Inspection on 01/08/06 for Treetops Care Home

This inspection was carried out on 1st August 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Treetops Care Home 09/11/09

Treetops Care Home 24/07/09

Treetops Care Home 20/04/09

Treetops Care Home 07/01/09

Treetops Care Home 28/05/08

Treetops Care Home 15/11/07

Treetops Care Home 16/04/07

Treetops Care Home 03/01/06

Treetops Care Home 08/03/05

Treetops Care Home 04/11/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH Lead Inspector Sarah Buckle Key Unannounced Inspection 1st August 2006 and 21 August 2006 08:30 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 Treetops Care Home DS0000017984.V305279.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. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treetops Care Home Address 23/25 Station Road Epping Essex CM16 4HH 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) 01992 573322 01992 570241 Essex Residential Care Homes Limited Mrs Vivienne Lesley Clancy Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 52 persons) 3rd January 2006 Date of last inspection Brief Description of the Service: Treetops Care Home is a large detached property set in a residential area within five minutes walking distance of the town centre of Epping. The home is owned by Essex Residential Care Homes Limited and the registered manager is Mrs Vivienne Clancy. Treetops Care Home is located close to the railway station and a bus service runs regularly. Local shops, banks, post office, library and other facilities are within easy reach in Epping Town centre. This is an adapted property that provides accommodation for older people on four levels, which are serviced by passenger lifts. The home provides a residential care service for older people. The fees at Treetops Care Home range from between £444.43 and £600.00 per week. This information was provided on 1st August 2006. Items not covered in this cost include chiropody, which is £15.50, hairdressing, which ranges from £1 - £25.00, newspapers and toiletries. Most of the beds within the home are contracted with social services. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine key unannounced inspection which included two visits to the service. During the course of the inspection information was collected from a number of sources. The registered manager completed pre-inspection information, which was sent to the Commission. Rotas and menus were also forwarded. Information contained within the service file was examined and surveys were presented to the home for residents and relatives to complete and return to the Commission. Eleven residents completed surveys and seven relatives completed comment sheets. During the course of the inspection, a tour was undertaken of the home’s premises; the registered manager was spoken with in depth. The deputy manager, six residents, two relatives, a GP, two health and social care professionals and four staff members were also spoken with. Observations were made of the residents and care workers within the home and one mealtime was also observed. Information received in surveys and interviews and gained from observations is contained within this report. What the service does well: What has improved since the last inspection? There was clear evidence of family involvement in the care planning process within the two care plans examined during the inspection. The care plans examined during the inspection had been reviewed and changes in the residents needs had been added. The number of staff taking an NVQ has increased. The registered manager stated that 18 of the staff team now have NVQ2 and that 6 more are currently taking NVQ3. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 6 Twenty-seven staff members have undertaken POVA training. 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. Treetops Care Home DS0000017984.V305279.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 Treetops Care Home DS0000017984.V305279.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The initial assessment procedure with the home is satisfactory. EVIDENCE: During the inspection, two care plans were sampled for the purpose of examining the initial assessment procedure. One of these was looked at in depth. Both care plans contained thorough and detailed information regarding the identified abilities and support needs of the individual and addressed personal, social, physical and health care. COM5 documentation was included within the initial assessment. Care and support plans were developed directly form the information contained within the initial assessment and the COM5. There was evidence of family involvement in the completion of care plans. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 9 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 judgment has been made using available evidence including a visit to this service. Care plans are adequate and health care needs are in the main part met. Medication is well managed. Residents are not adequately treated with respect and dignity. EVIDENCE: Two residents were case tracked during the inspection and their care plans were examined in detail. The support plans were written in a step-by-step manner making them easily understandable, however, they were handwritten which in some instances made them difficult to read. Both of the care plans sampled had evidence of regular reviews. One care plan had additional information added to it as the residents’ need changed. It was not always clear which support plan was being examined as they did not all contain a relevant title. One COM 5 stated that a resident had had a stroke and that he has tremors. The tremors were referred to throughout the care plan, but the stroke was not mentioned anywhere other than in the COM5. