CARE HOMES FOR OLDER PEOPLE
Tree Tops Residential Homes 27-29 View Road Rainhill, Prescot Merseyside L35 0LF Lead Inspector
Elaine White Unannounced 22nd June 2005 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 Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Tree Tops Residential Homes Address 27-29 View Road Rainhill Prescot Merseyside L35 0LF 0151 426 4861 0151 431 1080 treetopsreshomes@btconnnect.com Tree Tops Residential Homes 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) Kate Joanne Lashwood Care Home 43 Category(ies) of DE(E) Dementia - over 65 13 registration, with number OP Old age 30 of places Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The service must at all times employ a suitably qualified and experienced manager who is registered with CSCI. Date of last inspection 18th October 2005 Brief Description of the Service: Tree Tops Residential Homes is located in the Rainhill area of Prescot. The home is easily accessible to bus, road and rail links.The home is owned by a family partnership. The manager is Kate Joanne Lashwood. There are two homes within the complex, Tree Tops, which accommodates 30 service users in the older age category, and Delphlands, which accommodates 13 service users who are elderly mentally infirm. Neither home provides nursing care.The homes both offer passenger lifts and stair access and both homes share kitchen facilities. The home has plans to extend the facilities in the near future. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There has been one visit to the home since the last inspection in October 2004. This was to investigate a complaint, which resulted in action required by the home. The home responded efficiently to resolve the issue within the time scale required. A tour of the building was conducted. Case tracking was conducted on 4 residents to assess the care and support provided. A selection of care, staff and home records was also viewed. The managing director David Beattie, care manager, 10 staff and 8 of the 43 residents were spoken with and their views obtained of the home. Satisfaction comment cards were also given to residents and relatives to complete at their leisure. Comments received have been favourable regarding the home and the very caring nature of the staff and the improvement in the standard of the environment and atmosphere in the home. What the service does well:
The home has an ongoing training programme, which provides the staff employed with the necessary skills to enable them to deliver care and support to the residents. A training room is available to provide ‘in house’ training for staff. External courses are also available in specialist areas i.e. challenging behaviour. The home is committed to providing NVQ (National Vocational Qualifications) for their employees. The home has an established group of staff who have worked at Tree Tops for many years and were complimentary regarding the support and direction of the management. An ‘open door’ policy is in place and staff and residents commented on how approachable the management are. “If I don’t like anything I will tell David”. (Resident). “David is a perfectionist. He has turned this place around” (Employee). The home provides a very clean, pleasant, homely, relaxed and comfortable atmosphere. The home is resident focused as relatives and residents are
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 6 encouraged to comment on the care provided via questionnaires and regular reviews. Visitors are made welcome and were observed to call at all times during the inspection. Information on the service is available to prospective residents and families. This is displayed at the entrance and includes a statement of purpose, service users guide, copy of the most recent inspection report and comments from residents and relatives about the home. A web site is also available to obtain information on the service. The home maintains a high level of occupancy. The home provides good quality food with plenty of fresh produce. Menus are displayed and alternatives always available. Residents provided positive comments on the food provided. “The meals are very good and there is always choices”. The chef is qualified in both intermediate and advance food hygiene awards and is to progress to a higher award. All new residents are assessed for their likes, dislikes, allergies and cultural preferences on admission. A range of activities are available for the residents and these are displayed on the activity board. Activities are continually updated to meet the needs and preference of the residents. Records are organised, easy to follow and kept up to date. What has improved since the last inspection?
