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Inspection on 27/04/05 for Tree Tops Nursing Home

Also see our care home review for Tree Tops Nursing Home for more information

This inspection was carried out on 27th April 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff provide a warm comfortable environment for people to live in. The staff are trained to provide nursing and personal care to service users with dementia and mental disorder and they are skilled in managing difficult behaviour. The staff demonstrated that they knew each service user well and approached them in a sensitive and respectful way. There was clear evidence of team working and personal care was delivered in private. Focus was on spending time with the service users on a one to one basis and to engage them in conversation and activity.

What has improved since the last inspection?

The quality of the daily records in the service users care plans has improved significantly, the care staff record their contact and the nursing staff complete a more detailed daily record on the health and welfare of each of the service users. The activity programme has been reviewed and is displayed in the home for people to refer to. There is a separate room available for the hairdresser to use and there are good systems in place to keep the home free from offensive odours.

What the care home could do better:

Make proper arrangements to ensure that all staff who administer medication keep accurate records to show that service users have received their medication. Improve the medication monitoring system and provide medication training for staff. Make sure that service users are safe and that all risk to health and safety is minimised. To make arrangements to have the sluice disinfector in working order and the staff working to the required infection control policies and procedures. To keep records of all fire equipment tests and to make the laundry area safe. Maintain the required staffing levels in the morning and overnight.