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 10 Risk assessments contained within the care plan were not sufficiently detailed and risk management plans were not adequate. The risk assessment form used by Treetops incorporates a number of risk factors into one document i.e. risk of falling; confusion; handling constraints; self-neglect etc. The information in relation to all of these areas is scant. For example, one resident had an identified risk of falling, the degree of this risk was ‘actual’ and that action to be taken stated ‘Senior care to report to management for further action’ and ‘level of risk will be reduced’. Both care plans had evidence of a pressure sore risk assessment. The first was graded as 10 on the Waterlow scale and the second was graded as 16. Neither had a risk management plan in place in relation to this or recorded evidence of ‘action taken’. The healthcare needs of the residents within the home were in the main part met. There were records to demonstrate that monthly weight checks were undertaken. The two residents being case tracked had gained weight over the last few months. There were records logging all professionals visiting the home i.e. GP; dentist; optician; chiropodist; district nurse and practice nurse. During the second site visit, the deputy manager was observed working with the GP, identifying all those residents who needed to see him and why. The GP did state during the inspection that not all residents were registered with the surgery, which meant that their results could go missing. One concern received by the Commission in August 2006 was in relation to a resident who had been in a lot of pain over a four-day period and had been offered paracetamol, but no visit by a GP. A letter received by the Commission in March 2006 outlined concerns about a relative who had been taken to hospital after a fall and who was found to be dehydrated with thrush of the mouth and a water infection. Treetops use the NOMAD medication system. Medication was stored appropriately. The controlled drugs were contained within a lockable metal cupboard and the register was appropriate. A random audit of the controlled drugs prescribed for two separate residents tallied. There were no omissions noted on the MAR sheets. Two of the residents within the home had handwritten medication profiles, which were not countersigned. One of these did not contain information regarding the quantities, date received and by whom. The privacy and dignity of the residents within the home is in the main part considered by the staff team. One service user survey returned to the Commission stated that the care and support received within Treetops could not be better and that ‘the staff are first class’ and ‘always alert’ however, another stated that they found that ‘the night staff can be upsetting’ and that they have been left waiting a long time for their call bell to be answered. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 11 Another resident stated that they would like “More baths and regular checks to see I am still alive and kicking. [There are] long waits to answer call button”. During the visits to Treetops staff members were seen engaging positively with residents, however, there was an occasion in the lounge when three carers were standing on some steps overlooking the room, chatting amongst themselves rather than looking after the needs of the individuals within the home and it was only when a senior staff member directed them that they integrated with the residents. Treetops Care Home DS0000017984.V305279.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 adequate. This judgement has been made using available evidence including a visit to this service. There are not sufficient activities available within the home. Family links are encouraged. The community is not accessible to all residents within the home and not all residents are able to exercise choice and control in their lives. In the main part, Treetops Care Home offers a well balanced diet. EVIDENCE: An activities co-ordinator is employed at Treetops for 15 hours each week. During both visits to the home the activities co-ordinator was on holiday. On both occasions no meaningful activity had been put in place to occupy the residents during her absence. Instead there were three TV’s on in various areas of the lounge for the residents to watch. One resident spoken with stated that the activities co-ordinator is a lovely lady who does her best to keep everyone occupied. Three of the ten surveys returned to the Commission stated that there are always activities available; three stated that there are usually activities arranged by the home and four stated that there sometimes are. Comments written on the surveys included “I enjoy the activities at the home”, and “Would like MORE. Would like to be taken out to the shops” and “Mum feels that there are not enough exercises to stop her getting stiff”. One resident survey stated that there are never any activities arranged by the home. The registered manager stated that she would like more meaningful Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 13 activities on a daily basis for the residents and that she would like to take the residents out, but that transport and insurance would be an added cost for the residents. The registered manager stated that there was a communion service on a monthly basis that all residents were welcome to attend. There was evidence of strong family links within the home. Both of the service users case tracked during the inspection had a strong family presence within the home, with relatives and partners visiting on a daily basis and staying in the home until late in the day. There was no section within the care plan relating to choices and decisionmaking. However, some residents chose to spend time in the lounge and others preferred to remain in their rooms. Although this was addressed in practice, the information was not recorded anywhere. Four weeks menus were forwarded to the Commission and these demonstrated that the residents within the home had access to a balanced diet. The lunchtime meal was observed and residents were seen to be sitting at the dining tables, which were laid with tablecloths. The TV’s in the main dining area were turned off during the course of the meal. The atmosphere was pleasant and the staff engaged in offering support to resident who required it. However, one resident survey stated that the food was cold when she received it and another stated that the “food could be better”. Treetops Care Home DS0000017984.V305279.