Inspection on 08/11/06 for Treehaven

This inspection was carried out on 8th November 2006.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Treehaven 05/11/07

Treehaven 18/01/06

Treehaven 07/09/05

Treehaven 08/02/05

Treehaven 05/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Treehaven Sandy Lane West Runton Cromer Norfolk NR27 9LT Lead Inspector Mr Jerry Crehan Unannounced Inspection 8th November 2006 09:30 Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 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 Treehaven DS0000027391.V319201.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 Adults 18-65. 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. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treehaven Address Sandy Lane West Runton Cromer Norfolk NR27 9LT 01263 837538 01603 279529 t.jeesal@virgin.net www.jeesal.org Jeesal Residential Care Services Limited 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) Jennifer Meek Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered for twelve service users plus one additional service user who is named in the Commissions records. 18th January 2006 Date of last inspection Brief Description of the Service: Treehaven is a large detached house situated on the edge of the village of West Runton. There is a large secure garden and an area set aside for horticultural work. There are workshops to the rear of the Home with one of these having been converted to house a small gym. The Home provides a service for up to twelve adults who have autistic spectrum disabilities. Accommodation is provided on the ground and first floors that is separated into three areas. All service users have a single bedroom. There are several communal rooms including a sensory room. The Home is owned and managed by Jeesal Residential Care Services Ltd Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 7.5 hours on 8th November 2006. Opportunity was taken to tour the premises, look at care records and policies, and communicate with or observe the home’s tenant’s in addition to its support workers and the manager. The inspection report reflects evidence from inspection of Key National Minimum Standards. Eight comment cards were received from service users prior to the inspection. These reflect the positive view tenants hold about their home. The range of weekly fees for the home is from £900 to £2,500. What the service does well: What has improved since the last inspection? The home has been effectively separated into three contained areas within the overall building. This provides an improved environment that is more homely and contained. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 6 It appears that all of the staff group associated with the home have worked very hard to minimise the disruption felt by tenants of the environmental changes happening around them. Pressures on staffing following the registration and opening of the Treehaven Bungalows Care Home in the Treehaven site have evidently reduced, with an establishing staff team of sufficient size. 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. The summary of this inspection report can be made available in other formats on request. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is excellent The needs and aspirations of people thinking about moving into the home are assessed. The home exceeds the requirements of the Standard in preparing support workers to meet prospective tenants needs and involving relevant parties outside of the home in this process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence of comprehensive assessment of prospective tenants and good assessment of tenants who had been accommodated in emergency circumstances, or at short notice. Evidence of a process including an application form completed by the existing service, and a pre-assessment undertaken by a senior representative of the home was seen. This included evidence of liaison and input from the prospective tenant. These documents are well designed to ascertain the level of support required by, and aspirations of, any prospective tenant. The service provides prospective tenants with the opportunity to visit the service as often as necessary prior to admission. There was evidence that the service has gone further in assessing prospective service users, facilitating their transfers to the home and in preparing support workers to meet the needs of newly accommodated individuals from the outset. Examples of this include establishing detailed transition timetables, with assigned responsibilities or roles for staff, community professionals, the prospective tenant and their relatives where appropriate. The arrangements for Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 9 one particular tenant included a three day training programme for staff that included the prospective tenants history, personality, environmental considerations, routine, communication and future plans. Training included input from the service the tenant was leaving and from relatives. A standard form of contract is made available to tenants at the home, which meets the requirements of the Standard. However, the manager indicated that contracts are being revised to include greater clarity regarding the arrangements for the costs of holidays for tenants. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. Tenants assessed needs and goals are reflected in their individual plan. Tenants make decisions about their lives with assistance as necessary and are supported to take risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sample individual care plans were reviewed. These set out clearly a ‘pen picture’ of the individual and a range of individual assessments. Information is developed into a ‘ personal support package’ that provides a summary of relevant assessment and care plan information. For many tenants these include a number of ‘teaching plans’ that refer to particular aspirations or other areas for development. There was evidence of regular monitoring of care planning and risk assessment information taking place at least monthly, and of more formal six monthly reviews involving tenants. ‘Risk Management Guidelines’ for tenants were reviewed, in addition to incident records involving the same tenant. Written guidance for support workers provides good detail about how behaviour may be manifested, what Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 11 this might be, how to deter/deflect the tenant. However, it falls short of providing support workers with guidance as to how they should respond in the event of physical challenge or aggression as a consequence challenging behaviour, and support workers appear uncertain about their actions in (infrequent) situations such as this (see requirement). Nightly meetings take place at the home, where tenants and support workers consider issues of relevance, such as concerns, achievements, the home’s environment and visitors to the home. Records were seen of a wider tenants forum involving tenants from other homes and a tenant from Treehaven. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good The home caters effectively for the lifestyle abilities and preferences of tenants. Links with the community are well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tenants care plans reviewed provided evidence of a ‘daily living schedule’. These schedules set out the routines and activities the tenant prefers. The weekly schedule for tenants includes a variety of activity that includes shopping trips, free time, foot spa, and cleaning. Other activities that are leisure oriented and involve travel from the home usually take place during the afternoon. Service users were observed undertaking their preferred activity throughout the day, including shopping trips, foot spa and laundry and cleaning tasks. Participation in a variety of activities was confirmed in observation of and discussion with tenants. There were no visits to the home by relatives of tenants during the inspection visit. A tenant spoken with confirmed that he has contact with his family, including visits home. The manager confirmed that relatives and other visitors Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 13 visit tenants regularly and are made welcome by the home. All eight service user comment cards received prior to the inspection visit indicate that tenants family and friends are able to visit them at the home. ‘Session plans’ set out clearly for support workers how they may support tenants to undertake their daily living schedule. All bedroom doors at the home are lockable to support privacy if required. Support workers were observed talking to and interacting with tenants throughout the inspection visit. First names are used as the preferred form of address for support workers, and service users with verbal communication. Individual preferences and choices are supported by the home, and any restrictions agreed due to risk are set out clearly in the care plan. Support workers and a dedicated cook prepare all of the meals at the home, with the main meal taken in the evening. However, tenants can participate in food preparation with assistance. Meals were not seen at the inspection visit. Individual preferences and dietary need were evidently catered for. Meals for the next day are communicated to some tenants by means of symbols, alternative symbols are available if the suggested option is not preferred/desired. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good Service users receive support in the way they require. Their personal and healthcare needs, including medication, are well attended to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care is provided to tenants so as to ensure their privacy and dignity. Support workers are supported by the clarity of information available within individual care plans, and were observed to support and guide tenants according to their individual needs. Records reviewed indicate that service users health is carefully monitored and that access to GP’s and other community health professionals is supported where necessary. There are no service users accommodated at the home who have responsibility for their own medication. The bulk of medication is available via the Monitored Dosage System (MDS), though there is also packet and bottled medication. On review of medication no discrepancies were identified, and records were good. Storage arrangements for medication are not ideal on one side of the home in a kitchen cabinet but were tidy and secure. Over stock of medication was kept to a minimum and stored in a separately. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 15 Staff with responsibility for administering medication confirmed that they had received appropriate training, and training records were seen. It is recommended that medication to be returned to the pharmacy be kept separate from medication stock held by the home to reduce the risk of it becoming mixed (see recommendation). Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good Arrangements for protecting and responding to the concerns and complaints of tenants and staff are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the service users guide, this is also made available in symbol format. Information in comment cards clearly indicates that tenants have an awareness of how they may make a concern or complaint known; generally this is by telling a support worker. Comment cards also make clear that tenants feel safe at the home. A record of complaints made by tenants is maintained. The manager indicated that she is responsible for investigating such complaints and providing a response, and that this includes meeting with the complainant. Records of tenant’s monies were reviewed and were satisfactory. Records seen corresponded with monies held. The home has relevant policies and procedures, which relate to the protection of the tenants from any form of abuse. A procedure for responding to allegations of abuse is in place that support workers are aware of. Support workers spoken to and records seen provided evidence of relevant training in recognising signs of abuse. