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Inspection on 12/06/09 for Treelands Care Home

Also see our care home review for Treelands Care Home for more information

This inspection was carried out on 12th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

People`s needs are assessed before being admitted to the home. This helps to ensure that the skills of the staff team are appropriate to meet the needs of the person. Staff have access to clear written information about the needs of each service user. Staff also have access to a range of training opportunities and support from colleagues and managers. This helps to ensure that service users are getting their assessed needs met in the correct way. The building offers a good environment which is well maintained, clean and hygienic. Staff maintain good relationships with the service users.

What has improved since the last inspection?

No requirements were made at the previous key inspection.

What the care home could do better:

Several issues have been identified where the Treelands management team need to improve the standard of service. We consider it to be likely, but not yet proven, that the current management team understand what needs to be addressed and are taking appropriate action. Specifically, but not exclusively, this relates to : Maintaining appropriate staffing levels and training records to ensure service users` needs are consistently met by staff with the knowledge and competency to do so. Responding to all complaints or concerns, from whatever source, in a timely manner, and maintaining comprehensive records of the nature of the complaint, the investigation undertaken and the outcome. Ensuring that all recruitment is undertaken at least to the legal minimum standards, particularly around vetting. Thorough records must be kept which allow the recruitment process to be seen to be undertaken reasonably, to protect the interests of the service users. Ensuring that regular visits are undertaken, and a report is compiled by an employee of Southern Cross who does not have a day to day interest in the running of the home. This is to ensure that if there are any emerging difficulties they are understood and addressed by the company in a timely manner.

