Inspection on 16/03/09 for Trees

This inspection was carried out on 16th March 2009.

CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trees 12/02/07

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Trees 20 Old Derby Road Ashbourne Derbyshire DE6 1BN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rose Moffatt     Date: 1 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Trees 20 Old Derby Road Ashbourne Derbyshire DE6 1BN (01335)300767 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Homelife Limited care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 3 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability Code LD Date of last inspection Brief description of the care home 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. Each person has their own private bedroom and they share a bathroom. There is a spacious lounge and a large kitchen with dining table. The current range of fees is £876.11 - £1296.42 per week, subject to a planned increase in April 2009. This information was provided by the owner/manager on 24th March 2009. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home Information about the home, including CSCI inspection reports, is available from the home. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use the service experience excellent quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of the home was on 12th February 2007. We looked at all the information we have received, or asked for, since the last key Care Homes for Adults (18-65 years) Page 6 of 27 inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an annual service review (ASR) of the home in March 2008. The ASR looked at all the above information. The ASR showed us the home continued to provide good outcomes for people living there. We carried out an unannounced inspection visit that took place over 6 hours on 16th March 2009. The inspection visit focused on assessing all the key standards. We sent out 3 surveys to people living in the home and received 3 responses, all completed with substantial assistance from staff. We sent out 5 surveys to staff employed at the home and received 1 completed response. There were 3 people accommodated in the home on the day of the inspection visit. People who live in the home and staff were spoken with during the visit. The people in the home were limited in the contribution they could make to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. All 3 people in the home were selected and the quality of the care they received was assessed by observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were thorough initial and ongoing assessments of individual needs so that people in the home, and their relatives, were confident their needs were fully met. Evidence: There had been no admissions to the home for many years. The assessments for the people in the home were checked at the previous inspection in 2007 and were described as thorough. The Service User Guide explained the admissions procedure. The AQAA said that Prospective users have the opportunity to make numerous visits and stay overnight to enable them to make an informed choice, and also that the compatibility of new people with present people in the home was important. The AQAA said the home could improve by making a video for any potential new people to see prior to visiting. There were detailed care reviews at least every 6 months for each person in the home. The person, their relatives, and staff in the home were all involved in the reviews. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a good understanding of peoples needs and preferences which ensured they received individualised care and support. Evidence: The care records included a care plan for each person. Although not written in a person centred way, the plans covered all aspects of the persons life. Each person had a personal profile with information about their life history, family, likes and dislikes. There were detailed care reviews every six months involving the person, their relatives and staff from the home. From observation and discussion, we found that staff had a good knowledge of the needs and abilities of people in the home. For example, how each person communicated their needs, wishes, and feelings. We observed that staff encouraged and supported people to make individual choices in their daily lives, such as choice of food, clothes and activities. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: There were risk assessments that covered all aspects of each persons life. For example, assessments of the risks associated with bathing, travelling in the car, and the environment of the home. The risk assessments had all been reviewed annually. The AQAA said that Meeting individual needs and supporting choices is one of Homelifes strengths. Supporting 3 individuals with 6 staff, with little change in the staff group, offers continuity and in-depth understanding of the individuals we support. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was an emphasis on providing a family lifestyle that met the individual needs and preferences of people in the home. This was achieved by the flexibility and continuity of the service. Evidence: The lifestyle and activities offered were based on the individual needs and preferences of the people in the home. People took part in a range of appropriate activities, such as swimming, horse riding, and walking. They used local community facilities, such as a local church, leisure centre, shops, pubs and restaurants. Staffing at the home allowed for flexibility in routines and activities. Staff actively encouraged and supported people to maintain and develop their interests and preferences. People in the home had a holiday each year accompanied by staff. There was a diary Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: of each holiday with photographs. There were also photographs of other days out and events. People in the home were involved as far as possible in household tasks, such as clearing away their dishes after meals and helping with shopping and gardening. The home had rabbits and chickens that people helped to look after. There was a vegetable patch and greenhouse in the garden so people could help grow their own food. People in the home were supported to maintain contact with their families. Relatives were kept informed of any significant events through the care reviews or other contact as necessary. People in the home and staff usually ate together in the large kitchen. People helped staff with the shopping and with some simple food preparation tasks. People also ate out at local restaurants for special occasions. The AQAA showed that people were offered a range of suitable activities and supported to maintain relationships with their families. