CARE HOMES FOR OLDER PEOPLE
Treeton Grange Nursing Home Wood Lane Treeton Rotherham South Yorkshire S60 5QS Lead Inspector
Stuart Hannay Key Unannounced Inspection 27th July 2006 09:25 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 Treeton Grange Nursing Home DS0000003092.V304258.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. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Treeton Grange Nursing Home Address Wood Lane Treeton Rotherham South Yorkshire S60 5QS 0114 2692826 0114 2695434 NONE 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) Treeton Grange Limited ** Post Vacant *** Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Treeton Grange is a care home with nursing situated on the outskirts of the village of Treeton that is near both Rotherham and Sheffield. The home also caters for service users who do not need nursing care. Buses pass by the home, though access to the village is limited for people with disabilities. The company no longer has its own minibus; it now accesses community transport for outings. The home is set in large gardens overlooking the countryside, and has ample car parking. The building was converted to a home from offices, and has had a large purpose built extension. It now accommodates up to fifty elderly people on two floors, accessed by shaft lifts and stairs. The rooms are mainly single rooms and all have en-suite toilets and washbasins. Five lounge areas and four dining areas are available, with one of the lounges having access on to the garden. The home’s Statement of Purpose is being revised and reprinted and was not available. The fees ranged from £329.00 - £481.00 per week. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted for 7 hours. Nine service users, three relatives and three staff members were interviewed to obtain their views about the service. A check was made of the environment and the following records were checked: staff training, fire safety, service users’ care plans, the service users’ guide and staff recruitment records. A check was made of the storage and recording of medication. The inspector also had lunch with the service users. What the service does well:
Treeton Grange was very much part of the community. A number of the service users interviewed had lived locally and knew staff members or their families. Service users said that the staff treated them with respect and kindness and they felt that they were well looked after. Some of the service users were not able to clearly express themselves but they looked clean and well cared for. Attention had been paid to their clothing. Relatives said that they were happy with the care provided and that they were made to feel very welcome in the home. Regular activities were provided at the home for those who wished to take part. There were qualified nursing staff on every shift who were supported by welltrained care staff. There were some issues with the format of the care plans but all the required information was in place and the home is in the process of establishing a new system for care planning, which should address the problems. The medication was generally safely stored and administered. There were systems in place to deal with complaints and any complaints had been acknowledged and responded to. The environment was on the whole well maintained and the bedrooms were spacious and well decorated. Service users said that they were pleased with their rooms, which they had been able to personalise. There were no unpleasant odours in the home. The home have appointed a new manager who has worked at the home before, she is suitably qualified and experienced and service users said that they were looking forward to having a permanent manager in place. Checks had been made to ensure that the major systems in the home, such as fire, gas, and electricity were functioning safely. The lifts and moving and handling equipment had been regularly serviced. The owners make frequent visits to the home and were knowledgeable about the service users, the staff and the building.
Treeton Grange Nursing Home DS0000003092.V304258.R01.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. Treeton Grange Nursing Home DS0000003092.V304258.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 Treeton Grange Nursing Home DS0000003092.V304258.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments were made of the service users prior to them coming into the home to ensure that the staff were able to meet their needs. There were suitably qualified and experienced staff available to ensure that the appropriate care could be provided. Information about the service was in the process of being revised and reprinted; therefore this was not currently available to assist potential users to make a choice about the home. The home provides some respite care but does not provide intermediate care. EVIDENCE: There was evidence in the three care plans checked that assessments had been made of the service users prior to them being admitted. The acting manager said that the staff visit people whenever possible prior to their admission. Three of the service users spoken with said that they had been able to visit the home before moving in to help them with their decision.
Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 9 The home’s administrator said that the Statement of Purpose, which describes the range of services at the home, had been revised and was in the process of being reprinted and was therefore not available. The service users interviewed said that their health and personal care needs were met and the care plans identified what help they needed. Both the qualified nurses and the care staff interviewed were knowledgeable about the needs of the service users. Staff and service users said that they felt there was generally a sufficient number of staff on duty. Treeton Grange Nursing Home DS0000003092.V304258.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were care plans in place to identify what help people needed and how their needs should be met, however the information was sometimes inconsistently recorded. Service users said they were well cared for, their care health and personal care needs were identified and appropriate action was taken to ensure these needs were met. Service users said that staff treated them with respect and dignity. The home’s medication system was generally well managed to ensure that it was safely administered but staff need to sign handwritten entries made on the medication records. The system needs to be checked by the pharmacist who supplies medicines to the home. EVIDENCE: Three care plans were checked. Each of these contained sufficient information to enable care staff to take the action required to meet the needs of the service users. Health care needs, including pressure area care and skin integrity assessments were in place. Dietary needs were identified and recorded. Any contacts with other professionals had been documented. The
Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 11 layout and format of the plans varied considerably and different paperwork had been used to record the same information in some cases. It was difficult to easily retrieve information from the care plans. The needs of the service users had been reviewed, however more detail was needed to improve the quality of these reviews. The manager showed the inspector the new paperwork for the care plans and this format should address the identified shortcomings and inconsistencies. It is intended that this will be introduced over the next 6 months. All the service users and relatives spoken with said that the staff were friendly and courteous. They said that they treated them in a respectful manner and made every effort to maintain their dignity, for example ensuring that doors were closed when personal care was being provided. Medication was securely stored and there were systems in place for receiving the medication into the home. There were medication administration (MAR) sheets for each service user; these recorded the type of medication, the dosage and how it was to be administered. There were reasonable stock levels in the home. Care staff interviewed confirmed that the only people who give out medication are the qualified nurses. Records were kept of each time the medication was given. Controlled drugs were safely stored. Not all the handwritten entries on the Medication Administration Record sheets had been signed by the person making the entry. The entries also need to be checked and countersigned by a witness to reduce the risk of errors. There had not been regular checks on the system by the pharmacist who supplies medication to the home. Treeton Grange Nursing Home DS0000003092.V304258.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users said that they were happy at the home and that there was plenty to keep them occupied. Service users and their relatives said that the home helped them keep in touch and maintain important relationships. They felt that they had control over their lives and were involved in important decisions about their care. Service users said that the food was good and there was evidence in the care plans that their dietary needs were assessed to ensure they received a good diet, including any special requirements. EVIDENCE: Nine service users were interviewed. The majority of these were able to say that they were very happy at the home. Those who were not able to say, due to apparent confusion or dementia, looked clean and well cared for. Staff had paid attention to people’s clothing and hair, the women wore make-up and the men had been shaved. They said that there were regular activities at the home, which they could join in with if they wished. The home employed an activities co-ordinator who worked from Monday to Friday at the home, providing games and stimulating activities. Some service users interviewed
Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 13 said that they preferred their own company and liked to stay in their rooms and read or watch television. Service users said that they were encouraged to eat their meals in the dining rooms but had the choice of eating in their rooms if they wished. All those spoken with said that the food was of a good quality, that there was choice everyday and there was plenty to eat. The care plans checked contained information about service users’ dietary needs and their personal preferences with regard to food. The inspector ate lunch with some of the service users – it was of good quality and served in a relaxing, non-hurried atmosphere. Three relatives were interviewed. They said that the home made them feel very welcome and they could drop in at anytime they liked during the day and early evening. If they wished to come later in the evening they just had to arrange with staff to be let into the home. Relatives had been involved in making decisions about care on behalf of the service user if this was appropriate and all said that they were kept up-to-date with information or concerns. Staff interviewed said there were no strict routines in the home and that service users could negotiate what time they wanted to get up or go to bed and when they wanted to have their baths or showers. The service users and relatives interviewed confirmed this. They also felt that they were consulted by the home about issues relating to their care. Treeton Grange Nursing Home DS0000003092.V304258.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and service users and their relatives have used it to raise concerns. The home responds to complaints and treats them seriously. Staff are aware of the need to report concerns and have had training in adult protection. EVIDENCE: The home has a clear complaints procedure and keeps a log of complaints received and the outcomes of these. Two recent complaints were recorded; they had both been resolved to the complainants’ satisfaction. One concerned the accidental omission of a dosage of medication to a respite patient for which the home apologised. The second concerned the poor physical condition of a service user admitted to hospital; however, it was quickly established that this was due to illness rather than any neglect of care by the home. Two staff interviewed had both had training on adult protection and the recognition of abuse as part of their NVQ Level II qualification. They were aware that there were procedures in place and of their obligation to report any concerns to the relevant authorities The acting manager said that all staff were due to attend training on adult protection, provided by Rotherham council, in the forthcoming months. No recent adult protection issues had been raised at the home.
Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 15 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, tidy and well maintained ensuring that the service users live in pleasant and comfortable surroundings. All the bedrooms and the communal areas were clean and fresh smelling. EVIDENCE: The communal areas of the home were light and pleasant. Seven bedrooms were checked on both floors of the home. They were pleasantly decorated, personalised and clean. A range of furniture had been provided for the service users and all those interviewed said they were very happy with their rooms, which all had en suite toilets. There were no unpleasant odours noted in the communal areas or in any of the bedrooms checked. The carpet in the downstairs corridors had been regularly cleaned and shampooed but was showing signs of wear and marking due to the use of wheelchairs. The bathrooms and toilets were clean and all the equipment was in good condition.
Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 16 The gardens and grounds were attractive and accessible to service users. They had been kept in good condition. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team were qualified and experienced in working with this group of service users; they understood their needs and had received training to ensure they could care properly for them. The home generally had good recruitment records but not all the checks were in place. EVIDENCE: Staff at the home had received a range of statutory training and training related to the specific needs of service users. Those interviewed were knowledgeable, not only about the specific needs of the service users, but also their individual personalities. Three staff members, one qualified nurse and 2 care staff were interviewed and they all they felt they worked well as a team. The recruitment records of two employees were checked and these contained most of the required information: application forms, employment histories, references, CRB and POVA checks. However, written references had not been obtained for one of the staff recruited. The care staff interviewed said that they had received regular professional supervision from their line managers. Statutory training for some staff was out of date. This included some manual handling, fire safety and food hygiene training. The home has systems in place for this training to take place on an annual basis, but due to the change in manager at the home, it had not been arranged within the required timescales.
Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 18 Service users said that they felt that they were well looked after by the staff and that there were always enough people on duty. Staff felt that there were usually enough people on duty and the rotas for the previous two months confirmed the numbers indicated by the staff were being maintained. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 19 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, 32, 33, 34, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff felt that their line managers were supportive and approachable and there was a well-established system of professional supervision to ensure that staff were maintaining a good level of care to the service users. The owners visit the home on a frequent basis but need to ensure that their written reports are completed on a monthly basis. Staff felt that they worked well as a team. The views of the service users were taken into account when decisions were made both about their individual care and general issues within the home. Effective health and safety systems were in place to minimise the risk to service users and staff. The building was safe without any obvious risks to service users, however footplates must be used when pushing service users in wheelchairs. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 20 EVIDENCE: A new manager has been appointed to the service, which has not had a registered manager in place since last year. The service was covered by another manager but she has since moved and was not registered with the Commission For Social Care Inspection. During this time the directors and other managers within the group have provided support, however staff and some service users said that they were looking forward to having a permanent manager again. All levels of staff interviewed felt that their line manager was approachable and that any concerns they raised would be taken seriously. It was clear from meeting with the Responsible Individual of the home that he visits regularly and is aware of issues with the service users, the staff and the building. Written reports had been completed to support this, however these need to be done on a monthly basis. Service users and relatives spoken with felt that their interests and concerns were taken into account when decisions were taken about the home and their care. The personal monies of 3 service users were checked. These were held on their behalf by the home. There were receipts for all transactions made on their behalf and the records had been checked on a regular basis. The monies held in the safe were accurate when checked against the individuals’ records. There were no obvious hazards noted in the building during the inspection and all the major systems – the fire alarm system, the gas and electric systems – had been checked on an annual basis. The fire alarms were tested weekly. The home had recently had a new alarm system fitted. As noted above, some staff were overdue with regards to having updated training in fire safety and manual handling. However, staff interviewed could describe the procedures to be followed in the event of the alarms sounding. One service user was noted being pushed around in a wheelchair without footplates on, which is potentially hazardous and could result in a fall or fracture. There were also some wheelchair users who propelled themselves around the home without using footplates and risk assessments must be made for this. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 21 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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 X 3 X 2 Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 4 Requirement The home’s Statement of Purpose must be made available to service users and potential service users. All the service users’ care plans must be put into the new format to ensure consistency of recording and reviews. Handwritten entries on MAR sheets must be signed by the person making the entry. A witness must also sign to confirm the instructions are accurate. The home’s medication storage and system must be checked by a pharmacist. Two written references must be provided for staff recruited to work in the home. All staff must have updated manual handling training All staff must have updated fire safety training. The manager designate be registered as soon as possible Regulation 26 reports must be completed on a monthly basis. Footplates must be used when
DS0000003092.V304258.R01.S.doc Timescale for action 01/11/06 2. OP7 15 01/02/07 3. OP9 13 (2) 01/09/06 4. 5. 6. 7. 8. 9. 10. OP9 OP29 OP30 OP30 OP31 OP33 OP38 13 19 and Schedule 2. 13 (5) 23 (4) (d) 8 26 13 (4) (c) 01/10/06 01/10/06 01/10/06 01/10/06 01/12/06 01/10/06 01/10/06
Page 23 Treeton Grange Nursing Home Version 5.2 pushing service users in wheelchairs. Risk assessments must be completed for service users who use their wheelchairs unaided by staff and do not use footplates. 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. 1. Refer to Standard OP31 OP19 Good Practice Recommendations The manager designate be registered as soon as possible The carpet in the downstairs corridor should be replaced. Treeton Grange Nursing Home DS0000003092.V304258.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ 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 Treeton Grange Nursing Home DS0000003092.V304258.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. 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!