Key inspection report Care homes for older people Name: Address: Treelands Care Home Greenhurst Crescent Oldham OL8 2QQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Steve Chick     Date: 1 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Treelands Care Home Greenhurst Crescent Oldham OL8 2QQ 01616267173 01616289793 treelands@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare (Kent) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: No Service User to be admitted into the home who is under 55 years of age. The manager must be supernumerary at all times. Date of last inspection Brief description of the care home Treelands is owned and managed by Southern Cross Health Care Services Limited, which is a private company with a number of other homes in the area. Treelands is a purpose built home, located in the Fitton Hill area of Oldham. Care Homes for Older People Page 4 of 31 Over 65 40 20 40 40 0 40 20 0 40 4 Brief description of the care home Treelands provides general nursing and personal care for up to 40 service users, specialist dementia care for a further 40 service users and care for service users with other mental health needs. The home does not provide care for service users under the age of 55 years. Accommodation is provided over two floors, the first floor being accessible by a lift. Each floor is divided into two units, which are separately equipped with bath and shower rooms, treatment rooms and lounge/dining rooms. The general nursing unit occupies the ground and first floors on one side of the building, whilst service users with mental health needs occupy the ground and first floors on the other side. All bedrooms provide en-suite facilities. Separate self-contained, secure gardens are accessible from each unit. The current weekly fees (as at June 2009) range from 375.00 pounds to 754.70 pounds. Further details regarding fees are available from the manager. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Treelands knew that the visit was going to take place. Two inspectors took part in this unannounced visit. One inspector returned by appointment to talk to more staff. The quality rating judgement has been made using a variety of sources and is not just based on our experience of a visit to the home. For the purpose of this inspection, during our visits, three service users were spoken to, as were two relatives of service users. Additionally discussions took place with the acting manager and four staff members. A further three staff were interviewed in private. In order to obtain information about how well the manager and staff looked Care Homes for Older People Page 6 of 31 after the people living at the home, we also spent a period of two hours sitting in the lounge, watching how staff dealt with and spoke to residents and getting a feel of what it would be like to live at the home and sit in the lounge most days. All the key inspection standards were assessed at the site visit. We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the service, these are called notifications and any relevant information from other organisations. Before the site visit, we asked for surveys to be sent out to a sample of residents, and staff, asking what they thought about the care at the home. At the time of writing this report three residents, and five staff had returned their surveys to us. Some of the information from these surveys is included in the report. We also asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, some of these comments have been included in the report. We undertook a tour of the building and looked at a selection of service user and staff records as well as other documentation, including staff rotas, and the complaints log. Since the last inspection several complaints and safeguarding issues have been investigated, primarily by Oldham Metropolitan Borough Council. Southern Cross (the company which runs Treelands) has cooperated with these investigations. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 31 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they come to live at the home to make sure their needs can be met. Evidence: We looked in detail at the care provided to 4 people. Each person had been assessed before they were admitted to the home. Assessments included risk assessments for falls, nutrition, mobility and skin damage and also where appropriate, mental health assessments. One person was readmitted back to hospital and their assessment was reviewed again before their return to the home to make sure staff were clear about any changes that had happened whilst the person was in hospital. Information obtained through assessment had been used to create a draft care plan for each person. This provided a starting point for staff to use until they got to know the person and further assessed their abilities and preferences. Care Homes for Older People Page 11 of 31 Evidence: Treelands does not offer intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were being met by staff that respected their privacy and dignity. Evidence: We looked in detail at the care provided to 4 people. Each person had detailed care plans in place that addressed their needs, as identified during their assessments. From our observations we were satisfied that the care described as being needed in peoples care plans was what staff were delivering in practice. For example where people needed help to move position in bed to prevent pressure ulcers, records showed that staff were doing this as outlined in the persons care plan. Care plans and risk assessments, in the main were reviewed monthly. Regular, more formal reviews of care were undertaken, which involved the person receiving care, their family and in some cases other professionals such as social workers or community psychiatric nurses. Comments from the people receiving care and their representatives were all positive in the reviews we read, with people saying that they were very happy with the care staff provided. Care Homes for Older People Page 13 of 31 Evidence: Peoples heath care needs were monitored closely and staff were proactive in finding ways to assess improvement or deterioration in peoples health. For example it was not possible to weigh one person due to their physical condition but staff used other measurements to assess their nutritional status and guage whether they were gaining or losing weight. Records showed that people have seen GPs, speech and language therapists (SALT), dieticians and opticians. Where advice or instructions had been given by other healthcare professionals this was clearly recorded on peoples care plans and systems were in place to make sure staff were up to date with any changes that needed to be implemented. Staff had been proactive in the management of one person with challenging behaviour, involving other professionals and altering the level of staff supervision to protect the person and others from risk of harm. In some cases peoples wishes regarding their end of life were recorded, which is good practice as it ensures staff are able to help them be cared for at this time in the way they wish. Entries were made in each persons daily record several times a day. Whilst these were dated they did not always specify the time when they were written. This is recommended to provide a clearer audit trail for when care was evaluated. We looked at how staff managed the medicines for a small number of people. Records were detailed and accurate and stocks of medicines were stored appropriately. People we spoke to said they were able to choose how to spend their day, for example one person said they spent most of their time in bed as this was more comfortable for them and staff respected their wishes. People commented that staff were kind and understood their needs well. One visitor we spoke to thought staff cared for her relative very well saying, Staff are absolutely marvellous here. They cant do enough. There is continuity as some staff have been here a long time as mum has. They indoctrinate new staff with their ethos and values, which are respect for the residents. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate range of activities is available to service users and visitors are welcome to the home which enhances service users fulfilment and social stimulation. Evidence: The manager told us in the AQAA that social assessments and religious beliefs were incorporated into the care plan. They also told us that social care profiles were completed for residents and relatives were encouraged to assist in the completion of these documents. There was some evidence on care files looked at that there was a map of life which gave a brief history of the individual. This is important to help staff understand the people they are looking after, in the round. During the visit one inspector sat in the lounge of one dementia care unit for two hours and concentrated on the experience of four service users during that time. Staff were seen to be relating well to the service users. Staff came across as attentive and were seen to initiate contact with individuals, checking if they were alright, or simply sitting with them. When one service user woke up, staff were reasonably quick to check if they wanted a drink. It was apparent that staff were aware of what individuals were doing without having an oppressive presence. Care Homes for Older People Page 15 of 31 Evidence: There is an activities coordinator on the staff team. They had not been working for some time, but the acting manager said they were now back and working regularly. Records of activities undertaken by individuals were seen. These are kept separately on each unit. Staff who we asked, told us that there was a range of activities available for service users to participate in if they wished. These included, but were not restricted to, movement to music, painting and drawing, aroma therapy sessions and occasional coffee mornings. The acting manager told us she was looking to arrange more outings. On the first day of our visit staff were seen to be assisting service users to sit out in the grounds as the weather was particularly pleasent. The home has a policy of allowing visiting at any reasonable time. Staff who we spoke to confirmed this and thought that visitors were made to feel welcomed. Service users were seen both in the communal areas and their own bedrooms. One meal time was observed which was undertaken in a calm atmosphere There was a choice of food on the menu. Two people commented on behalf of their relatives that the vegetarian options were not as varied as they would like. One person who returned a survey said they thought the menue was too modern and would like more ordinary food. However, service users who were asked during our visit, said that they liked the food. Staff who we asked told us that the provision of food was good, and one cited the good food as amongst the best things about Treelands. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Currently, service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaint they may have would be dealt with appropriately. Evidence: We were told in the AQAA that all complaints are fully investigated and responded to. We looked at the current complaints log which presented as being appropriately maintained. The manner of dealing with complaints more recently, presented as being undertaken well. However, information from staff, relatives of service users and investigations undertaken by Oldham Metropolitan Borough Council (OMBC) staff all indicated that this has not always been the case since the previous key inspection. Staff who we asked, told us that they believed complaints would be listened to and dealt with appropriately. Some told us that they were more confident of this under the current management regime that they may have been previously. All staff who completed a survey for us said they knew what to do if someone had concerns about the home. Service users described the staff as kind, which would also suggest that concerns or complaints could be raised with the staff. Since the last key inspection there have been several complaints and safeguarding investigations undertaken by Oldham Metropolitan Borough Council. Southern Cross have cooperated with these investigations, some of which were continuing at the time Care Homes for Older People Page 17 of 31 Evidence: of this key inspection. Training records indicated that 75 of staff had undertaken training in the Protection of Vulnerable Adults (POVA). We identified a small number of staff from those who were recorded as having received the training and checked that there was written evidence of them having received it. All the relevant training certificates were seen. The acting manager also told us that more staff had training booked for July 2009. All staff who we asked, demonstrated an understanding of the need for vigilance in connection with protecting service users from abuse or exploitation. This included an understanding of the need to use the whistle blowing procedures if necessary. All staff who we asked, said they believed that the service users living at Treelands were safe. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in suitably adapted, clean, comfortable and pleasant surroundings. Evidence: A partial tour of the home was undertaken. The home was clean, tidy and well maintained. There were bad odours in a very small number of rooms early in the morning but by later in the day these rooms had been cleaned and smelled fresh. Clinical waste bins were situated appropriately throughout the home and waste was disposed of in a way that reduced the risk of spread of infection. A number of peoples bedrooms were seen and these were generally homely, with peoples personal possessions used to give them an individual feel. On 3 of the units each bedroom door was painted a different colour and letter boxes and door knockers were fitted. Memory boxes were displayed outside many peoples rooms with photographs and meaningful objects to help people find their rooms. Bathroom and toilet doors were also colour coded to help people orientate themselves to their surroundings. Rummage boxes were placed along the hallways with items that people could pick up and look at, to aid sensory stimulation. Pictures and displays on the walls were made Care Homes for Older People Page 19 of 31 Evidence: from different textiles, again to present different tactile sensations. Other pictures were of well known celebrities that could be used to stimulate discussion and chat amongst people. Staff photographs were displayed on each unit to help people identify the staff that were helping them. Display boards had the details of activities and events that people could get involved with. Photographs of people participating in different events, and art work created by people living at the home were displayed for people to enjoy. Sensory corners were provided on both floors where people could sit and relax in a very peaceful setting. One bathroom on the Beech unit was in need of redecoration as there was some water damage on the ceiling and the wallpaper was peeling. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Minimum staffing levels are provided to promote the health, safety and well being of service users. Recruitment procedures are not applied with sufficient rigour to minimise the risk to service users of inappropriate staff being employed. Evidence: Since the last key inspection, we had been made aware of concerns in connection with the perception of there being low staffing levels and low staff morale. Also the perception that a relatively high use of agency staff was not providing the consistency of carers which can help the quality of life experienced by service users. However, one visitor who we spoke to said they appreciated the continuity of staff on the unit where their relative was. There is no specific ratio that defines the number of staff required for any particular number of service users. Appropriate staffing levels can only be worked out on the basis of the dependency of the service users resident at the time. The current acting manager told us that this is the approach used by her at Treelands, and that she had reduced the usage of agency staff. We were given a copy of the staff rota which we asked for, relating to the week beginning 31st May 2009. Several of the surveys returned to us by staff, specificaly identified low staffing as a problem. In response to the question are there enough staff to meet the individual Care Homes for Older People Page 21 of 31 Evidence: needs of all the people who use the service , none said always, one said usually, one said sometimes, and two said never. However, observation during our unannounced visit, indicated that there were sufficient staff on duty. We specifically discussed the historic and current staffing levels with some, randomly selected, staff. They all told us that staffing had improved in the last month or so and was no longer perceived as