Inspection on 28/11/07 for Treetops

This inspection was carried out on 28th November 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Treetops 04/11/08

Treetops 14/12/06

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 Unannounced Inspection 28th November 2007 10:00 Treetops DS0000068336.V354899.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.V354899.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.V354899.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 karla.treetops@yahoo.co.uk Midshires Healthcare Ltd Karla Jane Brown Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2006 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. Information about the home, including CSCI inspection reports, can be obtained from the registered manager. The fees charged ranged from £300 to £850 per week. The basic fee at the home is currently £850 per week, with additional charges made if people require extra support. The registered manager provided this information on 28th November 2007. Treetops DS0000068336.V354899.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 about 5 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 9 people accommodated in the home on the day of the inspection visit. People who live in the home and staff were spoken with during the visit. The registered manager was available and helpful throughout the inspection visit. Records were examined, including care records, staff records, maintenance, and health and safety records. The communal areas and one of the bedrooms was seen. The Annual Quality Assurance Assessment had been completed and returned prior to the inspection and information from this has been included in the body of this report. Surveys were sent out to people living in the home and information from the 7 survey responses received has been included in this report. What the service does well: What has improved since the last inspection? The 2 requirements made at the last inspection had been met, resulting in improvements to the information provided to people living in the home, and safer storage of kitchen knives. There was a programme in place to encourage and support people who wanted to manage their own medication. 2 people were being supported on the programme and were making good progress towards independent management of their own medication. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 6 Opportunities for leisure and other activities had been improved. People had been enrolled on college courses, including literacy, numeracy, child-care and creative writing. A permanent manager had been appointed and had successfully completed registration with CSCI. Comments received about the management of the home included: “it is run well”, “ the manager is well organised”, and “the manager is easy to get on with”. 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. Treetops DS0000068336.V354899.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.V354899.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 good. This judgement has been made using available evidence including a visit to this service. There was a comprehensive needs assessment process so that people were confident the home was able to meet their needs. EVIDENCE: At the last inspection in December 2006, the Service User Guide was not available and a requirement was made to ensure that people living at the home had access to the Service User Guide. At this inspection visit it was seen that each person at the home had a copy of the Service User Guide, and there was a copy available in the main entrance area. The Service User Guide had been reviewed and updated. There were some minor changes needed in the Service User Guide and Statement of Purpose to ensure people had all the correct information. The Annual Quality Assurance Assessment (AQAA) said that new people were “admitted only after a full assessment has been carried out by a person competent to do so, within an agreed timescale”. The care records of 2 people admitted to the home since the last inspection included a range of assessment information. There was a comprehensive assessment carried out by the home, Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 9 plus information from social services and from community mental health services. Most people surveyed said they had received enough information about the home to make a choice about living there. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 10 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. There was a user-focused approach to care and support so that people were encouraged to make decisions about their lives. EVIDENCE: The records seen included individual support plans and risk assessments. The support plans generally included sufficient detail, included all areas of the person’s life, and had been reviewed monthly to date. The risk assessments were detailed and had been regularly reviewed. Support plans and risk assessments seen had not been signed by the person to indicate their involvement, although there was evidence of their involvement through talking to people, records of reviews and from the survey responses. Staff spoken with were aware of using the support plans as working documents to ensure people’s needs were properly met. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 11 People living in the home had access to a local advocacy service. The AQAA said that there were plans to “arrange and agree a weekly visit from the local advocacy service, as a permanent arrangement for the service users”. One person said, “I like it here – there’s always someone around if you’re not feeling too good”. Most people surveyed said that they could make decisions about what they did each day, and that they could do what they wanted to do during the day, evenings and weekends. Comments included “I make decisions for each day, sometimes with support” and “I like to go out at weekends”. One person said, “I would like more to do”. