Inspection on 11/06/07 for Trees Nursing Home

This inspection was carried out on 11th June 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 Nursing Home 08/11/05

Trees Nursing Home 06/07/05

Trees Nursing Home 05/01/05

Trees Nursing Home 17/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Trees Nursing Home 12 Candlers Lane Harleston Norfolk IP20 9JA Lead Inspector Ginette Amis Unannounced Inspection 11th June 2007 010:45 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 Trees Nursing Home DS0000015693.V343024.R01.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 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. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trees Nursing Home Address 12 Candlers Lane Harleston Norfolk IP20 9JA 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) 01379 853919 01379 855307 Mrs Susan Nolan Mr Nicholas David Francis Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (1) of places Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 Brief Description of the Service: The home is situated in the centre of the small market town of Harleston. The services and facilities are of a good standard and all sited on the ground floor. The home can accommodate 20 older people over the age of 65 years who may have care or nursing needs, and one service user who may have a physical disability. There are 21 single rooms (17 with en-suite facilities). There are attractive landscaped gardens with flower-beds and paths around the property that can be accessed by service users. There is ample parking space to the front of the premises. The home is supported by local GP surgeries and appropriate health care services. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection was unannounced and took place on a Monday, between the hours of 10.45 and 16.00. Three residents and 2 relatives of residents were interviewed. One nurse and 3 carers were spoken with and 2 of the care home’s owners, including the registered manager assisted with information. What the service does well: What has improved since the last inspection? Following a complaint regarding catering the care home has taken steps to ensure the meals it provides are acceptable to its residents. A recent survey, together with comments made during the inspection by residents would indicate a high level of current satisfaction. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 6 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 Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, and 6. Quality in this outcome area is good. Clear information was available to prospective residents that comprehensively described the services offered at Trees Nursing Home. The needs of prospective residents, whether applying for a permanent or temporary place there were fully assessed prior to agreement over admission being reached. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care home’s statement of purpose was contained within the service user guide made available to all potential residents and interested parties. The guide gave a comprehensive over view of the service provision, explaining the type of service offered, the accommodation available, the experience and competence of the management and staff group, how and when residents’ needs would be assessed and an example of the contract to be entered into. During the inspection visit, the files of 6 residents were examined. Five files belonged to residents who occupied permanent accommodation at Trees Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 9 Nursing Home and one to a person in receipt of short term care. All 6 files contained evidence that a full assessment of the person’s needs had taken place prior to their admission to Trees. The manager said that short stays were arranged only infrequently. During the inspection visit, the manager made arrangements with a prospective resident for them to visit the care home to assess its’ suitability in their own view. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. Residents’ health and personal care needs were regularly reviewed and detailed in their care plans along with the action designed to meet needs. Courses of action were in addition discussed within staff handover sessions. Accident records were carefully monitored and medication appeared to be well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of 6 residents were examined and found to contain detailed care plans. In each case, daily records had been summarised by the nurse in change of each shift. Care plans had been designed to meet assessed needs, including health and personal care, social and emotional needs, continence, hygiene, mobility and nutrition. Each aspect of need had been regularly reviewed to ascertain its continued relevance and suitability. Where ever possible residents had made their own contribution to the care plan. The plans included a brief social history compiled when residents were admitted and Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 11 these were intended to ensure that residents were regarded in the round and not solely in light of their current needs. Residents’ files were available to care staff as required. In addition handover sessions took place on every shift change, between nurses in charge and between nurses and care staff during which the progress of each resident that day was detailed, any problems discussed and treatments or advised courses of action explained. Residents and their relatives stated they had complete confidence in the managers and staff who cared for them, one saying “they’re very good, they do everything they can to make sure you’re well cared for and if there’s ever a problem they deal with it right away. They want things to be right.” One GP who attended residents there had returned a pre inspection questionnaire to CSCI indicating his confidence in the care given at Trees Nursing Home. During the inspection the content of accident records was examined and it was evident one resident in particular was prone to repeated falls. The reasons for this and steps taken to address risks had been well documented and were also subject for discussion during hand over. Medication was securely stored, appearing on inspection to be well managed. Medication was principally dealt with in monitored dose form, as delivered by the pharmacy. A controlled drugs cabinet was in place and records were found to accurately reflect the administration that had occurred. A dugs fridge was also in place for storing insulin and antibiotics. All medication was subject to regular audit by the manager. None of the residents were deemed able to take charge of their own medication and only nurses in charge were appointed to administer medication to residents. During the inspection visit the nurse in charge explained the findings of investigation into the 2 unexpected deaths at the care home during May 2007, both of which had resulted from natural causes. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 Quality in this outcome area is excellent. Residents were given a range of activities to choose to engage in, could receive visitors or go out with relatives whenever they wished. The standard of the catering was good with a range of choices offered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the morning of the inspection visit a musical appreciation event was in progress at the Trees Nursing Home. This session was well attended by residents. Residents and staff reported that similar events took place regularly and were always popular. The care home offered a range of activities, including quizzes, keep fit, games, reminiscence sessions and bingo. In the course of the inspection visit a number of residents were taken out by their relatives or had visitors. Two residents’ relatives spoken with said they visited daily and were always made welcome. In addition, members of the staff team sometimes took residents into the nearby town. Two residents mentioned how they had waited for a place to become available at Trees Nursing Home because they themselves were originally from that Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 13 locality, and wanted to be able to maintain contacts in the community, and said this was now possible for them. Two residents had their own transportation (invalid carriage or motorised wheelchair) used to visit local shops and the pub. Most residents had TV sets in their own rooms and one lady had recently taken delivery of a lap top computer. One couple recounted how the care home had put on a party to celebrate their recent milestone wedding-anniversary. Residents spoken with seemed to enjoy the different opportunities available to them. All described the staff as friendly and helpful and all said they felt at ease with the managers. Residents said they enjoyed having access to the attractive and well-kept garden. All of the residents spoken with during the inspection visit said that they enjoyed the food offered by the care home. Two relatives of residents said they also frequently had a meal when paying a visit there and found the quality of the food to be good. This view was borne out by the findings of the care home’s own quality assurance survey, which depicted overwhelming satisfaction with catering services. Lunch was served during the inspection and this meal also provided evidence of food being offered in adequate quantity, appearing and smelling appetising with a good choice of alternatives available. Staff were observed sitting at table with residents so as to assist those who had some difficulty feeding themselves. The atmosphere in the dining room, a pleasant and airy room, was relaxed and friendly and the meal was managed in a leisurely manner. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents were protected by the care home’s policies and procedures. There was an appropriate complaints procedure in place and residents and their relatives felt perfectly able to approach any member of the senior staff team should they have a concern they wished to raise. Members of the staff team were conversant with their duty to protect vulnerable adults from abuse and with the whistle blowing procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no complaints made to the care home since the previous inspection. Residents and their relatives spoken with said they would have no hesitation in approaching any member of the senior staff team should they have any kind of concern or complaint to raise, adding “They would do what ever necessary to make sure things were put right.” “ You could speak to any of them, they’re all helpful and just want you to be satisfied.” The care home’s complaints procedure was readily available and contained in the service user guide. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 15 As part of their induction training, new members of staff were advised regarding the need to protect vulnerable adults from abuse and as to the whistle blowing procedure. Members of the staff team had also received training courses specific to this area. Two members of the care team interviewed were very clear they would take action in the event of witnessing or suspecting any resident was being abused Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25 and 26 Quality in this outcome area is good. The care home offered suitable, well- maintained accommodation. The premises were clean and kept in good order and all available equipment was well maintained. The safety of residents and staff was safeguarded by appropriate policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care home had been built specifically to meet the needs of older people and offered a good standard of accommodation. Standing in secluded and well -kept grounds, though close to the town centre, Trees Nursing Home was easy to access and appeared well maintained. In the pre inspection questionnaire returned by the manager to CSCI maintenance was described as “ an on going project” with “all bedrooms redecorated as they become available”. The Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 17 standard of decoration throughout the home was generally good and the premises were clean and tidy and free of any offensive odour. There were 3 bathrooms, though one was currently unused. The nurse in charge reported it to be inconvenient and under review for redesigning. One of the remaining bathrooms had recently undergone some work to make it more attractive and the manager stated similar work was about to be undertaken to soften the appearance of the second, very functional but austere bathroom. The majority of residents occupied rooms with en suite facilities and all bedrooms were of a good size, light and airy, with covered radiators and good quality, comfortable furnishings. Residents had been encouraged to personalise their rooms with small items of furniture, pictures and ornaments etc. Those rooms entered were comfortable and well liked by their occupants. One relative commented on how helpful the managers had been in facilitating the desired arrangement of furnishings. The care home had in place a range of equipment to aid residents’ comfort and for assisting their mobility. Equipment was regularly checked and serviced. The last full fire inspection took place in October 2005 when the care home was found to be well protected with satisfactory policies, procedures, risk assessments and fire fighting equipment in place. This equipment had last been checked and serviced in November 2006. Staff received annual fire training and drills and all new staff were trained in this aspect during their induction. Alarms were tested weekly. The environmental health officer last visited the care home in November 2006 without cause for concern. Other records relating to the regular checks and servicing of all equipment and appliances used in the care home were detailed by the manager in the care home’s pre inspection questionnaire submitted to CSCI. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Quality in this outcome area is good. The care home was staffed by an adequate number of appropriately trained and experienced staff, who, during the inspection visit, demonstrated good knowledge and understanding of the people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were appropriate numbers of staff on duty throughout the day of the inspection and the staff rota suggested this to generally be the case. One nurse was designated to be in charge of residents’ care at all times of day and night. At set times other managers were also available, the care home being overseen by its’ owners who each took responsibility for specific aspects of management. One resident at the care home had a contracted personal carer (in addition to the team) working throughout the day. The records of all staff members were made available for inspection and a random sample of these were examined and found to contain evidence as to the observance of good recruitment and selection practices. Staff received appropriate induction and mandatory training. They were offered additional training to suite their own and the needs of the care home. Training was managed by the providers in conjunction with another care home owned by them, with a training officer employed to jointly or separately, as needs dictated, serve the training requirements of both care homes. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 19 There remained 27 of the care team who held NVQ Level 2 accreditation or above but there were currently 3 more care staff about to enrol for accreditation. A recommendation has been made that 50 of the care team ought to be qualified to this level. One member of staff spoken with had just completed NVQ 2 and was keen to go further with training and development and commented on how well she had been supported by the managers to achieve her aim. All staff spoken with gave a positive impression of working at the care home and said training opportunities were always open to them. Staff were polite and friendly and observed interacting with residents and one another and during handover sessions. A good knowledge of residents needs was very evident during handovers as was the level of personal commitment to the caring role. Residents described staff as kindly and helpful and as “people you can always turn to.” Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36 and 38. Quality in this outcome area is good. The providers’ assertion (in their service user guide) that the needs of residents should always be put first appeared to be upheld by a strong but open and inclusive system of management that encouraged all members of the staff team to contribute towards the friendly but competent ethos of the care home. This judgement has been made using available evidence including a visit to this service. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 21 EVIDENCE: The care home continued to be managed by its owners who were in regular daily contact but provided care at Trees Nursing Home and another care home in Norwich. Members of the management team were well qualified and experienced in caring for elderly people. Management responsibilities were split between the providers with one partner registered to manage the overall care of residents at Trees. Records were maintained to a good standard, securely kept but readily made available for inspection. Health and safety records were noted in the section relating to the environment. The care home had a well-developed quality assurance scheme and the findings of research into residents’ views had been evaluated and used to improve and develop services. Findings were available to the public in the service user guide. Interactions between management, care and auxiliary staff were observed throughout the inspection visit and seen to be open, respectful but relaxed and facilitated a good exchange of useful information. Possible causes for concern were thoroughly examined, courses of action were carefully considered with managers giving every opportunity for care staff to voice their views before reaching a decision and disseminating advice or instruction. Members of staff said they felt well supported by their managers who they considered approachable and very helpful. Although members of the staff team were appropriately led during each shift, and during handovers or when ever necessary guided in the discharge of their duties, the care home had yet to introduce a formal system of staff supervision. Such a system had been prepared and was currently being piloted at the providers’ other care home. It was the managers’ intention to introduce the system to Trees in the coming weeks. A requirement was made for formal staff supervision to commence at Trees Nursing Home as soon as possible. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 22 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 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP36 Regulation 18 Timescale for action That a planned system for formal 01/09/07 supervision of staff should be introduced as soon as possible. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations The Home should be aiming to achieve the target of at least 50 of staff being qualified to NVQ level 2 or above. Trees Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Nursing Home DS0000015693.V343024.R01.S.doc Version 5.2 Page 25 - 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. 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