Inspection on 08/11/05 for Trees Nursing Home

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 11/06/07

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 Mrs Susan Golphin Announced Inspection 8th November 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 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.V255018.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 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.V255018.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection, which took place between 9.am and 4pm. The registered provider Susan Nolan and the manager Nick Francis have a good knowledge and understanding of the regulation and inspection process and use the event to promote the development of the resource. The earlier part of the day was spent with both Susan Nolan and Nick Francis to discuss recent progress and planned changes to the care planning system. Three residents, three staff and on visitor were seen on the day. The CSCI received five comment cards from residents and five from GP’s and other health care professionals. All the resident comments were positive and complimentary about their care. One negative comment about meal presentation and standard was also made and this was shared with the management who will be addressing the matter directly with the resident. All the comments have been incorporated into the report. Feedback was given to Susan Nolan the registered provider and the manager Nick Francis at the end of the inspection. What the service does well: The home consistently provides a high standard of nursing care to older people There is a competent and confident group of staff who are well supported by the management and who have a good understanding and knowledge of residents needs and how they can be met. Residents seen on the day said that the staff are kind and caring and look after them well, and gave examples of personal care and input by staff. The environment is well maintained to a high standard and the CSCI have received confirmation from both the environmental health services and the fire service to say that the active protection measures in place in the home are well managed and also of a high standard. Staff commented on the good support they receive and also on the training opportunities made available to them. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 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. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4. There are appropriate policies and procedures in place to provide residents with a clear assessment of need, information about the home and the service provided and written contract on admission. EVIDENCE: All prospective residents are provided with a written contract on admission to the home. A full assessment of need is also completed prior to admission by the placing agency or the manager. The manager always checks and reviews the information received with the residents or their representatives to ensure the information is accurate and reflects their needs and wishes. The management are reviewing the way in which they confirm that the home can meet residents assessed needs. Currently the process in place for confirming a place is not always consistent and can be brief. It is their intention to confirm the arrangement in writing setting out how individual needs can be met. The information will continue to be part of the written contract and also agreed plan of care. (see recommendation) Four care plans were seen on the day and all contained an individual assessment of need. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 9 Residents confirmed that they or their representatives visited the home prior to their admission to assess suitability and choice. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10,11 There is a clear care planning process in place, which provides staff with the information they need to meet resident’s healthcare needs. Personal support in this home is offered in such a way as to promote resident’s privacy and dignity, including the processes for end of life care and supporting bereaved relatives and family. EVIDENCE: The care plan process has been revised and is being brought into use. The system is easier to use and the information remains detailed clear and accessible to staff. Residents or their representatives are asked to sign up to the agreed plan of care. (see recommendation) Residents spoken to on the day confirmed that their personal care needs are met and that any request is met willingly. Two residents have only been in the home a short while but said that they feel they have made the right decision to move into Trees. The staff group have a wide range of experiences in dealing with death and bereavement and caring for residents at the end of their life. Through training and supervision they have developed a sensitive approach to this area of their Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 11 work and benefit from good support and counselling from their line management and peer group. Staff and residents were able to give personal examples of good care practice and demonstrate that care needs are met and that resident’s rights are respected. Standard 9 was not inspected on this occasion other than to confirm that the manager completes a full medication audit on every resident every two months A random sample of the audit record was seen on the day and found to be well documented and up to date. The audit information and the medication administration record and stock label numbers all accurately corresponded. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, Social and recreational interests are promoted and encouraged through regular group activities and contact with the local community. Residents are able to socialise with others as they choose, and maintain both family and community contact. Residents are encouraged to make decisions about their own lives. EVIDENCE: Residents can choose from a range of activities available throughout the week and include music sessions, which includes music appreciation. Crafts and reminiscence keep fit and quizzes. In addition there is a ‘pat-a-dog’ visit once a week and games of bingo which the residents said they like very much. Relatives and friends are encouraged to visit at any time with an expectation that resident’s privacy and personal space is respected. Residents spoken to said that they do make decisions about what they want to do each day, one resident attends a day centre in the city. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 There is a robust complaints procedure in place, which promotes an open relationship with residents and their representatives. Policies and training protect residents from abuse. EVIDENCE: There have been no formal complaints this year. Residents said that they would talk to the manager if they had any complaints. One concern has been raised through the inspection process and has been passed to the management for their attention. One resident said that they would also talk to members of staff who are very good at ‘sorting things out if I am in a muddle’. Others commented that the manager and the owner of the home regularly call and ask everyone if things are alright which they find reassuring and helpful. External training sessions about protecting vulnerable people have been attended by all the staff. The sessions include the use of videos, workbooks and discussion. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 The standard of the environment in this home is high and provides the residents with a comfortable and homely place to live. Specialist equipment to aid mobility and independence is available. There is a well-defined infection policy in place in line with clear clinical advice and guidance for all staff. EVIDENCE: Both the interior and exterior of the home is well maintained to a high standard. The gardens and immediate grounds offer a pleasant aspect from resident’s rooms and can be accessed by paths and lawns. Resident’s rooms are furnished and personalised with good quality furnishings and fittings. Two residents with high dependency / nursing needs are being cared for with specialist equipment to promote good input of care. One resident is being nursed in bed and has a fully adjustable bed so that a range of positions can be achieved. Some of the beds are fitted with special mattresses that fit the ‘profile’ of the resident and are more comfortable and supportive. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 15 The manager is currently ‘road testing’ a particular type of easy chair to be used for a resident normally confined to bed but will be able to be cared for safely in the chair and will help to maintain good skin tone and promote tissue viability. The infection control policy and the separate policy for the management of MRSA is reviewed regularly and updated as the manager becomes aware of any new initiatives or practice. Monitoring of the process is done through clinical supervision. On the day of the inspection the standard of cleanliness and maintenance was exemplary. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home have a well-established staff group who have a good range of skills and experiences to meet the healthcare needs of the residents. The recruitment and selection procedure for the home supports and protects residents. EVIDENCE: There are adequate numbers of staff employed throughout the day and night. Three staff were spoken to on the day and expressed positive views about the way they work as a team and provide practical and professional support to each other and to the resident group. They spoke competently and confidently about care practice and how residents healthcare needs are met on a daily basis. The registered providers are currently reviewing the staffing levels in relation to the changing needs of older people referred to them for both residential and nursing care. The purpose of the review is to ensure the quality of the service provision and maintain consistent staffing levels that meet resident needs. There are now five staff with NVQ 2 and one with NVQ3 a substantial increase from 7.9 to 29 in the last year. Each member of staff has a personal file with information relating to their recruitment and application form and references and CRB check. The personal staff details are maintained in a central office for both homes. Four staff files were seen and were up to date and well maintained. It has been agreed that a data base print out of the Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 17 information held relating to staff employed in the home will be kept on site for ease of access. (see recommendation). Staff training is in place and includes external sessions for appointed first aiders- fourteen staff have completed this course this year. One of the training staff for the home is undertaking a course at the city college on ‘teaching adults’. The management have recently appointed a new trained member of staff who it is said comes with expertise in staff supervision and dementia training including managing challenging behaviours. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 The home is well managed with positive leadership from the registered providers. The style of management promotes the resident’s care and personal interests at all times. The home regularly reviews aspects of the service provision through a good programme of self-assessment and seeking the views of both the resident, relatives and other healthcare professionals. There are policies and procedures in place to monitor the safety and maintenance of the premises and facilities and ensure compliance with other legislation. EVIDENCE: The management and maintenance of the premises and equipment and other facilities is undertaken by Richard Nolan. The standard of record keeping and the safeguard checks in place for both equipment and services is well maintained and of a high standard. Recent inspections by the environmental service and fire services confirm that the home complies with Health and Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 19 Safety at Work act 1974,and The Food Safety Act 1990. Also both the active and passive fire protection measures are to a high standard and a suitable and sufficient risk assessment of the premises has been carried out. Mandatory training for all staff takes place on a regular basis and staff confirmed that they have received relevant direction and guidance in respect of moving and handling, basic food hygiene, fire prevention and protection and first aid. Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x 3 x x x 4 STAFFING Standard No Score 27 4 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 4 Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 21 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. 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. 1 Refer to Standard OP4 Good Practice Recommendations It is recommended that the registered providers continue with the review of this standard and implement the plan to revise the way in which confirmation of placements is made. It is recommended that the registered providers complete their revision of the care planning process and bring it into use as soon as possible. It is recommended that the registered providers maintain up to date information relating to staff recruitment, selection and CRB checks on site for inspection purposes. 2 3 OP7 OP29 Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Trees Nursing Home DS0000015693.V255018.R01.S.doc Version 5.0 Page 23 - 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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