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 12 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 good This judgement has been made using available evidence including a visit to this service. There were appropriate activities and opportunities offered so that the lifestyle in the home met the wishes and expectations of people living there. EVIDENCE: Each person had a weekly timetable showing planned therapeutic and leisure activities. People were supported and encouraged to use local facilities, such as a local day centre, shops and pubs. The AQAA said that “we have successfully supported one of our residents to take up an opportunity for voluntary work in the local community” and also that people had been enrolled on college courses, including literacy, numeracy, child care and creative writing. People were encouraged and helped to keep their bedrooms clean and to do their own laundry. People had their own keys for their bedrooms. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 13 People were supported to maintain links with family and friends where possible. One resident was supported to regularly stay overnight with their family. The daily menu was displayed in the main kitchen and in the small kitchen used by people to make drinks. Minutes of meetings showed that the menus had been discussed by people living at the home and their choices included. There were alternatives available if people did not want the planned meal. People were encouraged to eat together in the dining area. Staff said that they usually joined people living in the home to eat the main meal of the day. People were encouraged to help with shopping for food and preparation of meals. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 14 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. The focus on individualised care ensured that people received support appropriate to their needs and preferences. EVIDENCE: The individual support plans included details of people’s personal preferences regarding care, support and daily routines. There were records of the input of other healthcare professionals, such as GPs, community nurses, chiropodist and dentist. There were records of specialist support by community psychiatric nurses and psychiatric consultants. People had been referred when needed to other services, such as services to support people with alcohol dependency or substance misuse. Two people at the home were being supported to manage their own medication. They had each signed an agreement and risk assessment. Their medication was kept in a locked cupboard in their bedroom, with the keys kept by staff. Staff would unlock the cupboard and observe the person taking their medication and signing the medication administration record each time. The Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 15 aim of the programme was that the person would progress to keeping the key and be able to manage their medication safely without prompts from staff. The medication in use was stored securely. Additional stocks of medication were stored in a locked box in the medication room. This was not sufficiently secure. When brought to the attention of the registered manager, action was taken on the day of the inspection visit to install a suitable cupboard in the medication room. The manager confirmed by letter on 28th November 2007 that the cupboard had been installed and met the relevant guidelines. The reference book about medication for staff to use was several years out of date. Medication was administered by staff who had received appropriate training. 2 members of staff signed medication administration records (MARs) when giving medication. Where medication was given ‘as required’, an explanation was recorded on the MARs. One person had been given an ‘as required’ medication regularly for some time and this was being reviewed by the psychiatrist on the day of the inspection visit. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 16 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 good 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 people were protected and their concerns were effectively dealt with. EVIDENCE: People living in the home were encouraged to express their views through regular meetings and also quality assurance surveys. The AQAA said that people were “prompted and supported to contact advocacy services if they wish”. The complaints procedure was included in the Service User Guide and each person had a copy of this. Records of complaints were seen. These showed that complaints were taken seriously and the outcome recorded. All the people surveyed said they knew who to speak to if they were not happy, some named their keyworkers as the person they would go to. Most people surveyed said they knew how to make a complaint, although 2 people said they did not. No complaints about the home had been received by CSCI since the last inspection. The home had notified CSCI of significant events as required. The AQAA said that “All staff receive POVA training as part of their induction, this is then refreshed on an annual basis and forms part of the Company’s mandatory training requirements”. Staff spoken with confirmed that they had Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 17 received training and were clear on the procedures to follow if abuse was suspected or alleged. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 18 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 generally well maintained, clean and comfortable so that people lived in an environment that was safe, pleasant and suitable for their needs. EVIDENCE: The home is situated on the first floor of the building, reached by a flight of stairs. There were no people accommodated who had difficulty in using the stairs. The communal areas of the home and one of the bedrooms were seen. The home was refurbished to a high standard before opening in December 2006. The registered manager said that some carpets, and the flooring in the small kitchen area were to be replaced within the next 2 months. It was noted that the main kitchen floor was damaged and heavily marked in places. The registered manager said that this floor would also be replaced as soon as possible. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 19 Since the last inspection, a domestic style washing machine and tumble dryer had been put into use so that people could do their own laundry, with supervision from staff if needed. A requirement was made at the last inspection that there must be secure storage for knives in the main kitchen. At this inspection it was seen that a locked drawer had been provided and so the requirement had been met. The home shared extensive grounds with the service on the ground floor of the building. Improvements had been made to outdoor paths to ensure they were level and safe for people to use. The AQAA said that further improvements were planned to include a swimming pool and gymnasium on site. The home appeared clean throughout and was free from offensive odours. Most staff had received training about the control of infection. Most people surveyed said the home was always fresh and clean. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 20 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 good This judgement has been made using available evidence including a visit to this service. There were satisfactory recruitment practices and a good staff training programme so that people were protected and well supported. EVIDENCE: The registered manager said that the usual staffing was 2 support workers covering the morning and afternoon shifts, then 1 waking and 1 sleeping in staff at night. 1 additional support worker was provided during the day at weekends. Extra support workers were also provided to accompany people to appointments or activities if necessary. Staff spoken with said that staffing levels were suitable for the needs of people living in the home. Most people surveyed said that they were treated well by the staff and that the staff always or usually listened to them and acted on what they said. One person said, “Sometimes I think they don’t understand me”. Since the last inspection a new staff induction programme had been introduced that met Skills For Care standards. Training records and information from staff Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 21 showed that staff had received all of the required training. Staff had also received training relevant to the needs of people living at the home, such as dealing with challenging behaviour. 2 of the 10 support workers employed at the home had achieved National Vocational Qualification (NVQ) at Level 2. 5 of the support workers were working towards NVQ and 3 new staff were to be enrolled when they had completed their induction programme. The records of 2 members of staff were seen. The records were well organised. 1 record had a short gap in the employment history that had no explanation. For 1 person, the Criminal Records Bureau (CRB) disclosure had been applied for but not yet received. A POVA First check had been received. The registered manager said that this person was working under supervision. It was discussed with the registered manager that the home’s recruitment policy should make clear the arrangements in place to protect people when staff were allowed to start work without a CRB disclosure. Staff spoken with said, “the training is very good” and “we have all the training we need”. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 22 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 good This judgement has been made using available evidence including a visit to this service. The home was well managed and there were good systems in place so that the health, safety and welfare of people was promoted and protected. EVIDENCE: The registered manager had been employed since the last inspection and had successfully completed the registration process with CSCI. The registered manager had suitable experience and had achieved NVQ Level 4. Comments received about the management of the home included: “it is run well”, “ the manager is well organised”, and “the manager is easy to get on with”. The quality assurance system included surveys of people living in the home and of visitors to the home. There was also a suggestions box for anyone to Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 23 use. People were encouraged to raise any issues at monthly meetings. The notes of meetings showed that action was taken to address issues raised. For example, one person had requested that the television should be switched off at mealtimes and others had agreed. It was observed that this happened on the day of the inspection visit. There were regular audits of records in the home by the company’s compliance manager. The compliance manager carried out monthly visits and produced a report to meet the regulations. Information in the AQAA showed that equipment in the home had been serviced and maintained as required. Records were seen of accidents and incidents. CSCI had been notified as required of significant events. Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 24 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 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 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 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Treetops DS0000068336.V354899.R01.S.doc Version 5.2 Page 25 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 YA34 Regulation 19(1)(b) Requirement The required documents and information must be in place for all staff employed at the home, specifically, a full employment history with explanation of any gaps. This will ensure a robust recruitment system to protect people living in the home. Timescale for action 31/12/07 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 Refer to Standard YA6 YA20 YA34 Good Practice Recommendations People (or their representatives) should be encouraged to sign their care plans to indicate their involvement and agreement. There should be an up to date medication reference book so that staff have current and accurate information. The recruitment policy should include clear information about how people living in the home will be protected when new staff are allowed to start work before a CRB disclosure is in place. The quality assurance system should include a report of the findings of surveys. The report should be made DS0000068336.V354899.R01.S.doc Version 5.2 Page 26 4 YA39 Treetops available to people living in the home. This will ensure people know their views are taken seriously and acted upon. 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