Inspection on 20/06/05 for Treelands Care Home

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Treelands Care Home 12/06/09

Treelands Care Home 04/06/08

Treelands Care Home 26/06/07

Treelands Care Home 26/04/06

Treelands Care Home 24/11/05

Treelands Care Home 28/09/04

Treelands Care Home 11/05/04

Treelands Care Home 16/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

SignHealth

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

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

CARE HOMES FOR OLDER PEOPLE Treelands Greenhurst Crescent Oldham OL8 2QQ Lead Inspector Sandra Bennett Announced 20 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Treelands Address Greenhurst Crescent, Oldham, OL8 2QQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161-626-7173 0161-628-9793 Southern Cross Healthcare (Kent) Ltd CRH Care Home 80 Category(ies) of DE Dementia (40) registration, with number DE(E) Dementia - over 65 (40) of places MD Mental Disorder (20) MD(E) Mental Disorder - over 65 (20) OP Old Age (40) PD Physical Disability (40) PD(E) Physical Disability - over 65 (40) SI Sensory Impairment (4) Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The manager must be supernumerary at all times. No service user to be admitted into the home who is under 55 years of age. Date of last inspection 28th September 2004 Brief Description of the Service: 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. It 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. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This scheduled inspection took place on 20th June 2005. Time was spent talking to eight service users, two relatives and four staff. The care for four service users were looked at in detail, looking at their experience in the home from the time of their admission to the present day. Records of care were examined, staff duty rotas, personnel files, financial records and medication records. A total of 38 questionnaires had been sent to GP, Health Professionals, service users and their relatives. At the time of writing this report four GP questionnaires were returned; three stated they had seen some improvements in the management of the home. One reported they were dissatisfied with the overall care provided to service users. Questionnaires from four health and social service professionals were also returned, one commented on the impact management changes had on the home but did feel the home was working hard to correct issues. Another reported that staff made time to communicate with them, one other did not feel that staff had a clear understanding of service users needs. They also felt that appropriate decisions weren’t made when the home could no longer meet the needs of service users. Comments from relative’s questionnaires were that staffing levels needed to be increased and the agency staff reduced. Only one service user questionnaire was returned which reported general satisfaction with the care but would like more activities. At the end of this inspection the provider was given immediate feedback on issues raised in this report. What the service does well: At the time of the inspection service users were well presented, bright and interactive with staff and other service users. Food served was of ample portions, nutritious and presented well. Choices were available for those service users not wishing to have the dish of the day. Assessments of service users needs are undertaken by the home or obtained from health professionals prior to their admission. Interviews with service users and their relatives confirmed that information was given to them regarding facilities and services in the home. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5 The home was aware of service users needs prior to their admission. Service users were informed of their rights and responsibilities within the home and encouraged to visit prior to their admission. EVIDENCE: The service user guide provides information on facilities and services in the home. Service users confirmed they were encouraged to make trail visits in order to assess if the home could meet their needs. One relative stated they had looked at six other homes before making a decision to place their relative at Treelands. After a six-week period a review was held in order to assess the suitability of the placement and their general satisfaction. Contracts of residency were in place and stipulated the rights and responsibilities of both parties. Assessments of service users are obtained from professional agencies or a person qualified to undertake assessments within the home. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Social care plans and wound care assessments required more detail to ensure service users needs are consistently met. Service users are treated with respect and their personal care and privacy needs are met. EVIDENCE: The files of four service users were examined. Improvements had been made to care planning. All the files examined had in place a nursing assessment completed by the home. On the mental health unit, assessments also included those from mental health professionals and the referring agency. Care plans were detailed and comprehensive and included corresponding risk assessments. Care plan interventions were detailed and evaluated. Records were maintained of mental health care visits made to service users. Wound care assessments were limited and did not detail the size and depth of the wound. Social care plans were not always completed. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 10 There was no recorded consultation with families regarding the use of cot sides for individual service users. Aids and adaptations were assessed on an individual level alongside communal facilities to promote independence for service users. Six service users were interviewed regarding their care and treatment, all reported that staff were considerate in dealing with their personal care. Service users and their representatives reported that there had been problems with the laundry and the return of clothing to appropriate service users. However they now felt that these issues have been addressed. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 The social needs of service users are met. Meal times were well managed with a choice of food. Service users have control over their lives. EVIDENCE: An activities co-ordinator is employed 35hrs a week to increase the stimulation for service users. Social care plans of service users should be fully completed to reflect their interests, hobbies and the level they wish to participate in activities. A Treelands Tatler newsletter is published on a regular basis and includes a staff members profile and potted history, celebrations of the month, forthcoming events and a poet’s corner to which all service users are encouraged to contribute. On the day of inspection several service users had chosen to get up and take breakfast later in the day, having a light lunch with the main meal of the day being in the evening. At interview service users stated they felt routines of daily living were flexible. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 12 Service users have a choice of meals, which are served in pleasant surroundings in small dining areas to promote interaction between service users. One service user said on admission she did not like the lay out of the room or the curtains and was pleased that the staff team took the time to ensure the room was to her liking. Two families were interviewed and reported that they were able to visit the home at any reasonable time. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 Service users had their legal rights protected and safe guards were in place to ensure their protection from abuse. Service users were confident that their complaints about the home would be addressed. EVIDENCE: The homes complaint procedure stipulates timescales for action. At interview service users were aware of whom they should complain to. A record is kept of complaints made to the home the outcome and any action taken to rectify issues. There have been a total of 23 complaints made about the home in the previous twelve months. Three of these were investigated by the CSCI in relation to care practices and were found to be substantiated. Adult protection and whistle blowing policies were in place. Staff at interview demonstrated an awareness of these procedures and their responsibility in reporting any such event. Training had been provided in the protection of vulnerable adults. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19/25/26. All areas of the home are well maintained. Improvements have been made to the environment for those service users with dementia. The control of odours on the dementia care unit needs to be improved EVIDENCE: Treelands provides a good standard of single ensuite accommodation for service users. There have been improvements to the environment for those service users who suffer from dementia. Garden areas have been provided with additional seating and flower tubs provided at an height service users can access in order to help with gardening. Information boards are in place inside the building alongside photos relative to the service user age group. The home is in general clean and tidy and without odours. The exception being the downstairs mental health unit day room were an odour was present. The front door bell, intercom and nurse call system are all interconnected which results in the call system sounding frequently. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 15 During some periods of the day this noise was consistent, which was distressing for service users who have no alternative other than be subject to the noise. This situation may lead to nurse call systems not being answered immediately. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27/28/29/30 Staffing levels in the home should be increased. Staff recruitment, induction and training were robust and provided protection for service users. The number of staff who hold NVQs needs to be increased. EVIDENCE: Minimum levels of staff are provided at busy parts of the day for instance, the homes night shift begins at 8pm at which time many service users are not in bed. At the time of the inspection fifteen service users on the mental health unit out of a possible nineteen were up, three of the service users presented with challenging behaviour where only one RGN and one carer for those service users were on duty. Further care was provided on a one to one basis for service user. The home has a method for assessing dependency levels of service users; unfortunately this is not linked to the provision of staff hours. NVQ training is ongoing, however this still remains short of the 50 of staff required. There was evidence that additional training is provided to meet service users needs. A record is maintained of staff participation in training events and the supervision they receive. The supervision process must be extended to include night staff. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 17 Staff recruitment procedures and induction were robust and provided protection for service users. At interview staff confirmed that regular staff meetings take place in which they have an opportunity to air their views and opinions. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37 and 38. Improvements have been made in management structures, communication, task allocation and staff supervision and training. Further developments are needed to the recording systems and provision of supervision for night staff. The lack of a permanent manger compromises the continuity of care in the home and may put service users at risk. The health and safety of service users and staff is safeguarded by the home’s policies and procedures. Service users finances were dealt with appropriately. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 19 EVIDENCE: The home has been without a permanent manger since they opened in June 2004. A number of people have been recruited into the post but have not completed the registration process. This has had a negative affect on the service and resulted in a high turnover of staff and has caused the management systems in the home to be inconsistent. Which is apparent through the number of complaints received by the home and the CSCI. A senior member of the company who is RGN and has a number of years experience in management has been acting manager for approximately six months. Since the last inspection of the home a number of positive changes have been made in recording systems, staff supervision and training. Regular staff, service users and relatives meetings have increased communication. Interviews with night staff indicated that they did not always receive any formal supervision. Quality assurance questionnaires had been sent out and were available for inspection; unfortunately these had not been dated making evaluation difficult. A key worker system for staff has been implemented to help promote better accountability for the deliver of care in the home. An application to register a manger must be forwarded to the CSCI together with a system, which will ensure a smooth transition from the acting manager to the registered manger in order to ensure continuity of management systems in the home. Monies held on behalf of service users correlated with recorded accounts. Receipts were in place for any expenditure. The records that are required by statute had improved, although some further work is required as noted previously in standards 7and 8. Regular checks are made on the environment and equipment in respect of health and safety. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 1 3 2 3 3 2 2 3 Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 7/12/37 Regulation 15(1) Requirement The registered person must discuss with relative and service users when bed rails are used. Social care plans must be completed fully. The registered person must ensure that wound care asesments reflect the size and depth of the wound and this is recorded in care planning. The registered person must ensure that all areas of the home are free from odours. The registered person must undertake a review of staffing levels on the mental health unit to ensure the meet in line with the assessed needs of the service users. A system must be developed to ensure staffing levels are linked to the needs of service users. The registered person must ensure that the number of staff who hold NVQ is increased to 50 . The registered person must submit an application to register the manager. Previous timescale of 31/10/04 Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 22 Timescale for action 30/9/05 2. 8/37 15(1) immediate 3. 4. 26 27 16(2k) 13(3) 18(1) Immediate Immediate. 5. 30 18(1) 31/9/05 6. 31 8/9 30/9/05 not met. 7. 36 18(2) The registered person must ensure all night staff received regular supervision. 30/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 33 25 Good Practice Recommendations The registered person should ensure that service user questionaires are dated in order to enable effective evaluation. The registerd person should review the noise level from the interconecting intercome system in order to ensure the comfort of service users. Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne, OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Treelands F54 F04 treelands A s42440 v224836 200605 stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!