Inspection on 14/12/06 for Treetops

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Treetops 04/11/08

Treetops 28/11/07

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME ADULTS 18-65 Treetops Midshires House 10-12 Church Street Riddings Alfreton Derbyshire DE55 4BX Lead Inspector Rose Veale Key Unannounced Inspection 14th December 2006 10:00 Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Treetops DS0000068336.V323516.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treetops Address 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) Midshires House 10-12 Church Street Riddings Alfreton Derbyshire DE55 4BX 01773 528080 01773 528285 Midshires Healthcare Ltd Mr Robert Baillie Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection First inspection Brief Description of the Service: Treetops is a service for up to 11 adults with mental disorder, providing accommodation, personal care and support. Treetops is situated on the first floor of Midshires House in the village of Riddings, near Alfreton. The fees charged range from £1278.80 to £9277.28 per week, depending on the assessed needs of the resident. This information was provided by the project manager on 14th December 2006. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 4½ hours. The inspection visit focused on assessing all the key standards. There were 8 residents accommodated in the home on the day of the inspection. Residents and staff were spoken with during the visit. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. The building was originally registered as 2 services. One was for older people with dementia and the second for adults with mental disorder. The services were taken over by Midshires Healthcare Ltd who de-registered the service for older people with dementia. The existing service for adults with mental disorder, which is on part of the ground floor, remains registered, although no residents are currently accommodated there. The company made improvements to the de-registered part of the service and created two new services. Treetops is on the first floor and the second service, on the remaining ground floor, is for adults with autism. The residents of Treetops had moved from the original ground floor service into the newly refurbished accommodation during the 2 weeks prior to the inspection. What the service does well: What has improved since the last inspection? What they could do better: The Service User Guide was not available to residents or for inspection as it was said to be in the process of being updated to reflect the new service. It was observed that the serving of meals and the use of the main lounge appeared institutionalised. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 6 Residents were not actively encouraged to be involved in the recruitment and selection of staff. 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. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a good system in place so that residents’ needs were fully assessed, but there was a lack of essential information for residents to make informed choices about living at the home. EVIDENCE: The Statement of Purpose had been reviewed and updated in November 2006. Some information required was not included: the qualifications and experience of the registered provider and the staff, and the number and sizes of rooms in the home. The Service User Guide was not available as it was said to be in the process of being reviewed and updated to reflect the new service. The care records of 3 residents were examined. Each record included assessment information obtained from the hospital and / or social worker prior to the admission of the resident. The home’s own assessment information was comprehensive. A care plan had been produced from the assessment information with the involvement of the resident. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were involved in the planning and review of care so that they were encouraged and supported to take control of their own lives. EVIDENCE: The 3 care records examined included individual care plans and risk assessments. The care plans were detailed, regularly reviewed and were signed by the resident to indicate their involvement in planning and review. The care plans seen included all the assessed needs of the residents. The home was in the process of introducing new care plans that were designed to be from the perspective of the resident and to include more detail. Each of the care records seen included a range of risk assessments appropriate to the needs of the resident. The risk assessments were detailed and had been regularly reviewed. Residents had been involved in the risk assessments and in any decisions made about limitations in place. Staff spoken with were knowledgeable about the needs and preferences of residents. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 10 Each resident was assigned a keyworker. There were records of regular oneto-one discussions between the resident and their keyworker. There was evidence that action was taken to meet the wishes and needs of residents as raised in the one-to-one discussions. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities and activities were provided in and out of the home so that residents were encouraged to maintain fulfilling lifestyles. EVIDENCE: The care records seen included details of residents’ preferences, likes and dislikes regarding daily routines, social activities, educational opportunities, and food and drink. Residents were encouraged to help with domestic tasks, such as keeping their rooms clean, personal laundry, and preparation of meals. There was evidence that residents were encouraged and supported to maintain family relationships through letters and visits. Residents used local shops, churches and pubs. Some residents attended a local adult education centre. Residents had enjoyed a holiday together in the summer. Residents spoken with said they liked using the kitchenette for making drinks and sitting in the adjoining quiet room area. One resident said they liked Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 12 watching television in the large lounge area. One resident said they enjoyed playing music CDs. Residents had been involved in making and putting up Christmas decorations. Residents had keys to their bedroom doors. They could choose when to be alone or in company, although it was noted in the care plan if a resident was to be encouraged not to spend too much time alone in their room. It was observed that there was good interaction between residents and staff. One resident commented that there was “always someone to talk to”. The large lounge / dining room was used by residents as the main area for relaxation and watching television. The layout of the home meant that residents and staff could only access the quiet room, small kitchen and staff office by going through the lounge. During the inspection visit it was observed that there was almost continual ‘traffic’ of residents and staff walking through the lounge. The door from the lounge to the corridor with the quiet room squeaked loudly when opened, which was frequently during the inspection visit. The menus were seen and appeared varied. Residents were consulted about food preferences and menus. Residents were encouraged to help with the preparation of meals. The lunchtime meal on the day of the inspection appeared appetising and residents were given a choice. The meal was served from a trolley by staff to a queue of residents and this appeared an institutionalised and outdated practice. This could have been improved by, for example, residents serving themselves whilst seated at the dining tables. Residents were encouraged to eat together in the main lounge / dining room. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was good understanding by staff of residents’ needs so that residents had individualised, sensitive, flexible support. EVIDENCE: The care plans seen detailed the support required by residents with personal care. Support included prompting residents regarding personal hygiene and encouraging personal choice in clothing and appearance. Each resident had a keyworker and there were records of regular discussions between them, including preferences about personal care and support. Staff spoken with were knowledgeable about the care needs and preferences of residents. Staff spoken with and staff records showed that staff were appropriately experienced and trained. There were records of the monitoring of residents’ general health, such as monthly weight and blood pressure checks, and the input of the GP, District Nurse, chiropodist, dentist and optician. Records were kept of additional, specialist support provided from the Community Psychiatric Nurse and psychiatrist. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 14 There was a monitored dosage system in place for medication. There were no residents assessed as being able to take control of their own medication. All staff who were responsible for administering medication had received appropriate training. Medication was stored securely. The Medication Administration Records, (MARs), seen were correctly completed. Records were kept of the receipt and disposal of medication. There was evidence of good practice in the administration of medication: 2 staff were always involved in administration of medication and both staff signed the MARs; each resident who had medication to be given ‘as required’ had a form detailing the circumstances when the medication should be given so that staff had clear guidance. The medication policy for the home was seen. It did not include details about residents who could take control of their own medication, and did not include that medication should be retained in the home for 7 days following the death of a resident in case of a coroner’s inquest. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were policies in place and good staff awareness so that residents were protected and their concerns effectively dealt with. EVIDENCE: Records of complaints were seen, (of complaints made when residents were living in the previous service). Complaints had been appropriately dealt with and details of action taken were recorded. Residents were aware that they could complain and said they would raise any concerns with staff. Residents’ meetings minutes showed that concerns and complaints were raised and discussed. The home had a policy / procedure in place for safeguarding vulnerable adults. The policy was the Derbyshire County Council guidelines and was not specific to the home. Staff spoken with had received training in safeguarding vulnerable adults and were aware of the procedures to follow. Residents said they felt safe living in the home. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 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 and comfortable so that residents lived in a safe and pleasant environment suitable for their needs. EVIDENCE: A tour of the home was carried out, including the communal areas, kitchen, laundry and some of the bedrooms. The home had been refurbished throughout prior to opening. The home was clean throughout and free from unpleasant odours. The home was situated on the first floor of the building and was accessed by stairs with a gate at the top. There was a shaft lift installed that was intended for moving items such as furniture or equipment. The residents of Treetops were unable to use the lift as it gave access to the separate ground floor unit. The Statement of Purpose for the home clearly stated that the home was not suitable for residents with mobility problems who would be unable or unsafe to use the stairs. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 17 The communal areas were comfortably furnished and had domestic style lighting. Walking through the large lounge / dining room was the only way to the quiet room / small kitchen and staff office, (see Lifestyle section). Residents had use of a small kitchen area to one side of the quiet room for making drinks. The main kitchen appeared small to cope with providing meals for up to 11 residents. There had been a recent visit by the Environmental Health Officer who had recommended provision of additional fridges. This had been done. There was no secure storage for knives in the kitchen. The bedrooms seen were pleasant, bright and comfortable. All the bedrooms were single and had en-suite toilets, some had en-suite showers / baths. Residents spoken with were pleased with their new home and had personalised their bedrooms with their own possessions and furniture. The laundry facilities were in the ‘old’ service and so were only accessible to staff. There was a domestic style washing machine and tumble dryer installed in a small storage room in Treetops. It was stated that this was not yet in use. There were extensive grounds to the home. Access had been restricted to the ‘old’ service on the ground floor as this was to be refurbished. Some of the paths had been made safer by the use of bark chippings. A ‘Portakabin’ had been removed, as required at the site visit prior to registration. Further work was planned to ensure the grounds were safe and pleasant for residents to use and it was said that this work would be continued after the winter. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment and training systems were sufficient to ensure that residents were protected and their needs were met. EVIDENCE: The staff training records seen showed that staff had received training in required areas such as first aid, health and safety, safeguarding vulnerable adults, manual handling, food hygiene and infection control. Some staff had received training specific to the needs of residents, such as dealing with challenging behaviour. Staff spoken with were pleased with the training programme offered and said that training had improved in recent months. Induction training records seen included the policies and procedures of the home and the basic required training. The induction programme did not meet Skills for Care standards. The project manager said that a new induction programme that met Skills for Care standards would be starting soon for new staff. The project manager said that 4 out of 10 care staff had already achieved National Vocational Qualification, (NVQ), and 2 staff were working towards the Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 19 qualification. The home was therefore making good progress towards the National Minimum Standard of having 50 of care staff with NVQ. The records of 4 members of staff were examined. All the records included the required information. The records of 2 staff recruited recently included interview notes. Residents were introduced to prospective staff when they came for interview. Residents were not directly involved in the recruitment and selection of staff. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home and the systems in place were sufficient so that residents’ health, safety and welfare were protected. EVIDENCE: There were temporary management arrangements in place at the time of the inspection visit. It was planned that the existing manager for the previous service would act as manager for Treetops until a new manager was recruited. However, the manager had left before the move to Treetops. The temporary manager for Treetops was Rob Baillie, assisted by a deputy manager and the project manager. As the Rob Baillie was on annual leave at the time of the inspection visit, the project manager was overseeing the management of Treetops. A new manager had been recruited and was due to start in January 2007. The new manager was visiting Treetops on the day of the inspection Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 21 visit. Staff spoken with said the management arrangements were working well. There was a quality assurance system in place with monthly satisfaction surveys of residents, visits by the provider, residents meetings, and health and safety audits of the home by the manager. The residents’ surveys showed that residents were satisfied with life at the home. Where any issues had been raised or comments made on the surveys, there were notes of the action taken. The project manager said the satisfaction surveys were usually carried out monthly but had not been done for a few months because of the upheaval of moving to the new accommodation and the change in management arrangements. Health and safety records were sampled and were up to date. The records included the maintenance of the lift, accident reports, and fire safety records. Records were kept of maintenance jobs required with a note of when the jobs were completed. Treetops DS0000068336.V323516.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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. 2. Standard YA1 YA24 Regulation 5(1)(2) 13(4)(a) (b)(c) Requirement The Service User Guide must be available to all residents. Secure storage for kitchen knives must be provided. Timescale for action 16/02/07 31/01/07 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 2 3 4 Refer to Standard YA1 YA23 YA34 YA35 Good Practice Recommendations The Statement of Purpose should include all the items specified in Schedule 1. The policy / procedure for the safeguarding of vulnerable adults should be made specific to the home. Residents should be encouraged and supported to become involved in the recruitment and selection of new staff. The induction programme should meet Skills for Care standards. Treetops DS0000068336.V323516.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Treetops DS0000068336.V323516.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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