The home has made progress to meet all the requirements made at the last inspection. Care plan documentation is organised, easy to read and clearly identifies the tasks to be undertaken by the care staff. Medication policies and procedures are in place and medication is recorded at the time of administration. Photographs of residents are on medication records and sample signatures of staff who administer medication are in place. A structured activity plan is in place for both units. This is regularly reviewed on a one to one basis with residents to enable the home to meet their needs and choice. A social profile is conducted and recorded for all residents to identify their personal interests. Staff confirmed that they are given more time
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 7 to spend with the residents to involve them in the activities provided. This was observed during the inspection as staff were available to assist with the afternoon activities. Residents of one unit played bingo in the garden, while the residents of the Delphlands unit sat in the sunshine and listened to music. Repairs required at the last inspection have taken place in room 5 and bathroom 3. 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 Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5. The home has an excellent statement of purpose and service user guide, which is easy to read, contains bright pictures thus making it user friendly. Details within these items include: aims and objectives, contracts, facilities, complaints procedures and service user views of the home. This information is also available on the home web site. Contracts are clear and contained the information required. Full assessments of need are carried out prior to admission by senior staff. The home encourages prospective residents and their relatives to visit prior to admission. EVIDENCE: The statement of purpose and service user guide was viewed and is made available to all residents, prospective residents and relatives. A copy of this is available to view along with the most recent inspection report at the entrance. A sample 4 case files viewed demonstrated that full assessments had been completed prior to admission to ensure the home can meet those needs. Discussion with residents and staff confirmed that prospective residents and their relatives are invited to visit to view the service provided. One resident
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 10 commented, “I didn’t need to come and have a look around as I had heard it was good”. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9,10. Care plans are detailed, easy to read and drawn up with the residents and relatives. Policies and procedures are in place for the safe handling of medication. Residents feel that they are treated with respect and dignity by the staff employed. EVIDENCE: 4 care plans viewed demonstrated that each resident has an individual plan of care, which is drawn up with the residents and their families. The plans contain detailed information on the needs of each resident to enable the home to provide the care required. Records showed that access to health care professionals is available and all visits are recorded. Residents interviewed provided positive comments on the care and support provided. “The staff are very good. They get used to your ways”. Care staff spoken to confirmed that the information provided in the care plans is easy to follow and outlines the tasks to be done. Observation and discussion with staff and residents during the inspection confirmed that dignity and respect is maintained at all times. Staff knocked prior to entering rooms and spoke politely to the residents at all times. The home has a treatment room, which is available for use by health care professional visits i.e. district nurses. Treatment can also be provided in
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 12 the resident’s own private room. One resident commented, “The staff bathe me and are very polite and helpful”. Medication policies and procedures are in place and all medication received/administered and returned is accounted for. The medication round was observed during the inspection and the procedures followed. Medication was found to be appropriately stored. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15. Care plans identify the needs, choice, social and cultural interests of the residents. An activity programme is in place and is reviewed monthly. Relatives and residents are encouraged to comment on the service provided via meetings and questionnaires. Families and visitors are able to visit the home when they wish. A wholesome, appealing, balanced diet is provided and is served in pleasant surroundings. EVIDENCE: The statement of purpose and service user guide provides detailed information on the activities, menus and visiting arrangements. Visitors were observed to sit and chat with the residents in the conservatory, garden and entrance area. An activity programme is displayed near the dining room for the residents to view. Discussion with the managing director confirmed that the activities are reviewed monthly to meet changing need and provide new activities introduced. Activities include bingo, trips out to Martin Mere bird sanctuary and music afternoons. During the inspection residents were observed to play bingo in the garden supported by the staff. 10 residents in the Delphlands unit were observed sitting in the garden listening to music in the sunshine while 3 other residents were watching the tennis inside. A pleasant, relaxed and friendly atmosphere was noted and the residents were provided with ice cream in view of the hot weather. Communion is available at the home and ethnic minorities are provided with transport to attend church. Residents interviewed confirmed
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 14 their satisfaction with the activities provided. One resident who has been at the home for 6 years said, “I enjoy the activities especially the drawing and bingo. My family visit me every week”. Another resident commented, “I had a party for my birthday and they provided an entertainer it was lovely”. The home has a qualified chef who has worked there for 3 years. Discussion with the chef, residents and tour of the kitchen confirmed that wholesome, balanced and good quality food is provided. The kitchen was well stocked with quality, fresh produce. The chef assesses the likes, dislikes, dietary and cultural needs of all the residents. Records show when assistance is required and any allergies. The residents were observed to eat their main meal in the dining room in a pleasant relaxed atmosphere with staff support if required. Daily menus are displayed in the dining room and alternatives always available. Positive comments were received from the residents interviewed. “The food is very good”. “There is plenty of choice”. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 A clear and accessible complaints procedure is in place and residents, relatives and friends are confident that there complaints will be addressed. EVIDENCE: A clear and accessible complaints procedure is in place and is contained in the statement of purpose and service user guide. The home has a ‘grumble’ book, which records smaller but just as important concerns and the action taken. Discussion with staff, residents and management confirmed that an ‘open door’ policy is in place and should anyone have any concerns they will be listened to and acted upon. A number of residents interviewed commented that should they have any concerns they would tell the management or staff. One resident commented, “If I don’t like anything I will tell David (managing director). Since the last inspection an unannounced visit was made to investigate a complaint. The home acted efficiently to resolve the issue within the time scales set. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 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 standard(s) 19,20,23,24,25,26 The home provides a safe, clean, pleasant, hygienic and well-maintained environment with sufficient indoor and outdoor facilities. An ongoing maintenance programme ensures that repairs are conducted to maintain the standard. Not all rooms have single occupancy, as there are 2 double rooms in the main unit. Residents’ rooms are comfortable, clean and contain their own personal possessions. A small number of improvements were identified during the inspection and are contained in the requirements and recommendations of this report. EVIDENCE: Since the last inspection redecoration of the ground floor corridors has taken place. The home has very well maintained grounds, which surrounds both units and are accessible for residents. The residents were observed to use the gardens during the afternoon to sit in the sunshine, listen to music or play bingo. The home employs a full time gardener and maintenance person.
