENCE: During the visit the residents were seen to be walking around the home as they wished. The bedroom doors were not locked and staff were supportive of those residents who were doing things, such as one resident was carrying and ripping up boxes, another resident was walking around pushing a chair. They only intervened if they thought that person was impinging on someone else or were going to hurt him or herself. Staff were seen to speak to all the residents but gravitated to those who were more alert. The activities organiser has set up an activities care plan for each resident. This includes a risk assessment for communication and mobility, a social and hobbies history. From this he is devising activities that will be suitable for individuals and groups. He has identified one-to-one activities and he has worked with the manager to release a carer from the rota so trips out can take place. The care staff are DS0000028018.V335126.R01.S.doc Version 5.2 Page 15 encouraged to spend time with the residents and recent trips out have include visits to Betton Farm and a walk around Peasholm Park. He also provides some activities for the residents who are bed bound such as talking to them, nail care, hand massage and relaxing music. During the visit there was a selection of music played to cover all musical tastes, this included listening to Radio 2, 3 and 4. There was no TV present and he explained this was only used for film afternoons or evenings. There is an entertainer and a clothes show in June and after this monthly events will be organised. There is a visitor’s policy in place and visitors are welcomed at any time. Visitors spoken with said that they could always go in to a private room if they wanted to. They said they are always welcomed by the staff and all praised the new manager who made efforts to introduce herself to all the visitors. The residents’ rooms are currently being personalised in a project with the activities organiser and the relatives. When this was mentioned at the relatives meeting they were quite keen to be involved in this project and said they would bring in personal items of importance to the resident. The manager is in the process of encouraging representatives to provide some pocket monies so that when the residents go out they can buy things. There was however no evidence of any advocacy information in the building. There is a planned menu in place, which has been developed by the lead nurse. It allows for the use of full fat products, such as full cream, butter and full fat milk. She was also aware of portion sizes preferred by the residents. The meal observed was chaotic although everyone who needed assistance was given it. However, a trained member of staff was seen assisting a resident standing up or sitting next to a resident on a table. Whilst there were few spare chairs the trained staff should lead by example and assist someone at the correct level not standing over them. The residents were not offered salt and pepper with the meal nor was anyone offered extra portions. A member of staff spoken with during lunch said that they did not know if the person they were assisting liked the food they were being offered. The member of staff thought the resident would spit it out if they didn’t like it. The cook is made aware of the likes and dislikes of the residents through a list placed in the kitchen but this could be a more comprehensive list. Key workers should work with families to find out favourite foods of the residents. During the day coffee and drinks were served at regular intervals although no snacks were offered at the same time. Although fruit was available from the kitchen only one person was seen eating a piece of fruit through the day. In discussion with the manager it was suggested that a tray of cut fruit be offered in a morning for residents if they wished or wanted it. At the relatives meeting the activities organiser said that they had tried several ‘modern’ foods such as curries, pizzas and other slightly spicy food on an evening and these trials had been well received by the residents. The speech and language therapists said that the spicy food might help residents DS0000028018.V335126.R01.S.doc Version 5.2 Page 16 swallowing difficulties. The relatives appeared pleasantly surprised by this and then started contributing ideas of what their families enjoyed. These meals had been served in addition to the planned meals. DS0000028018.V335126.R01.S.doc Version 5.2 Page 17 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): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. EVIDENCE: There is a complaints policy in place and information is displayed in the entrance hall about how people should make a complaint. There have been no complaints to the manager or the Commission since the last inspection. Feedback received from the surveys sent to relatives indicated that they were confident that their complaints and concerns would be taken seriously: • • “Complaints I have had have been dealt with promptly and satisfactorily” “They are always willing to listen and take action”. Several relatives spoken with during the visit said that they had confidence in the new manager to listen and act on any concerns they may have. There was also a relatives meeting and both the proprietor and the manager stressed that someone was always available either on duty or by phone if they had any concerns. Several or the relatives were reassured by this message as they