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Inspection on 26/04/06 for Treelands Care Home

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

This inspection was carried out on 26th April 2006.

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

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

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

The home environment is fairly new and this provides a modern comfortable environment for residents. The home was clean, tidy and free from odours. Residents and visitors were complimentary about the staff and about the service the home provides. One resident said the, "staff team are okay, respectful and ensure my dignity is maintained". A visitor said, "I`m satisfied with the service, it`s unfortunate my wife needs care". Care was delivered in an appropriate respectful manner and staff interactions with residents were good. Resident`s personal monies are maintained safely by the home. General maintenance records for the home were available and these were comprehensive.

What has improved since the last inspection?

The manager has worked hard to improve the service provided at Treelands. The staff team were positive about working in the home. Pre-admission mental health assessments were now recorded and care plans were generally comprehensive. Nutritional assessments were recorded and there was evidence that professional support was sought as required. The meal service had improved. The manager monitored and sampled meals regularly and the feedback she had received was that residents were more satisfied with the quality of the food provided. Criminal record checks were obtained before the employment of new staff in the home. Staffing levels were being monitored and increased in line with the home`s increasing occupancy. Rotas identified the designation and the shift worked by the staff member. Staff did receive planned one-to-one supervision. The home responded appropriately when there had been allegations of abuse and staff demonstrated a good awareness of the different types of abuse. The home had allocated one member of staff some dedicated training hours so that regular training was being offered in the home.

What the care home could do better:

One area of further development in the home is the assessment and care planning of resident`s social care needs. The home does provide an activities co-ordinator but the home now has four units, which are operational. This means each unit has limited input from the activity co-ordinator and this should be reviewed. It is acknowledged that the quality and content of the care planning documentation had improved since the last inspection however further improvement and development is required. Observations of the quality of the care delivered were not always clearly reflected in the resident`s care plan. Some care interventions were generalised and did not detail the individual care needs and preferences of the resident. NVQ 2 training was not established and the ratio of staff with NVQ was low. The manager had arranged for a training group to visit the home in early May to register some care staff for the NVQ. The system of allocating staff to attend training needs to be reviewed and training should be extended to include all ancillary staff. Employment records should be recorded in more detail to include explanations of decisions made Night staff commenced duty at 8 pm and the staffing numbers in the home reduce. Staffing levels between 8 pm and 10 pm should be reviewed to ensure residents do not receive a diminished service.The food menus should include the dessert or pudding offered after lunch and tea and should reflect nutritional recommendations by offering five portions of fruit and vegetables.