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home received effective and sensitive personal and healthcare support to meet their needs and preferences. Evidence: The care records had good details and staff were knowledgeable about each persons individual needs and preferences. From the daily records, discussion with staff, and observation, we found that people were provided with sensitive and flexible personal support. There was an emphasis on ensuring dignity and independence were promoted, both in and out of the home. Continuity and consistency of support was ensured through a small, stable staff group and effective partnerships with each persons relatives. We observed that people in the home had clothes, possessions and interests appropriate to their age and personality. We observed that staff talked to people in the home in a calm and positive way. We observed that staff encouraged people to be as independent as possible. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: From discussion with staff and looking at the care records we found that the health needs of people in the home were monitored and any problems were identified and dealt with promptly. Each of the care records included details of visits to the GP, dentist, optician, and chiropodist. People were supported to attend for appointments, rather than rely on home visits. The records showed that people had access to more specialist services as required, such as speech and language therapy and physiotherapy. Medication was stored securely. None of the people in the home were able to manage their own medication. All staff involved in administering medication had received appropriate training. There were satisfactory records of medication, including all medicines received into the home and all those returned to the pharmacy. The medication reference book was several years out of date. The AQAA said the service had changed over time,adjusting to the maturing of the people we support. They planned to improve by recruiting an additional female member of staff, and also by exploring the ramifications of an ageing group. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory policies in place and good staff awareness so that people were protected and any concerns effectively dealt with. Evidence: The complaints procedure was included in the Service User Guide. As noted earlier in this report, the Service User Guide did not have the correct contact details for CSCI. No complaints had been received by the home since the previous key inspection in February 2007, and no complaints had been received by CSCI. Compliments were kept and were shared with staff. Relatives were given the opportunity to raise any concerns at the six monthly care reviews. Staff were able to raise any issues during individual supervision or at team meetings. The safeguarding vulnerable adults policy had recently been updated. The staff had received appropriate training. No referrals of safeguarding issues had been made about people in the home. There were suitable policies and procedures in place to ensure the personal money of people in the home was kept securely and properly accounted for. The AQAA said the service has continual dialogue with parents, carers, field social workers and encourages an open house approach. Care Homes for Adults (18-65 years) Page 18 of 27 Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, well maintained and suitably furnished to provide people with a safe, pleasant, homely environment that met their needs and preferences. Evidence: The home was a large, detached bungalow with a well kept garden at the rear and room for car parking at the front. It was well maintained throughout and furnished in a domestic style. The home was clean and fresh throughout. Staff were aware of basic infection control procedures. There were appropriate risk assessments in place regarding the environment of the home. The AQAA gave details of improvements made over the last 12 months, and plans for further improvements in the next year. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff with appropriate training to ensure people were well supported and their needs were met. People were protected by the recruitment procedures. Evidence: We looked at the records of 2 members of staff. Both records had a Criminal Records Bureau (CRB) disclosure in place and the providers policy was for this to be renewed every 3 years. One record for a newly recruited member of staff was waiting for a photograph. The other record was missing a second written reference. This record was for a member of staff who had been at the home for several years. The manager said the references may have been filed elsewhere, but if he could not find it, he would send for another reference. Training records showed that staff were up to date with training appropriate to the setting and the people in the home. More than 50 of the staff had achieved a National Vocational Qualification (NVQ) at Level 2 or above. Staffing was flexible to meet the needs of the people in the home. There were sufficient staff to provide cover as required for holidays and sickness. The home did Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: not use agency staff. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a well organised home that was effectively managed to meet their needs and best interests. Evidence: The manager was suitably qualified and experienced to run the home. He had been the owner and manager of the home for many years. The AQAA was completed by the manager and contained clear, relevant information supported by a range of evidence. The AQAA showed where the service had made changes and where they still needed to make improvements. The data section of the AQAA was accurately completed. There were quality assurance measures in place appropriate to the size of the home and the abilities and needs of the people living there. The relatives of people in the home were invited to share their views at the six monthly care reviews. Staff were encouraged to raise any issues and bring ideas to the monthly team meetings. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Records showed that checks of fire safety equipment and systems were up to date. Accident and incident records showed appropriate action was taken. There was no current Landlords Gas Safety Certificate in place, although there was evidence that gas appliances had been properly maintained and were safe. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 13 There must be a current Landlords Gas Safety certificate in place. This will help to ensure the safety of people in the home. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should be updated with the correct contact details for CSCI, (the Care Quality Commission after the 1st April 2009). The care plans should be written in a person centred style to more accurately reflect the homes commitment to meeting individual needs and supporting choices. There should be an up to date reference book about medication to so that staff have current and correct information. 2 6 3 19 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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!