DS0000028018.V335126.R01.S.doc Version 5.2 Page 18 were only able to visit on weekends and didn’t feel it was always appropriate to speak to the nurse in charge. Staff spoken with understood the complaints policy and the whistle blowing policy and said that they were sometimes the first person someone spoke to if they were unhappy. This information was then shared with the person in charge of the shift. An Adult Protection protocol is in place and staff were aware of their responsibilities under this procedure. Staff have received training through National Vocational Qualification and the manager also reinforces the training in the monthly staff meetings. The manager understands the procedures and attends meetings and provides information to external agencies when requested. Staff spoken with understood their responsibilities if they suspected any form of abuse or mistreatment of the residents. DS0000028018.V335126.R01.S.doc Version 5.2 Page 19 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): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a warm, comfortable and safe environment. They can access all areas of the home, which encourages independence EVIDENCE: A tour of the building was made and several improvements in the environment were identified. The ground floor space has been reorganised and redecorated with new lighting installed in the communal areas. This now means that the dining room can also double as a quiet area and a place where residents can do arts and crafts. The manager has also removed several mirrors and the TV is used productively rather than it being on all day. The room that used to be the dining room is now a lounge area and new furniture has been provided. Relatives spoken with thought the new layout was much better and in their opinion helped to calm the atmosphere down as it now seemed less frenetic. DS0000028018.V335126.R01.S.doc Version 5.2 Page 20 The use of pictorial prompts around the building has started. All of the toilets had an appropriate picture on the door and staff commented that these seemed to have made a positive difference to the residents. All of the bedroom doors had a picture frame on the outside where the activities organiser had started putting photographs of the occupant from when they were younger, to help them identify their own rooms. This was mentioned during the relatives meeting and the activities organiser told relatives that these pictures had enabled one resident to recognise themselves or their partner. The relatives were supportive of this initiative and agreed to bring in photographs. The furnishing in the bedrooms have been reorganised so that it matches what is in the room. Several of the bedrooms contained personalised items in them and the staff were working with the relatives to bring in items that might stimulate a particular memory. In one bedroom there was a lot of football memorabilia relating to the club that that resident supported. This again helps the residents to identify their own rooms. The manager said that all of the bedrooms were unlocked during the day unless the occupant had to be helped to their room and the relatives asked for it to be locked. This was found to be the case during the visit. The building of the new conservatory is at a standstill but the proprietor is hoping for it to be completed by the end of July. In discussion with the manager it was clear that this building, will be usable all year as it will have both heating and air conditioning. The laundry, although small in size, is appropriate for the service provided. There are two washers each with a sluicing programme and a separate area for storing the clothes once dry and until they are ironed and taken back to the bedrooms. All areas of the home seen during the visit were clean and odour free. DS0000028018.V335126.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff who are now receiving regular training and in sufficient numbers to ensure they are properly supported. EVIDENCE: There are no staff vacancies at the moment and the process of recruitment was discussed with the manager. She was clear about the need for the completion of an application form, two references, an interview with both the manager and the clinical lead and a Criminal Records Bureau disclosure prior to the commencement of employment. Three staff files were checked and they contained all the appropriate documentation as required by The Care Homes Regulations 2001. Several staff were spoken with during the visit and said that they had filled in a pre-appraisal form, which was going to be used in the process of supervision. The staff are aware that they were going to receive supervision but this is still in the process of being implemented. There are regular team meetings and staff are able to air any concerns that they may have and is also used to deliver training. The staffing rotas were examined and they showed that there are four care staff and two nurses on duty until 3pm and this reduces to four care staff and one nurse until the night shift where there are two care staff and one nurse on DS0000028018.V335126.R01.S.doc Version 5.2 Page 22 duty. As well as the care staff there are two domestic staff a laundress two cooks and an activities organiser. At a weekend there is only one nurse on duty with the care staff. The staff spoken with said that whilst there were no extra staff on duty the tasks they had to do had been reorganised and this gave them more structure to the day. All the staff