CARE HOMES FOR OLDER PEOPLE
Tree Tops Residential Homes 27-29 View Road Rainhill Prescot Merseyside L35 0LF Lead Inspector
Mrs Elaine White Unannounced Inspection 21st January 2006 01.00p X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 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@btconnect.com 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) Tree Tops Residential Homes Kate Joanne Lashwood Care Home 43 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (30) of places Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 30 OP and up to 13 DE(E) The service should employ a suitably qualified and experienced manager who is registered with the CSCI 22nd June 2005 Date of last inspection 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 thirty service users in the older age category, and Delphlands, which accommodates thirteen 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. Communal facilities in Tree Tops include two lounges, one smoking and one non – smoking, a dining room, conservatory and large well maintained gardens. Delphlands has a communal lounge, dining room and a small-enclosed garden. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. 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 have been no visits to the home since the last inspection in June 2005. A tour of the building was conducted. Case tracking was conducted on six residents to assess the care and support provided. A selection of care, staff and home records was also viewed. The managing director David Beattie, six staff, five relatives and nine of the forty-two residents accommodated were spoken with and their views obtained of the home. Comments received were favourable regarding the home, the very caring nature of the staff and management, the standard of the environment and pleasant atmosphere in place at 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 meet the needs of 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 and dementia care. The home is committed to providing NVQ (National Vocational Qualifications) for their employees. The home has an established group of staff and a low staff turnover. Staff are sufficient in numbers to meet the needs of the residents and include management, care staff, domestics, cooks and laundry assistants. Staff were complimentary regarding the support and direction of the management. A number of staff spoken to said they had worked at the home for over ten years and commented that they ‘wouldn’t wish to work anywhere else’. An ‘open door’ policy is in place and relatives and residents commented on how approachable the management and the staff are. “If I want to talk to them I just call into the office or see a member of staff”. This was evident during the inspection as the staff and management chatted freely with the residents and their visitors. Relatives and visitors called in at all times during the inspection and were made welcome by the staff and offered drinks and snacks. Relatives
Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 6 spoken to provided positive comments on the care and support, cleanliness of the home and pleasant approach of the staff. “I call in at all times of the day and the staff always make me welcome”. “This is the best home in the area”. “I am treated like one of the family”. The home provides a very clean, pleasant, homely, relaxed and comfortable atmosphere. A full maintenance programme is in place and a maintenance person is on site to respond to repairs where needed. The home is resident focused and relatives and residents are encouraged to comment on the care provided via questionnaires and regular reviews. One relative said, “If you have any comments to make you can see any of the staff or complete a questionnaire, which are left by the front door for you to complete”. 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 and has a waiting list for admissions. One vacancy was in the process of being filled at the time of the inspection. 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. Risk assessments are in place for each resident and are reviewed when their needs change. Environmental risk assessments are provided for the building. Fire records are maintained up to date and all service certificates in place to promote the health, safety and welfare of the residents and staff. 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. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 7 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 Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Full assessments are carried out prior to admission to ensure the home can meet the needs. EVIDENCE: A sample of case files viewed demonstrated that full assessments are completed prior to admission to ensure the home can meet those needs. Admissions check list in place ensures that the home obtains the necessary information on each resident to enable the staff to meet their needs. These include personal profiles, medication, manual handling needs, nutritional screening, continence and preferences and choice. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8. Care plans are detailed, easy to read and drawn up with the residents and relatives. Residents’ health care needs are fully met. EVIDENCE: Care plans viewed show each resident to have an individual plan of care, which is drawn up with the residents and their families and is reviewed monthly. 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. Weight, personal care and bathing records are maintained. Discussion with a district nurse attending the home to provide care to the residents commented, “I am very happy with this home. The care staff respond to any care needs and act on my advice. I call in at all times of the day and have never seen anything which causes any concern”. Residents and relatives interviewed provided positive comments on the care and support provided. “The care staff are wonderful”, (Resident). “I wouldn’t mind coming in here myself. The staff are great”, (Relative). Care staff spoken to confirmed that the information provided in the care plans is
Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 11 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 upheld 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 the resident’s own private room. One resident commented, “The staff are very caring”. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The residents are encouraged to exercise choice and control over their lives. EVIDENCE: Care plans outline in detail the needs, choice, social and cultural interests of the residents. An activity programme is in place, which provides a range of activities from dominoes to day trips and entertainers. There are a number of communal areas available where residents can sit and chat, watch TV, take part in activities or go to their own room for privacy. Relatives and residents are encouraged to comment on the service provided via meetings and questionnaires, which are left at the front entrance. Families and visitors are able to visit the home when they wish. One relative said, “I call in here at all times of the day and night and I am always made welcome.” A wholesome, appealing, balanced diet is provided, served in pleasant surroundings and alternatives are always available. The chef discusses food preferences, likes and dislikes with each resident and records are maintained for reference and menu planning. The routines in the home are flexible and residents choose when they go to bed and where to eat their meals i.e. dining room or own room. “If there is anything I need I just ask”, (resident).
Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 13 Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Policies, procedures, training and recruitment systems in place help protect residents from abuse. EVIDENCE: Abuse policies and procedures are in place and staff interviewed demonstrated their awareness of identifying abuse and the action required. The staff training matrix showed that POVA (protection of vulnerable adults) awareness training is provided and the majority of staff have completed the course. Financial policies and procedures and records and receipts are obtained for all financial transactions. The home’s recruitment and selection process ensures that all staff are only employed on receipt of a satisfactory CRB (Criminal Record Bureau Check) and two written references. Staff files viewed were found to be very organised and contained the necessary recruitment information and training records. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 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 the following standard(s): 19,26. The home provides a safe, well-maintained, pleasant and hygienic environment for the residents to live. EVIDENCE: An ongoing maintenance programme ensures that repairs and decoration are conducted to maintain the standard. A number of rooms have been redecorated since the last inspection. The home has very well maintained grounds, which surround both units, are accessible for residents and used in the summer months. The home employs a full time gardener and maintenance person. A number of resident’s rooms were viewed and were found to be comfortably furnished and clean and contained their own possessions. Residents spoken to commented they are satisfied with the accommodation provided. One resident said, “My room is lovely. I have everything I need”. Residents on both units have access to communal areas. In Tree Tops these include a dining room, a conservatory and two lounges. Whilst in Delphlands there is a lounge and a
Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 16 dining room. These are in the process of being changed around and refurbished. 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. Environmental risk assessments are in place. As there are no radiator covers therefore risk assessments are provided for all residents. 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 has been repainted as required at the last inspection. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 A robust recruitment and selection 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. Risk assessments are in place. EVIDENCE: Viewing of duty rotas, training records and staff files demonstrated that the residents are supported by suitably appointed, trained and competent staff. Staff files are very organised and contained all the information required. Staff are employed following a Protection of Vulnerable Adults check (POVA) and two written references. A full training programme confirmed that staff are offered a range of training, which meets the statutory requirements. Staff spoken to said,” We get lots of training”. “I completed a dementia course, which helped me to understand the needs of the people I 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. “The staff are wonderful”. Relatives commented, “The staff are very good and very approachable”. Staff are encouraged to obtain NVQ qualifications. Environmental and residents risk assessments are in place and updated to reflect changing need. Radiator risk assessments are completed, as there are no radiator covers in place.
Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 18 Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35,38 Financial policies and procedures are in place. The home promotes the health, safety and welfare of the residents. The home is well managed. EVIDENCE: A pleasant relaxed atmosphere was pleasant throughout the inspection. Staff and residents chatted freely and visitors were made welcome. Residents commented, “Staff are very approachable”. “David is lovely”. Staff said, “I love it here”. “ I have worked here thirteen years”. A visitor commented, “I wouldn’t hesitate to put my relative here”. The home is well managed. The records are organised and easy to read. The staff spoken to feel supported, well trained and happy in their jobs. The residents spoken to said they feel safe and comfortable. And relatives said they are satisfied with the care and support provided.
Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 20 Financial policies and procedures are in place and records and receipts maintained of all financial transactions. Risk assessments are in place and regularly reviewed. Fire records are kept up to date and all certificates for services are in place. The home’s ongoing maintenance programme ensures that repairs are attended to and the standard is maintained. Quality assurance audits are conducted annually on areas of care and the environment, which identifies areas in need of improvement and attention. A full up to date training programme provides the staff employed with the skills to carry out the jobs safely and meet the needs of the residents. Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 4 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 4 X X 3 X X 3 Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tree Tops Residential Homes DS0000022416.V279445.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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