CARE HOMES FOR OLDER PEOPLE Tree Tops Nursing Home 12 Ryndleside Northstead Manor Drive Scarborough YO12 6AD Lead Inspector Mary Slattery Unannounced 27 April 2005 10:30 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tree Tops Nursing Home Address 12 Ryndleside, Northstead Manor Drive, Scarborough, North Yorkshire YO12 6AD 01723 372729 01723 372729 Telephone number Fax number Email address 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 J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Yes Service users in the category(DE) must be aged 55 years upwards. Date of last inspection 11th November 2004 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 sea side town of Scarborough. The amenties and the facilities of the town centre are a short distance from the home. There are single and double bedrooms over three floors and access to the upper floors is by either the stairs or a passenger lift. There is ramped and level access to the home and level acces around the home. There is a garden area at the front which service users use in the fair weather, parking is available at the back of the house and on the road at the front. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection carried out on the 27th April 2005, which started at 10:30am and finished at 14:30pm. At full tour of the home was carried out which included the service users private accommodation. A selection of records were looked at the medication system was audited. Time was spent listening to and talking to service users and staff, observing the activity in the home, the interaction between the service users and the staff and staff practice. The focus of the inspection was on a number of key standards, inspecting the case records of five service users to establish if they corresponded with their assessed needs and with the service offered by the home. Staff were available throughout the inspection and the finding were discussed with the owner of the home as the manager was not on duty. What the service does well: The staff provide a warm comfortable environment for people to live in. The staff are trained to provide nursing and personal care to service users with dementia and mental disorder and they are skilled in managing difficult behaviour. The staff demonstrated that they knew each service user well and approached them in a sensitive and respectful way. There was clear evidence of team working and personal care was delivered in private. Focus was on spending time with the service users on a one to one basis and to engage them in conversation and activity. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 People are invited to the home to look at what is offered and information is gathered about people moving in to ensure that their needs are met in a safe manner. EVIDENCE: The manager and or the qualified nurses arrange to visit people before they move into the home to assess their needs to establish that their needs can be met and to ensure that any equipment needed is in place prior to admission. The information gathered at the assessments was recorded in the service users care plans. There was information about of their physical, social and mental health care needs, areas of risk and details of difficult behaviour. Tree Tops provides care for people with dementia and mental disorder who are not always able to make an informed choice about moving into the home. The policy of the home is to invite the service users and their family or representative to visit to discuss the facilities and services on offer and assist the service users in making a decision to move in or to make that decision on their behalf. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 9 The care plan records held information about who to contact on behalf of service users and who information will be shared with. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9. There are systems in place to meet service users health care needs but the home has failed to improve their procedures for recording medication administered. EVIDENCE: The care plans records of five service users were looked at in detail four of the care plans gave information about their mental and physical nursing needs, their likes dislikes, a social history, assessment of risks, equipment currently in use for the prevention and treatment of pressure sores. The daily records showed that their needs had been met and information about any changes in their conditions. There are systems in place for staff to review the needs of the service users and details of any action taken as a result of these reviews. A service user recently admitted to the home had been assessed prior to moving in but there were no care plans or risk assessments in place. The service users are not protected by the home medication policies and procedures as staff had failed to sign for medication that was prescribed to be administered. An official notice was left which informs them of the immediate action they are to take to resolve this issue. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 11 There were two service users being nursed in bed both needed treatment for pressure sores. They were being nursed on pressure reliving mattress and they appeared well groomed and comfortable. Advice had been sought from the tissue viability nurse and the appropriate treatments applied. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13. 14 and 15 Visiting arrangements are flexible allowing service users to maintain good and regular contact with family and friends. The meals provided are nutritious and offer a varied diet with plenty of choice. EVIDENCE: The statement of purpose details the arrangements for visitors and visitors are encouraged and supported to their relative and to join in activities organised by the staff. The service users living in the home are not always able to exercise choice and control over their lives due to the nature of their mental health condition. The staff were observed helping them to make choices about where in the home they wished to be, speaking to them in respectful manner and addressing them with their preferred term of address. The front and back doors are locked and this arrangement is to keep people safe. Staff were available to escort people out of the home where indicated or requested. The nutritional needs of service users are assessed and staff talk to the service users and relatives to establish their likes and dislikes, these are then incorporated into the menu. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 13 There was lots of choice offered and the food was prepared to individual needs. Lunch was a pleasant time and there were plenty of staff available to assist the service users. There a some service users who have very healthy appetites and the staff make sure that these are satisfied. There were plenty of drinks available throughout the day as a routine but also on request. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff awareness of abuse ensures that service users are safeguarded. EVIDENCE: There is an adult protection policy and procedure in place and a number of the staff have attended abuse awareness training, others have completed the abuse awareness module covered in NVQ training. Staff knew about the types of abuse their responsibility to report on poor practice. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 23, 25 and 26. The standard of the environment has improved and provides service users with a clean and comfortable place to live. EVIDENCE: The home was warm, bright and free from offensive odours. The service users bedrooms are pleasantly decorated and furnished and the doors have locks fitted. There is a range of equipment available including specialised seating, hoists, assisted baths and wheelchairs to assist service users who have limited mobility. There are systems in for the testing of equipment and the required certificates were in place including fire risk assessment and insurance cover. Staff said that the fire safety equipment is tested on a weekly basis but the fire log record had not been completed since January 2005. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 16 The sluice room on the ground floor was being used as a store room and staff said that the sluice was not in working order. The sluice facilities being used were not sluice disinfectors. There was no sink in the laundry and no access to the back of the washing machine and drying machine to remove the fluff and dust that had gathered. This situation poses a fire risk and a health and safety risk and arrangements are to be made to fit a sink in remove the dust and fluff. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27and 30 The service users receive a good standard of nursing and personal care from the staff. EVIDENCE: The home employs qualified nursing staff with the relevant mental health qualification and care staff, a number of whom have achieved NVQ Levels 2 and 3 in care. External and in house training is made to staff available to update their practice and to review performance. The staff spoken to demonstrated awareness and knowledge of the needs of the service users, the importance of keeping accurate care records and working as a team to ensure that the needs of the service users are met in a consistent way. The staff rota showed that at times the home is not meeting the required staffing levels. There should be two qualified nurses on duty each morning and three members of staff on duty overnight. On a number of occasions there is only one nurse on duty in the morning and two members of staff on duty overnight. Staff are employed are employed to cook and clean. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Some of the practices do not safeguard the safety of the service users. EVIDENCE: There is a health and safety policy and procedure in place and all staff attend health and safety training. This training includes moving and handling, infection control. First aid and fire safety. There was no evidence to show that the fire safety equipment had been tested as required. The staff said that the sluice that was out of action had not been in working order for a long time therefore the arrangements in place for the sluicing of foul waste were not in line with infection control. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x 3 x 3 1 STAFFING Standard No Score 27 1 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x x 1 Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The registered person is required to keep accurate records of all medication administered to service users. The registered person is required toreduce the risk of fire by removing the dust and fluff from behind the machinery in the laundry.To test the fire safety equiment on a weekly basis and record the outcome of the tests. The registered person is required to make arrangements to prevent the spread of infection.To have a sluice disinfector in working order. The registered person is required to have staff in sufficient numbers at all times. Timescale for action 27th April 2005 and thereafter. 1st May 2005. 2. 24 13(4) 3. 26 13(3)( c) 30th May 2005. 4. 27 18(1)(a) 30th May 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is recommended that all care plans are completed as soon as possible after a service users is admitted to the J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 21 Tree Tops Nursing Home home. Tree Tops Nursing Home J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 J53_J04_S28018 Tree Tops Nursing Home_V223050_stage4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!