Inspection on 12/02/07 for Trees

This inspection was carried out on 12th February 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Trees 16/03/09

Trees 23/01/06

Trees 12/08/05

Trees 02/12/04

Trees 22/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Trees 20 Old Derby Road Ashbourne Derbyshire DE6 1BN Lead Inspector Andrew Bailey Unannounced Inspection 12th February 2007 10:00 Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trees Address 20 Old Derby Road Ashbourne Derbyshire DE6 1BN (01335) 300767 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) Homelife Limited Clive John Marshall Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Trees is a small home providing accommodation and personal care for three people with a learning disability. The accommodation is a domestic style dormer bungalow, which has large well-maintained gardens. The bungalow is located in a residential area of Ashbourne, close to the centre of the town. Residents’ accommodation is located on the ground floor, with the staff sleep-in accommodation on the first floor. Each resident has their own private bedroom. There is a bathroom with toilet close to residents’ bedrooms, and a separate toilet in the utility room. There is spacious lounge area, and kitchen/dining room. The latest inspection report is available at the home. The current range of fees is £833.91 - £1207.95 per week excluding hairdressing, certain personal activities and a second holiday (where applicable). The fees are inclusive of 24-hour care and individual costs for existing residents. This information was confirmed at the inspection visit. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took place over approximately five hours. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice. The inspection was focused on assessing compliance with specific key National Minimum Standards. On the day of the visit the three residents were at home during part of the inspection and the manager and three of the staff were also present. What the service does well: The manager and staff are committed to ensuring that residents’ needs are met and to maximising residents’ opportunities to develop and to live fulfilling lives within this domestic style environment. The manager administers and oversees robust systems and procedures to protect residents and to safeguard their welfare. The home has safe systems for the management and administration of medication. The home is clean and attractively decorated. Records confirm that services at the home are properly maintained. A varied and nutritious diet is provided, with fresh produce used where possible. Preferences of residents are considered in the preparation of meals. Residents have access to a range of external professionals as necessary, for example general practitioner, psychiatrist and community nursing input. Staff spoken with at this visit were clearly dedicated and enthusiastic. Whilst it was not possible to obtain direct and detailed feedback from the residents it was clear from observing staff interaction with residents that there was a professional and caring approach to meeting residents’ needs. Trees DS0000020111.V327395.R03.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the service will establish that the needs of residents can be met before they move in. EVIDENCE: There had been thorough needs assessments for the current residents, but these dated back to the early 1990’s. There have been no recent admissions to evaluate against the National Minimum Standards. The manager has developed assessment systems and supporting documentation in accordance with the criteria for this standard, which would be utilised in the event of future admissions. The admissions procedure is explained in the Service User Guide. There is on-going assessment of need for the current residents, with sixmonthly formal review meetings arranged. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed plans of care indicate that health and personal care needs are met and that residents are supported to take risks as part of their lifestyles. EVIDENCE: There were individual care records for the three residents living at the home. All care records were examined as part of the case tracking process. The plans were comprehensive and had been regularly updated in the light of changes, and had been reassessed at the formal six-monthly reviews. Plans are drawn up with the involvement of family/advocates and relevant agencies and specialists. Residents are involved as far as is possible or is appropriate. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 10 The individual care plans include professional intervention and assessment, health & personal care, risks, relationships, communication, holidays, finances and recreation. Staff at the home sign to acknowledge that they have read and are familiar with the current care plan for each resident. Residents are encouraged to make their own decisions, as far as is possible. Resident input may be limited due to their condition, and so it is ensured that relatives or advocates are fully involved in significant decision making. Resident’s individual preferences are recorded in the care plans, for example, recreational activities. Risks are discussed and documented at six-monthly reviews and on a continual basis. Risk management is integral to policy formulation at the home. For example, individual hygiene plans consider the risks involved with hot water. General risk assessments are undertaken, which take into account both the resident and the environment. External trips and visits, including holidays and transportation, are all risk assessed. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents in developing appropriate and fulfilling lifestyles as part of the larger community. Residents enjoy a balanced, varied and nutritious diet. EVIDENCE: Occupational and educational activity is tailored to individual needs and abilities. There has been supported attendance at woodwork, concrete products and literacy and numeracy classes in the past. Currently, there are examples of residents participating in a range of pursuits e.g. horse riding, shopping, visits to places of interest, swimming, meals out, bowling, cinema, holidays and tending to livestock. Activities involve significant community contact and there are also efforts made to retain contacts with ‘old friends’ of Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 12 the residents. Relatives are welcomed to maintain contact with the residents and in most cases there is at least monthly contact with relatives. Daily routines, activities and family contact arrangements are documented in the care records. There was evidence in one of the care records of dietician input for the resident, demonstrating the multi-disciplinary approach to meeting care needs. Staff are aware of the food preferences of the residents and catering is tailored to nutritional needs as well as to the preferences of the residents. A record book is kept of the meals served to residents. Examination of the records and discussion with staff confirmed that a varied and nutritious diet is provided, with fresh produce used where possible. Residents are involved in meal preparation as far as is practical, for example making toast and peeling vegetables. Residents also undertake supported shopping trips. Meals are integral to celebrating special occasions such as birthdays. Mealtimes are structured around the diagnosis and condition of individual residents, in regard to behavioural considerations. The mid-day meal took place during the visit and staff were observed to be supportive in their approach to the residents, with consideration given to individual’s needs. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents to meet their health and personal care needs, with involvement of other agencies as needed. Policies and procedures, and staff training ensure that residents are not placed at unnecessary risk relating to medication. EVIDENCE: There is an emphasis on sensitive and flexible support for residents. Care records detail specific requirements and staff demonstrate an individualised approach to supporting the residents. Records in individual care plan files validate that there is multi-professional input to residents’ care packages. There are routine GP checks (six-monthly for medication reviews) and annual health checks for residents have recently commenced with community nursing staff. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 14 There is written guidance for the ordering, safekeeping, administration and disposal of medications. The policy was reviewed in January 2007. Medications are stored securely. None of the current residents is able to take responsibility for their own medications. Medications are detailed in the care plans and on the Medication Administration Records (MAR sheets). The administration records were examined at this visit. All staff have undertaken medication training (arranged with the retail pharmacy), and training records sampled at this visit confirmed this. There are established contact arrangements with the retail pharmacy for advice. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures and staff training ensure that residents’ views are taken on board and residents protected from abuse. EVIDENCE: The complaints process is detailed in the Statement of Purpose and Service User Guide. There had not been any complaints received by the Commission or by the provider in the period since the last review of this service in January 2006. The manager reported that there are good relations with the relatives of residents. Six-monthly reviews provide an ideal opportunity for relatives to formally raise issues, in addition to the on-going contact with staff during routine visits. Examination of review records suggested that relatives thought well of the service. Observation of staff interaction with residents support that residents’ views are sought in respect of daily routines, and the impression gained was very much one of a supportive service run in the best interests of the residents. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 16 The home has a safeguarding adults policy and all staff have undertaken training (including local authority training). Training updates are arranged at appropriate intervals. There is a robust system for financial transactions in respect of residents’ personal monies. The six-monthly reviews are linked to the financial arrangements for individual residents and as such, the arrangements are open and transparent. Review documentation examined at this visit confirm this. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is clean and is furnished, decorated and maintained to a very good standard, providing residents with a safe, pleasant and comfortable place to live. EVIDENCE: A tour of the building was undertaken at this visit. The home is clean and is furnished and maintained to a good standard. Relevant risk assessments had been carried out and this had helped to determine the appropriate fixtures and fittings. For example, one of the bedrooms has a wash hand basin, whilst this facility has been considered inappropriate in the other bedrooms. There are sufficient communal hygiene facilities. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 18 There is a planned annual maintenance and renewal programme for the home. The home is very well located for access to local amenities. Fire safety arrangements are appropriate and up to date servicing of equipment was confirmed during this visit. All staff had received fire safety training within the last year (a sample of staff records was examined at this inspection). The laundry facilities are of the domestic type and in keeping with this homely setting and the needs of the residents. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient staff, appropriately recruited and trained to safeguard, support and meet the needs of the residents. EVIDENCE: All of the staff working at the home were employed before the last inspection in January 2006, at which time a thorough examination of recruitment records was undertaken. It was not necessary to re-examine these records at this inspection. The training records of a member of staff were examined and there was confirmation of up-to-date training appropriate to the setting and to the client group. Each staff member has an individual training and development file. Fifty percent of the staff has undertaken National Vocational Qualification (NVQ) Level 2 or 3 training. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 20 Staff rotas clearly identify the staffing arrangements and the name of the staff member responsible for medication on each shift is also documented on the rota. There are sufficient staff to meet the needs of the residents. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and runs with the safety, welfare and best interests of residents as its primary purpose. EVIDENCE: The manager is a qualified social worker and the Commission has verified his qualifications. The degree of quality assurance activity is proportionate to the aims and objectives of the service. The service provides a homely environment for a Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 22 maximum of three service users, and the current residents have been at the home for several years. Elaborate quality assurance measures are inappropriate for the number of residents and client group. Notwithstanding this, there are continual efforts to involve residents as fully as possible in the way that the service operates and to seek their views. The review processes provide advocates and external agencies and professionals with the opportunity to influence the way that the service functions. Audits are undertaken, with a health & safety audit carried out six-monthly. Audits are discussed at team meetings and at resident’s reviews. An annual development plan is produced for the home. It was evident from the documentation examined at this inspection that there was a conscientious approach to both documenting care and to the general organisation of the service. The maintenance records were examined and there was confirmation that electrical, fire safety and gas services had been suitably maintained and checked. Staff had received all mandatory training relevant to the setting. Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trees DS0000020111.V327395.R03.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!