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 17 A number of resident’s rooms were viewed and were found to be comfortably furnished and clean and contained their own possessions. Residents spoke satisfied with the accommodation provided. One resident said,” My room is only small but I am happy”. One member of staff spoken to commented, “The managing director is a perfectionist. I report any repairs and he makes sure they get done”. Discussion with the managing director and viewing of the maintenance programme confirmed that repairs and improvements are noted and contained in the programme for action. David confirmed that as soon as a room becomes vacant it is decorated “From top to bottom”. It was confirmed that future plans are in place to replace the strip lights in place in a number of resident’s rooms and to redecorate the upper floor rooms in the Delphlands unit. These are highlighted within the recommendations of this report. Residents on both units have access to a variety of communal areas, which include dining rooms, a conservatory and lounges. All were viewed during the inspection and were found to be comfortable and clean. The décor and furnishings are in good condition and create a homely atmosphere. Risk assessments are in place as there are no radiator covers in place. An organised laundry service is in place, which ensures that each resident has an individual storage basket for his or her clothing. Policies and procedures are in place for infection control. The laundry was found to require repainting. This was agreed with the managing director during the inspection and is contained within the requirements of this report. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 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 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) 27,29,30. The home has an established staff group who have a range of skills and are employed in sufficient numbers to meet the needs of the residents. A robust recruitment policy and procedure is in place. An ongoing training plan ensures that staff are equipped with the necessary skills to provide care and support to the residents. EVIDENCE: Viewing of duty rotas, training records, supervision and recruitment files demonstrated that the residents are supported by suitably appointed, trained and competent staff. Staff are appointed following a Protection of Vulnerable Adults check (POVA) and 2 written references. A full training programme is in place and staff confirmed that they are offered a range of training. “I love it here. There is lots of training”. We get interesting courses, which help us to understand the needs of the people we care for”. The home employs an established group of staff who maintain continuity of care to the residents. Residents spoken to provided positive comments regarding the care and support provided. “My carer is marvellous she helps me with everything”. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31,32,33,36. The management provide direction and support to the staff employed. The home is run in the best interest of the residents and creates a pleasant, organised, homely environment for them to live. EVIDENCE: The manager was on holiday during the inspection and the managing director was present. Positive comments were received regarding the management from both residents and staff spoken to. A senior carer commented,” David (managing director) and Katie (manager) are excellent. We get lots of training and lots of support”. A carer said, “I love it here. David is lovely”. Residents commented that the managers are “very approachable”. If I need to speak to them I just ask”. “Inspection is a good thing it keeps a check on the care we receive” A pleasant relaxed atmosphere was pleasant throughout the inspection. Staff and residents chatted freely and visitors were made welcome.
Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 20 The home encourages residents, relatives and visitor feedback on the service provided. This is arranged via meetings and questionnaires. The management conducts annual self-assessments of the service. A sample of these was viewed during the inspection. All areas are reviewed i.e. staffing, building, policies and procedures. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x x 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x 3 x x Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 22 no 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 26 Regulation 23 Requirement The registered person shall ensure that the laundry is repainted to provide an easy cleanable surface. Timescale for action 30th Sept 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. 2. Refer to Standard 19 19 Good Practice Recommendations The home to consider redecoration of the upper rooms in Delphlands unit to improve the standard. The home may consider the replacement of the strip lighting in a number of residents rooms to improve the standard. Tree Tops Residential Homes F53 F03 S22416 Tree Tops V226602 220605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor, Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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