CARE HOMES FOR OLDER PEOPLE Treelands Care Home Greenhurst Crescent Oldham OL8 2QQ Lead Inspector Tracey Rasmussen Unannounced Inspection 26th April 2006 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.V290206.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 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 Mrs Pauline Smithstone 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.V290206.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 24th November 2005 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.V290206.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process for Treelands Care Home commenced in April 2006. This inspection included a review of all available information acquired by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection and included a nine-hour plus site visit to the home on the 26th April 2006 by two inspectors. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, interviewing relatives; talking with residents; interviewing the manager and a range of staff. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. Almost two thirds of the requirements made at the last inspection had been addressed and it was noted that significant improvements had been made in many areas of the service provided. It is anticipated that this level of improvement is sustained. A brief explanation of the inspection process was provided to the manager at the beginning of the visit and time was spent with the manager at the end of the visit to provide verbal feedback of the findings from the inspection site visit What the service does well: What has improved since the last inspection? The manager has worked hard to improve the service provided at Treelands. The staff team were positive about working in the home. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 6 Pre-admission mental health assessments were now recorded and care plans were generally comprehensive. Nutritional assessments were recorded and there was evidence that professional support was sought as required. The meal service had improved. The manager monitored and sampled meals regularly and the feedback she had received was that residents were more satisfied with the quality of the food provided. Criminal record checks were obtained before the employment of new staff in the home. Staffing levels were being monitored and increased in line with the home’s increasing occupancy. Rotas identified the designation and the shift worked by the staff member. Staff did receive planned one-to-one supervision. The home responded appropriately when there had been allegations of abuse and staff demonstrated a good awareness of the different types of abuse. The home had allocated one member of staff some dedicated training hours so that regular training was being offered in the home. What they could do better: One area of further development in the home is the assessment and care planning of resident’s social care needs. The home does provide an activities co-ordinator but the home now has four units, which are operational. This means each unit has limited input from the activity co-ordinator and this should be reviewed. It is acknowledged that the quality and content of the care planning documentation had improved since the last inspection however further improvement and development is required. Observations of the quality of the care delivered were not always clearly reflected in the resident’s care plan. Some care interventions were generalised and did not detail the individual care needs and preferences of the resident. NVQ 2 training was not established and the ratio of staff with NVQ was low. The manager had arranged for a training group to visit the home in early May to register some care staff for the NVQ. The system of allocating staff to attend training needs to be reviewed and training should be extended to include all ancillary staff. Employment records should be recorded in more detail to include explanations of decisions made Night staff commenced duty at 8 pm and the staffing numbers in the home reduce. Staffing levels between 8 pm and 10 pm should be reviewed to ensure residents do not receive a diminished service. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 7 The food menus should include the dessert or pudding offered after lunch and tea and should reflect nutritional recommendations by offering five portions of fruit and vegetables. 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.V290206.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. The home can confirm it is able to meet resident’s needs on admission to the home. This judgment has been made using available evidence including a visit to the service EVIDENCE: Care files examined on all 4 units contained pre-admission assessment information, which was comprehensive and included assessments of skin integrity, nutritional status and moving and handling requirements. Mental health assessments and community care assessments were also available on the care files examined. Care plans had been recorded for each assessed need. One resident said his brother visited the home before his admission and told him the home was suitable for him. He said he didn’t remember seeing any information about the home. The manager stated that she undertook the pre- Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 10 admission assessment of the resident and sat with the resident informing him about the services provided at Treelands. A copy of Statement of Purpose and Service User Guide were available at entrance to the home. These were not reviewed. The home does not provide an Intermediate Care Service (Standard 6) Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 11 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): 7,8,9, and 10 Quality in this outcome area is adequate. Residents are treated with respect and dignity. The care planning documentation was not sufficiently detailed enough to meet the personal and health care needs of residents. Medication practices were safe. This judgment has been made using available evidence including a visit to the service EVIDENCE: Residents observed in all parts of the home were generally neatly presented and attention had been paid to personal grooming. A number of ladies did have bare legs early in the morning. The hairdresser was in the home and resident’s hairs were very smart. Observations of practices in all areas of the home indicated that staff had developed good personal interactions with residents; staff were respectful, pleasant and polite to residents. One resident spoken to on the general nursing unit said that, “staff were polite and respectful”. Staff at interview appeared to have good awareness and understanding of resident’s needs. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 12 Visitors spoken to were satisfied with the care. One relative said he and his loved one was “happy with care but would prefer to be home” and, “I visit every day and stay for lunch with her” Care planning documentation was seen on all four units in the home. Southern Cross have introduced a comprehensive care planning package which contains a lot of documentation to cover all aspects of care a resident may need. The consequence of this is that there are many records and forms to be filled in by nursing and care staff. It was noted on all four units some record sheets were not filled in. Discussion with the manager and operations manager identified that the home was trying to ensure staff removed the forms and charts from the care planning documentation if the resident did not require it. For example if a resident did not have a wound then the wound care documentation was not relevant to the resident’s care plan and so should be removed. Since the last inspection the quality and content of the assessments and care plans had improved. It was reported that all new admissions had been assessed by the manager prior to admission to the home and a baseline care plan recorded. Care assessments and documentation were available on each of the care files seen and for the most part this was comprehensive. Eight care files were reviewed at this visit. One resident’s care file seen had not been updated sufficiently to reflect changing care needs. This resident had had to move to the general nursing unit. This information was only clear in the daily written record recorded earlier in the month. A reassessment of needs had not been undertaken on the nursing unit and some of the resident’s original care plans had had additional information recorded but evaluation of the validity or quality of the content of care plan had not been undertaken. As a result the quality of the information was not as comprehensive as should be. The resident was sleeping during this visit, but she appeared clean and comfortable and there were no concerns identified about the quality of the care delivered to her. Discussion with nursing and care staff on the ground floor units did identify that staff were providing individualised care to the residents but the level of support provided was not always reflected in the care plans. Some care plan interventions were not as detailed or person specific as they could be. One plan recorded ‘give mouth care’; there was no reference to when and how this should occur or the resident’s personal preferences. One care plan recorded to prevent dehydration was very detailed and evaluated the care required to deliver subcutaneous fluids. This however had not been updated to reflect a period of time when the infusion had been stopped and then restarted a couple of days later. Records of oral fluid and Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 13 dietary intake were maintained in the resident’s bedroom and the resident’s medication administration sheet recorded broadly when a new infusion commenced. A specific record detailing the exact time the infusion commenced was not available. This was discussed with the nurse on duty. The social aspects of the service provided to each resident was not recorded. The home’s Physical and Social assessment was recorded and this contained general information about the resident. A separate social assessment record was not recorded on the care files seen nor were care plans for the social care needs of each resident. Records were available of the community health and medical services used by the home for each resident. Medication procedures and practices had improved since the last inspection. The home was still encountering problems with the supplying pharmacy in that the medication was not being delivered in a timely manner. The manager had formally complained to the pharmacy and a meeting was arranged to discuss this. A range of records were checked and these were recorded appropriately. Correct procedures for controlled drugs and the receipt and return of medication were being implemented. The medication treatment rooms were clean and reasonable tidy. The manager stated that weekly audits of medications were undertaken to ensure policy and procedure was being implemented correctly. Records were available of these audits and were viewed briefly. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 14 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): 12,13,14, and 15 Quality in this outcome area is adequate. Social activities are provided in the home however this needs to be developed further so all residents benefit from stimulation. Resident’s family and friends are welcome in the home at any time. The quality of food provided has improved so residents receive a varied nutritious menu of meals. This judgment has been made using available evidence including a visit to the service EVIDENCE: The home employs an activity co-ordinator to provide stimulation and social support for all residents on all four units. Given the size of the home and the diverse and specialist nature of resident’s living in the home one activity coordinator was insufficient to provide support to every one. It was noted in the afternoon on Beech unit that there was no activities being undertaken other than the arrival of visitors. Staff did spend time with residents to promote safety for example observing to prevent falls and to provide reassurance. The nurse said the activity person did come on the unit sometimes. One resident on Oak unit, who needed to be cared for in bed due to health care needs, said he was left for most of the day without social Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 15 interaction. He said ‘Staff do come in and sit and