Inspection on 24/11/05 for Treelands Care Home

This inspection was carried out on 24th November 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 20/06/05

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 Care Home Greenhurst Crescent Oldham OL8 2QQ Lead Inspector Sandra Bennett Unannounced Inspection 24th November 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Treelands Care Home Address Greenhurst Crescent Oldham OL8 2QQ 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) 0161 626 7173 0161 628 9793 Southern Cross Healthcare (Kent) Ltd Care Home 80 Category(ies) of Dementia (40), Dementia - over 65 years of age registration, with number (40), Mental disorder, excluding learning of places disability or dementia (20), Mental Disorder, excluding learning disability or dementia - over 65 years of age (20), Old age, not falling within any other category (40), Physical disability (40), Physical disability over 65 years of age (40), Sensory impairment (4) Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The manager must be supernumerary at all times. No Service User to be admitted into the home who is under 55 years of age. 20th June 2005 Date of last inspection 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. 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. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unscheduled inspection took place on the 24th November 2005. Time was spent talking to six members of staff, six service users on an individual basis and seven relatives. Group discussions with service users also took place. The care for six service users were looked at in detail, looking at their experiences in the home from the date of their admission to the present day. Records of care were examined, staff duty rotas, personal files and medication records. Ten service users and ten relative questionnaires were left for completion. Three relative questionnaires had been returned at the time of writing this report; all said they found the food unsatisfactory. They also had concerns over staffing levels and were at times unable to communicate with staff effectively. What the service does well: What has improved since the last inspection? What they could do better: Recording systems in the home are comprehensive, however the failure to complete these fully in relation to the care needs of service users and the lack of detailed staff instruction on care delivery poses a risk to service users and needs to be addressed. There was also a lack of organisation and filing systems. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 6 Medication ordering and administration procedures need to be improved to ensure service users are not put at risk. Food served was undercooked and of poor quality. The home should consult with service users and health professionals regarding the dietary preferences and nutritional value of meals served, keeping the situation under review. Improvements need to be made in staff training, induction and supervision especially in relation to staff on night duty. The number of staff who hold NVQ2 needs to be increased. The control of odours in certain areas of the home need to be addressed. Recruitment procedures need to be more robust in order to provide protection for service users. 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 Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 the following standard(s): 2 and 3. Service users are informed of the home’s services and contractual responsibilities prior to admission. The lack of fully completed dementia care assessments may lead to service users needs not being met. EVIDENCE: Contracts of service users were in place and stipulated their rights and responsibilities. Those service users who were private funded received Southern Cross contracts which covered admission procedures, fees, termination of contract, room to be occupied, meals laundry, care reviews and any additional payments e.g. newspapers. Six case files were examined all had pre-admission assessments, including dementia assessments. Not all dementia assessment had been completed fully. Interviews with families of service users confirmed they had been provided with information on the services available in order to help the service user to make an informed choice. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9. Service users assessments were not reflected in care planning. There was a lack of detailed recording in care planning and medication procedures which may pose a risk to service users. EVIDENCE: All files examined had comprehensive paperwork and format. One file for service users with nursing dementia care needs had waterlow scores, nutritional assessments and manual handling recorded. These assessments require details of the service users weight, which had not been recorded. One service user had been admitted with weight loss, the nutritional assessment made no reference to this. It was noted that a number of care plans had not been signed or dated. Information on assessments was not always clearly identified on risk assessments and care plans. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 10 Wound care plans and pressure relieving mattress checks need to identify the specific mattress settings for service users. One risk assessment referred to the type of bed and rails but did not specify the actual bed and rails used for the service user. One-service users had been moved from one of the residential units to a unit providing nursing care. This change had not been reflected in care plans or assessments. Care plan interventions on the residential unit were very general e.g. enable service user to maintain personal hygiene. No other instructions were recorded for staff to be aware how these actions should be carried out. Another care plan stated that the service user may present with challenging behaviour, however there were no instructions on how this was to be managed. Care plans for social stimulation and activity were not available. Some files did have a social assessment, which included reference to the service users social background. A basic activity record was available on one file. Daily records did not refer to any social aspects of the service users life. There were good detailed recordings of professional visits by audiology, podiatry and community psychiatric nurse intervention. Examination of medication records and procedures found that service users on the top floor had not received medication for two days in the month because the supplying pharmacist had mislaid prescriptions. The manager was unaware of this. Medication was in the medication trolley for one service user that was not on the recording sheet. All the units had hand written additions to recording sheets, which had not been signed or dated, one had been written up without dosage details. Receipt of medication records for syrups and medication brought into the home had not been recorded. There were systems in place for returning medication, however in one medication room there were an unacceptable amount of medication waiting to be collected. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 the following standard(s): 12 and15. Service users have access to outside interest however their interest and hobbies are not reflected in care planning and daily reports. The food served was of poor quality and undercooked, service users are not consulted on the quality and quantity of meals served. EVIDENCE: An activities co-ordinator is employed 35hrs a week to increase stimulation for service users. This work is spread over three units with service users who have various levels of abilities. Some service users said that they did not like to go out or be in groups. Social care plans of service users should be fully completed to reflect their interests and hobbies and the level they wish to participate in activities. This will enable service users who are unable to or do not wish to join in-group activities to access the activities co-ordinators services at a specified time on an individual level. Although a record is maintained of activities that take place there is no indication who had participated in the activity, neither was it reflected in care plans and daily reports. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 12 At interview one service user said, “I really enjoyed a recent trip to Blackpool” another said “I go out in the community to a computer club but transport is sometimes difficult”. This inspection took place over the lunch and teatime period. During interviews with service users and their families they raised concern over the quality of food served, one said the quantity was also insufficient as on occasion they had asked for more food for their relative and been told there was none left. One service users said custard was always lumpy and not very tasty. Another gave examples of food being served they were unable to eat e.g. jacket potatoes, beef burgers and chicken nuggets. The inspector sampled the food, which was found to be of poor quality, and undercooked and not eaten by many service users. The potatoes were hard, the braised steak was too tough for service users to cut up, cauliflower was dark in colour and the soup had little taste and very watery. Discussions took place with the manager who said a new cook had only been in post ten weeks and discussion had taken place over the quality. Instant mash was prepared to replace the uncooked potatoes, which was still unsatisfactory and tasteless. Consultation should take place with service users on their preferences of food and health professionals on the nutritional value of the food. The dining rooms are attractively set and enable conversations between service users to take place. On visiting the mental health unit it was found to have two large waste bins which were full, and situated in close proximity to the dining tables, this is neither in line with health and safety nor congenial to people dining in this area. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 the following standard(s): 16. 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. The management team at the home are presently investigating one complaint relating to poor care practices, medication issues and low staffing levels. The results of the investigation will be forwarded to the complainant and the CSCI. Service users and their families said they felt able to raise any concerns with staff. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 the following standard(s): 20, 22, 23, 24 and 26. The home is well maintained and provides a safe well-equipped environment to promote independence for service users. 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. The home is equipped with specialist aids and adaptations to promote service users independence. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 15 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 and three bedrooms. Several service users had personalised their rooms providing a homely environment. A number of service users spend most of their day within their rooms, which they had equipped with TV and video recorders. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staffing levels in the home pose a risk to service users. Staff recruitment, training, induction and supervision were not sufficient to provide protection for service users. Recording keeping and administration needs to be improved. The number of staff who holds NVQs needs to be increased EVIDENCE: Service users and their relatives said that staffing levels had been improved throughout the day allowing a greater degree of observation for service users. The homes night shift begins at 8pm at which time staffing levels are greatly reduced. Many service users choose not to go to bed at this time. At 10.30pm eleven service users on the mental health unit out of a possible nineteen were up, four of the service users presented with challenging behaviour with eleven of the nineteen requiring two staff to help them to go to bed. Only one RGN and one carer was on duty. Their duties also include cleaning the lounge and chairs when not attending to service users. The lack of time to complete these chores is a contributing factor to odours on the unit. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 17 Examination of the home’s duty rota found this did not always reflect the actual staff working on shift. Staff timesheets had to be checked in order to verify staff on duty over the period of time covered by the rota’s examined. NVQ training is ongoing, however this still remains short of the 50 of staff required. There was evidence that staff received in depth training in the care needs of service users with dementia, together with support and supervision from a specialist physician. A record is maintained of staff supervision, which only reflected day staff. The supervision process must be extended to night staff. At interview staff confirmed that regular staff meetings take place in which they have an opportunity to air their views and opinions. The home’s staff induction process was not sufficient to provided new care staff with the skills to carry out their duties. Moving and handling training had not been provided with staff having to wait several weeks on occasion. The manger reported that a member of staff had undertaken training as a facilitator to prevent future delays. Unfortunately the staff member had not had sufficient time to put this training into practice. Examination of recruitment procedures found that dates on Criminal Record Bureau Checks did not always correspond with the commencement of employment. One reference did not match that given on the application form. There was no evidence of gaps in employment or that poor references having been explored. The order in which the homes maintain files and systems was not streamlined and information was difficult to find. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 37. Recording and administrative systems need to be improved. Staff recruitment, induction, training and supervision were not robust enough to provide protection for service users. The introduction of a key worker system and regular staff meetings will promote accountability in the home. EVIDENCE: The home has been without a permanent manger since they opened in June 2004. The acting manger has been in post for approximately three months and has submitted an application for processing to become registered with the CSCI. There was evidence that staff and relative meetings were ongoing. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 19 A key-worker system has been implemented to help promote accountability in the delivery of care in the home. Recording systems, staff recruitment, induction, training and supervision of both care and ancillary staff need to be addressed to provided effective management and adequate delivery of care for service users. Records that are required by statue need to be improved especially in relation to standards 7,8,9,12,27, has mentioned previously in this report. The procedure file could not be found in order to be used as a reference tool for staff, management or inspection. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X 3 X 3 3 3 X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 2 x Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 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 OP3 Regulation 14(1) Requirement The registered person must ensure that mental health assessments are completed in full prior to admission of the service user. The registered person must ensure that service users assessments are reflected in care planning and give clear instructions to staff. Care plans must be signed and dated. Service users social care plans must be completed fully. The registered person must ensure that the social and recreational needs of each services users is detailed on their plan of care The registered person must ensure that medication is administered to service users as prescribed by their GP and that any changes to medication administration records are signed and dated. The registered person must ensure that medication brought into the home by service users is recorded and that all medication DS0000042440.V263628.R01.S.doc Timescale for action 31/12/05 2. OP7OP12O P37 15(1) 31/12/05 3 OP7 15(1) 31/12/05 4 OP37OP9 13(2) 17(1) 31/12/05 5 OP9 OP37 13(2) 24(1) 31/12/05 Treelands Care Home Version 5.0 Page 22 6. OP37OP8 12(1) 14(1) 7 OP8 12(1) 8 OP15OP33 16 (2) 24 (1) 9 OP8 12(1) 10. 11. OP26 OP27OP37 16(2k) 13(3) 18(1) 12 OP27OP37 17(2) 18(1) 18(1) 13. OP28OP30 14. OP29OP37 19 schedule 2 not in use by service users is returned to the chemist. The registered person must ensure that nutritional screening for service users is undertaken where a service user is identified as being nutritionally at risk on their assessment of need. The registered person must ensure that details of any aids needed by service users are recorded on the individual service users plan of care. The registered person must ensure that consultation takes place with service users on their choice of food, which must be cooked to their liking and provided in sufficient quantity. The registered person must ensure that consultation take places with the appropriate professionals on the nutritional needs of service users. 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 and demonstrate they meet the assessed needs of the service users. The registered person must ensure that the duty rota details the names of staff working on each unit and in what capacity. The registered person must ensure that staff training and induction is in line with Skills for Care training and that the number of staff who hold NVQ2 is increased to 50 . The registered person must ensure that Criminal Record Bureau checks and or POVA First checks are obtained before staff commence employment at the DS0000042440.V263628.R01.S.doc 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/05/06 31/12/05 Treelands Care Home Version 5.0 Page 23 15. OP37OP29 19 Schedule 2 16. OP36 18(2) home. The registered person must ensure that the reasons for the receipt of poor references and gaps in employment history are explored and the outcome of these investigations recorded on the recruitment files. The registered person must ensure all night staff received regular supervision. Timescale of 30/9/05 not met. 31/01/06 31/01/06 Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 24 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 OP12 Good Practice Recommendations The registered person should ensure that an activity record is maintained in order to identify those service users who participated. Treelands Care Home DS0000042440.V263628.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs 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. 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