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. An improved environment is provided for service users that is more homely, and is safe and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises are suitable for their stated purpose and are reaching the completion of a significant re-provisioning of space. The home has been effectively separated into three contained areas within the overall building, to provide an improved environment. At the time of the inspection there were four tenants in one area, five in the main central area, and one person in their own dedicated area to the side of the home. There are currently two vacancies, which are available in the central part of the home. Tenants were spoken to about recent changes, and through care staff gave mixed responses as to the benefits. However, it may be that tenants have yet to appreciate the benefit of the environmental changes, as there has been much disruption to usual and preferred routines. Bedrooms are evidently personalised to reflect the individual preference and taste of the tenant. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 18 The garden areas available to tenants are now separate, however, they are accessible by other tenants on invitation. Grounds and garden areas are well maintained. The home was clean and hygienic. Support workers have had infection control training and guidance. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. Service users are supported by a competent and enthusiastic staff team, and by safe recruitment practices. There is a shortfall in the number of NVQ qualified staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were ten tenants in residence at the time of the inspection visit, supported by five support workers. Staffing ratio’s for each shift has a minimum of three support workers allocated. The manager acknowledged pressures on staffing since the registration of Treehaven Bungalows Care Home in Treehaven’s grounds, though she indicated that the home has a satisfactory staff compliment of eleven support workers, and that this would be further enhanced by two new support workers who were starting their induction training on the day of the inspection visit. There is one night waking support worker and one worker sleeps in. At the time of the inspection visit 25 of care staff had achieved NVQ 2 or above (two care staff have achieved NVQ level 3). However, the manager stated that a further four staff are currently undertaking this training. This would exceed the required 50 of NVQ trained staff (see requirement). Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 20 Records for staff training indicate access to full induction training for support workers. This was confirmed in discussion with support workers who described working in a supernumerary capacity, being supervised by senior staff, having access to care plans, to policies, and having training sessions. Their progress was recorded individual induction booklets. Discussion with support workers provided evidence of their enthusiasm and knowledge for their roles. It was clear that they understand and share the aspirations of tenants, and that they have the commitment to support tenants to achieve them. Training for staff includes the full range of mandatory training with supporting documentation to evidence understanding of learning. Support workers at the home also undertake ‘induction into autism’ training to help to fulfil the specialist needs of the tenant group. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. Tenants interests underpin monitoring review and development of the service. Tenants benefit from a well run home, although the manager has not yet achieved the care qualification (or equivalent) set out in standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has three years learning difficulty management experience, and five years as deputy manager. She holds the City In Guilds Advanced Management in Care, and a Certificate of Disability Study. She is currently in the process of undertaking NVQ 4 in Care toward achieving the RMA, and hoping to complete early in 2007. Support workers spoken with during the inspection visit spoke favourably about the manager, indicating that she is both approachable and professional. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 22 The home produces an annual development plan. There are several ways in which the quality of the service is monitored. These include monthly reviews of the service user plans, Tenants meetings, staff meetings, annual questionnaires to professionals and relatives, health and safety monitoring, Regulation 26 visits undertaken monthly, Tenants Forum and the homes own Quality Forum. The staff are aware of health and safety issues and all receive training within their induction with regard to this area. The home demonstrates good practices ensuring service users health, safety and welfare. Staff are aware of risks associated with the potential challenging behaviour of tenants. Relevant health and safety training for staff, including moving and handling, first aid, fire and food hygiene training, support practices. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 4 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 24 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 YA6 Regulation 15(1) Requirement Timescale for action 30/11/06 2. YA32 18(1)(a) The registered person must ensure that individual care plans set out action required by care staff to manage behaviour and meet needs. The registered person must 31/12/06 ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. 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 YA20 Good Practice Recommendations It is recommended that medication to be returned to the pharmacy be kept separate from medication stock held by the home to reduce the risk of it becoming mixed. Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Treehaven DS0000027391.V319201.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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