talk sometimes’; ‘I do get fed up’. This resident’s care plan had no reference to his isolation or a care plan for social care needs. Upstairs there was a lot more activity going on. On the Sycamore unit carpet skittles was played which was followed by bingo. The residents appeared to enjoy the activities. The staff team supported the activity co-ordinator and there was relaxed interactions and gentle banter between staff and residents. Visitor spoken to said they could visit as often as they wished. The manager had been trying to develop and promote links with the local community and the home had recently sponsored a local school’s drawing contest that was judged by residents and prizes were given to children. The quality of meals provided in the home had improved since the last inspection and the manager did state she sampled meals regularly and kept a record of her observations. The manager stated that feedback from residents and relatives about the meal service had been much more positive recently. Both the lunchtime and the evening meal were sampled at this visit and both were tasty and nutritious. A cooked breakfast is offered everyday; lunch at this visit was lentil soup, sandwiches and or fishcakes, chips and baked beans and a dessert of cheesecake. The main meal of the day is provided in the evening. One resident said he was “Overall happy and satisfied” in the home and he also said about the food, “Good food, can’t please every one but I like the beef and the hotpot and roast potatoes.” Mealtime support provided to residents was discrete and appropriate. Interventions and support were provided in a relaxed environment. The kitchen was clean and tidy. The cook was reported to be absent and the assistant cook had prepared the meals. The assistant cook was able to discuss the different types of diets the home offered for example diabetic diet. An NVQ assessor was assessing the cook in Food and Professional Cooking during this visit. The assistant cook stated that he did discuss menus with residents and monitored what meals had been successful in the home. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 16 The home offers a four-week rolling menu, which includes choices. The menus do not detail the dessert menu. Observation of the menus indicates that the five-a-day fruit and vegetable recommendation was not provided regularly. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 17 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 and 18 Quality in this outcome area is adequate. Residents are protected from abuse and can be confident that complaints will be treated seriously. This judgment has been made using available evidence including a visit to the service EVIDENCE: A copy of the complaints procedure was available in the home and the manager has been proactive in following the procedure when a complaint is received. The number of complaints made in the home has reduced in recent months. A range of staff spoken too had had training in the protection of vulnerable adults and could detail what abuse was and what they would do if they suspected abuse. The home has had a number of protection of vulnerable adult investigations in recent months for alleged abuse which when investigated by social services did not identify abusive practices but did identify areas of development for the home. The home has improved their care and nursing practices in line with the identified outcomes of these investigations and practices continue to improve. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 18 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): Quality in this outcome area is good. The home is well maintained and provides a safe well-equipped environment to promote the independence for service users. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The home is a purpose built care home that has been open for less than five years. Treelands provides a good standard of single en-suite accommodation for residents with dedicated communal lounges, dining and bathing facilities. On the dementia care units, reference has been taken to therapeutic interventions and models of care for dementia by painting doors in bright colours and providing tactile collages on the walls for stimulation and aide memoirs. Outdoors the home has enclosed garden areas with raised flowerbeds and patio furniture. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 19 The home is equipped with specialist aids and adaptations to promote residents independence. The home was clean and tidy and no odours were noted. Domestic staff were working diligently in the home. Two laundry staff were working. They were organised and the compact laundry room was clean and tidy. Routine maintenance records of all monitoring and checks undertaken were available. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 20 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 Quality in this outcome area is adequate. Staffing levels are sufficient to meet resident’s needs. Not all staff are fully trained so resident’s care needs may not be always met in a timely manner. Employment vetting procedures could be improved to ensure the safety of residents. This judgment has been made using available evidence including a visit to the service EVIDENCE: In line with the increasing occupancy of the home staffing levels had also increased. Copies of the home’s rotas indicated that nurse and care staffing levels were sufficient to meet resident’s needs. Night time staffing levels start at 8 pm and the number of staff in the home reduces to two per unit. This could potentially result in a loss of choice and quality of service for residents who have no wish to go to bed early. Discussion with manager and the operations manager stated that they did monitor the service provided for example by looking at the number of night time accidents. The operations manager stated that there was no evidence that service is compromised in the later evening. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 21 The home had designated one member of staff to provide training to staff on Mondays. A training schedule offering a range of training including dementia care and abuse was available on notice boards throughout the home. The majority of staff said the provision of training had improved and they were pleased with this. However, three staff said that they could not always attend training because they had to find their own staff cover on the unit. Nurses spoken too confirmed that they were also on occasion unable to attend training, as the unit would be left without a nurse. The manager said that this was not the case and if this did occur it occurred only rarely. One staff member detailed the induction training she had received and said her induction folder was at home. Staff files seen did have training certificates available. The manager undertakes staff supervision including night staff. Records were available. The laundry staff spoken too had not had statutory health and safety training since the commencement of employment in the home. The manager was trying to improve the provision of NVQ training in the home. At this visit only six care staff out of a total of forty had obtained a NVQ 2. The manager did say a new NVQ training company was due to visit the home at the beginning of May. A sample of employment files were reviewed and these did contain the required documentation including references and CRB disclosures, however the application forms used only requested the previous 5 year employment history not the required full working life work history. The operations manager stated that new application forms were about to be introduced which did request this information. References were available on the files seen but two files used different referees than originally provided, clear explanations to justify why alternative references had the decision making progress were not recorded. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 22 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, 35 and 38 Quality in this outcome area is adequate. The management of the home promotes the health, safety and wellbeing of the residents. Residents do have a say in how the home is run so they are provided with opportunities to contribute to the daily routines of the home. Resident’s personal money is safe. This judgment has been made using available evidence including a visit to the service EVIDENCE: The manager detailed her training and education background, which included a registered nurse qualification, a dementia care certificate, a NVQ management certificate, a teaching certificate and a NVQ assessor certificate. The manager could also detail the more recent training she had been on to ensure her nurse clinical skills were maintained up to date. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 23 Evidence from this inspection has identified significant improvements in many areas of the service delivery and the manager stated she had worked very hard to improve the service in the home. The manager has open surgery every Wednesday evening so residents and relatives can see her. Regular relatives meeting are undertaken and a detailed newsletter is published and provided in the home. Staff meeting are also undertaken. A range of audits are undertaken in the home and it was reported that the company was in the process of changing its quality assurance procedures to achieve a British quality standard award. Copies of the audits were available in the home. The home’s administrative support assistant maintains detailed records of all monies held on behalf of residents. Records were available and a clear audit trail was evident. The home is in the process of opening a dedicated bank account for resident’s monies. The home employs a maintenance worker who undertakes routine repairs and monitors equipment to promote the health and safety of residents and staff. Records of maintenance including fire safety were available and these were comprehensive. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 3 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 25 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 OP7 Regulation Requirement Timescale for action 30/06/06 2. OP7 3 OP8 4. OP12 5. OP28 12, 14, 15 The registered person must ensure that re-assessments of resident’s care needs are undertaken and comprehensive care plans recorded to meet these changing needs. 15(1) The registered person must ensure that resident’s assessments are reflected in care planning and give clear instructions to staff. Resident’s social care plans must be completed fully. (Timescale of the 31/12/05 not met). 12,14, 15 The registered person must ensure an accurate fluid balance record is maintained for any infusion undertaken in the home. 12, 14, 15 The registered person must ensure that the social and recreational needs of each resident are detailed on their plan of care. (Timescale of the 31/12/05 not met). 18 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 DS0000042440.V290206.R01.S.doc 30/06/06 30/06/06 30/06/06 31/10/06 Treelands Care Home Version 5.1 Page 26 6. OP29 19 7. OP30 18 is increased to 50 . The registered person must ensure a full employment history is obtained and an audit trail to justify decisions in relation to obtaining references is maintained. The registered person should ensure that all staff including ancillary staff are allocated training and are not prevented from doing so by insufficient staff cover. 30/06/06 30/06/06 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 3 4 Refer to Standard OP7 OP12 OP15 OP27 Good Practice Recommendations The registered person should ensure that care-planning documentation is relevant to the resident’s individual care needs. The registered person should ensure employ additional staff to provide activities and social stimulation The registered person should ensure that the home’s menus follow nutritional guidelines and detail comprehensively all dishes on offer at each mealtime. The registered person should increase the number of care staff working in the home between 8pm and 10pm to ensure service quality is maintained. Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 27 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. Extracts may not be used or reproduced without the express permission of CSCI Treelands Care Home DS0000042440.V290206.R01.S.doc Version 5.1 Page 28 - 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. 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