problematic. Similarly they felt that staff moral was improving. We were told in the AQAA that 24 of the 47 permanent care workers held NVQ II or above, in care. The NVQ is a nationally recognised qualification which is intended to improve care workers knowledge, skills and competencies. The internal policy of the home (and of the company) is to maintain computerised records of staff training, including induction undertaken and training courses attended, as a complement to paper records. The acting manager told us that these records did not seem to accurately reflect the actual training undertaken by staff. Consequently the acting manager and a company trainer were auditing all the individual staff training files to get accurate information which will be used to inform future training needs. One example was seen where the records indicated that a member of staff had failed a multiple choice questionnaire designed to test their understanding of good moving and handling practice. There was no record of this failure having resulted in any retraining. Staff who we spoke to presented as knowledgeable and understanding of the service users needs. All who were asked, told us that they had access to training opportunities and were encouraged and supported to attend by their managers. All staff who returned a survey to us said that they had been given training which was relevant to their role. We looked at a small selection of files relating to the recruitment and vetting of staff since the last key inspection. While most of the legally required checks were undertaken, there were some areas identified where a more thorough approach was needed. Not all applicants had given a full employment history and there was no record of this having been questioned, nor a record of the explanation of any gaps. It was not always clear why a specific referee had been accepted. For example a senior member Care Homes for Older People Page 22 of 31 Evidence: of staff from a previous care home (who no longer worked there) had been approached for a reference, rather than the homes manager or owner. Another reference was seen where the reason given for leaving was different to that given by the applicant, and in another example, a second written reference could not be located. It was not clear from these records if these anomalies and omissions had been ignored, or satisfactorily investigated but not recorded. Observations of staff and service user interactions were that they were positive, natural and friendly. One visitor said about the staff, absolutely marvellous, they cant do enough Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home have not been consistent in applying policies and procedures for the benefit of the service users. Evidence: At the time of the visit to the home, Treelands had been without an operational registered manager for approximately eight months. During that period two temporary management arrangements had been put in place. The current acting manager and an operations manager, designated to support her, had taken up their posts at Treelands approximately eight weeks before this visit. The period since the last key inspection of Treelands seems to have been a difficult one. Information received from some staff, and some relatives suggested a shortfall from maintaining the previously achieved good standards at the home. More information in connection with these matters can be found elsewhere in this report, particularly in the complaints and protection, and staffing sections. Care Homes for Older People Page 24 of 31 Evidence: Staff who we asked, spoke positively about the current managerial team at the home. The acting manager was able to identify aspects of the running of the home which needed to be improved and had already made some progress in these areas. Due to the short length of time she had been in post, it was not possible for her to demonstrate the consistent implementation of those standards. We were told in the AQAA that as part of the internal quality assurance process, the home undertakes satisfaction surveys and stakeholder surveys. At the time of this visit the latest report showing how the home responded to these surveys, was not available. A small selection of records relating to money held on behalf of service users was looked at. These presented as well maintained, provided an effective audit trail and included receipts for items purchased on behalf of service users. As mentioned elsewhere in this report, there were some aspects of record keeping which needed to be undertaken more thoroughly. Additionally, records available at the home indicated that only 15 staff had received any one to one supervisions and only two appraisals had been completed within the whole staff team. This is significantly below the minimum standard required to support staff and help their professional development and ensuring an appropriate standard of care is being consistently delivered. The acting manager had identified this issue and told us that the unit managers reported doing more supervisions, but the records were not available. We looked at some copies of the reports of the monthly visits to Treelands undertaken on behalf of Southern Cross. These visits are to report on the conduct of the home, are a legal requirement, and must be undertaken by someone who is not directly involved with the conduct of the home. It appeared that for two consecutive months in early 2009 these reports had been compiled by the person who was the acting manager at the time, which was not appropriate. The apparent failure to be rigourus in undertaking these visits, may have contributed to the apparent corporate failure to identify quickly, and address areas of weaknesses, including around recruitment practice, staffing levels and support. We were told in the AQAA that equipment used in the home had been appropriately serviced or tested. We looked at a small sample of records to verify this, including the fire alarm and detection equipment and the servicing of the lift. These presented as being appropriately maintained. All staff who we asked, confirmed that personal protective equipment, such as Care Homes for Older People Page 25 of 31 Evidence: disposable gloves and aprons, was always available. The use of this equipment helps to minimise the risk of cross infection. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 22 All complaints, from whatever source, must be recorded. This record must include the nature of the complaint, the investigation undertaken and the outcome. The company must be able to demonstrate consistently that service users are protected by the thorough investigation of any concerns or complaints. 24/07/2009 2 29 19 All the required vetting procedures must be thoroughly and consistently applied. This includes obtaining a full employment history, obtaining two references from appropriate referees and checking that information given is consistent. A record of the exploration of any gaps or contradictions in the 24/07/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action information provided must be kept. All reasonable steps need to be taken to minimise the risk of exposing vulnerable adults to staff who are not suited to work with them. 3 31 8 The responsible person must 23/10/2009 ensure that an application is made for the registration of a manager . The registration with the Care Quality Commission is intended to ensure that the service is run by a person who is fit to do so and is accountable for the service provided. 4 37 26 The responsible person must 24/07/2009 ensure that the home is regularly visited by someone who is not directly involved in the running of the home and completes a written report of that visit. The company must be kept fully and accurately informed of the conduct of the home in order to take any action which is necessary to improve the service provided. Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 Comprehensive and accurate training records should be maintained for each member of staff. When a shortfall of competency is identified, urgent remedial training should be provided. A report of the findings of the annual quality audit, which includes the views of service users and other interested parties, should be available for service users or their representatives to see. Written records of staff supervision and appraisal should be maintained. 2 33 3 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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