spoken with said that they now had more time to sit and spend time with the residents. One relative spoken with said that they feel much happier with the care and support provided and prior to the appointment of the manager had been considering moving their relative, but had now decided not to. One member of staff said that they felt the manager had been a positive influence and felt that the nurses and care staff were working much more as a team. All of the staff have started a learning distance course in Dementia Awareness and have done some observational work in the home to identify good and bad practice. Several staff who have completed the National Vocational Qualification level 2 in care are keen to progress on the level 3. The nursing staff are undertaking the distance-learning course in the Safe Handling of medicines to update their training. Manual handling training had been provided and more was planned for the week following the site visit. Where staff have started their National Vocational Qualification level 2 they have been appointed a mentor form the nursing staff. Staff also operate a key worker system and it is part of their responsibility to work with the families of the residents to try and find out as much of their history as possible as this can inform the whole care planning process. At the relatives meeting they were informed of who the key workers were. One of the trained staff spoken with is involved with a Dementia Collaborative in North Yorkshire. This is a group that shares new ideas and best practice in dementia care and this is being used to introduce new ideas in to the home. DS0000028018.V335126.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in home where the management is improving and systems are in place to protect their health and safety. EVIDENCE: A new manager has been in post for a short time and she has implemented a lot of changes in that time. Staff spoken with during the visit said that • • • She is approachable She manages and is allowed to manage. She is firm but fair. DS0000028018.V335126.R01.S.doc Version 5.2 Page 24 They all said that they had confidence in her as a manager and since she had started and introduced more structure the home was calmer and there was more time for the residents. The manager is supported by both deputy manager and a lead nurse. The relatives spoken with said • • Fantastic everything has improved greatly Superb. Things have improved since she started she has introduced new ideas and the home seems much calmer. All of the relatives spoken with said they would be confident to take any concerns to the manager and felt she would deal with things fairly. She does not yet know all the relatives but that is because she has only been in post a short time. However, she took the opportunity to introduce herself to the relatives’ meeting and explained what she intended to do and how they could contact her. There is a limited quality assurance system in place and the manager is hoping to develop this through a number of ways. These include regular satisfaction surveys to the relatives, supervision and appraisal of staff, staff meetings and the weekly visits by the service manager who completes a monthly questionnaire. A discussion was held about the views of the residents and they are going to try and develop a pictorial questionnaire using the actual key worker, home and other elements of the service they receive. It was also suggested that a pocket version may also aid communication between residents and staff. The pre-inspection questionnaire provided all the dates for the testing of equipment in the home. Those checked were accurate. There were risk assessments in place and these covered the environment as well as the residents. The fire procedures were well highlighted and all the relevant testing was carried out in accordance with guidance. Accidents are recorded and stored in the resident’s own file, this information is used to help determine the need for extra support or a change in the care plan. When necessary accidents are reported to the Commission. All staff have health and safety training covering first aid, manual handling, food hygiene, and infection control. DS0000028018.V335126.R01.S.doc Version 5.2 Page 25 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 DS0000028018.V335126.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO DS0000028018.V335126.R01.S.doc Version 5.2 Page 27 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The care staff must have full information about people’s dietary needs in the care plan. Where a resident cannot sign to agree to the care plan this must be done by their representative. Timescale for action 22/07/07 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 OP7 Good Practice Recommendations It is recommended that all the out of date information in the care plans is archived. Information in the care plans should be in language understandable by anyone reading it. It is recommended that residents are given only personally prescribed medication and the practice of using one container for several residents should cease. When staff are assisting a resident at a mealtime they should ensure they are sat with them and give them the attention they require. 2 3 OP9 OP15 DS0000028018.V335126.R01.S.doc Version 5.2 Page 28 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 DS0000028018.V335126.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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