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 adequate. The judgement has been made using available evidence including a visit to this service. The complaints procedure is adequate. Residents are not suitably protected from harm and abuse. EVIDENCE: The PIQ completed by the registered manager stated that there have been thirteen complaints received by the home since the last inspection. It also stated that there have been three referrals made to the protection of vulnerable adults team. In the last three months there have been two concerns made by telephone to the Commission regarding the home. The callers have been advised to put their complaint in writing to the manager at Treetops or to make a POVA referral to Essex County Council. The complaints logbook was examined during the inspection. The complaints were clearly numbered and tallied with the appropriate ‘record of complaint’ contained within the separate complaints file. However, a recent complainant has telephoned the Commission to state that a complaint that they have made has not been responded to within the specified twenty-eight day period. The complainant stated that the twenty-eight day period was on 01/09/06. Information regarding a protection of vulnerable adults investigation, that was current at the time of the inspection, was not contained within these files. However, the registered manager stated that it was contained in a separate file. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 15 Essex POVA protocol was available within the office and at the second site visit the new Essex adult protection training material was seen. POVA training records were examined and it was positive to note that sixteen staff members had undertaken the training in March 2006 and ten in October 2005, meaning that twenty-six of the twenty nine care staff had valid POVA training at the time of inspection. However, one member of staff spoken with during the inspection was not aware of the POVA procedure as she stated that if she suspected abuse she would caution the carer concerned, and depending on the degree of the alleged abuse report it to the manager. She also stated that ‘sometimes people abuse without knowing’ and that she would not report this but that if ‘someone did something deliberately’ she would report it. Also, although POVA training has been undertaken the procedure is not being followed in practice. A recent allegation of abuse against a resident within the home was not reported by either the care worker allegedly involved or by the senior care worker who was told of the alleged incident after it happened. It was only when the resident informed her relative later in the day that the manager of the home was made aware of the alleged incident. The information regarding the allegation had not been recorded anywhere. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected 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 poor. This judgement has been made using available evidence including a visit to this service. The home is not adequately safe and homely. Appropriate infection control measures were not in place. EVIDENCE: The first site visit to the home began at 8.45. At this time there was a slight malodorous smell, however, during the course of the inspection this diminished. A tour of the premises was undertaken and the environment was generally tired, worn out, grubby and often unappealing. One downstairs bathroom had tatty curtains, which were not hung properly, the cistern lid on the toilet was cracked and the linen and towels within the room were frayed at the edges. On one of the stairways from the basement to the first floor the wallpaper was damaged and had evidence of damp. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 17 The bath panel in one bathroom was cracked and had been repaired with tape. There was a lot of damage throughout the home to the walls where wheelchairs had scraped the paint and plaster off. Doorframes also suffered from this sort of damage. Wallpaper was peeling from the walls in various places and the handrails were dirty and the paint had chipped off of them. A top floor bathroom had latex gloves hanging out of a flip top bin. There were wet green paper towels on the floor and the bath panel had been repaired with orange/red glue. There was a mattress stored in one bathroom. All of the bathing areas within the home have an institutional feel to them and are in need of immediate refurbishment. One health care professional spoken with stated that the environment within the home sometimes put people off taking up residence. The registered manager stated that a large-scale refurbishment of the home would soon begin. A second health care professional spoken with stated that this is meant to be in progress already. The level of hygiene within the home is not sufficient to prevent possible spread of infection. During the tour of the environment it was noted that there were cobwebs on the walls and in corners of some of the rooms within the home, dead flies in lampshades and dead flies and obvious dust on window ledges. The door to the sluice room was wedged wide open and there was a malodorous smell coming from the room. A flip top lidded bin within the room had no lid on it and consequently clinical waste was exposed. The carpet in the dining area, which also serves as a lounge, was stained with ground in food spillages. Dried flowers that were on the back stairwell during the first site visit were still there on the second visit, indicating that this had not been vacuumed. Disabled toilets on the ground floor were both messy and unappealing. One of the toilets had a flip top bin with the lid missing exposing clinical waste. There were latex gloves on the floor in the hallway. Four of the resident surveys returned to the Commission stated that the home is always fresh and clean, however, the remaining seven said that this was not always the case. Comments received stated that the home “sometimes smells” and “The furniture we sit on could do with a clean as there is spilt food on them”. One comment also states that there is spilt coffee and tea and food droppings. One relative comment card was concerned about the ‘smoking corner’ in the main lounge. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 adequate. This judgement has been made using available evidence including a visit to this service. The number of staff within the home is not adequate to meet the needs of the residents. The recruitment process is, in the main part, robust. Staff training is not adequate. EVIDENCE: Four weeks worth of staff rotas were examined and these confirmed that the home are providing the agreed levels of staff, this being nine in the morning, eight in the afternoon and five throughout the night. There were a number of occasions when only four staff members had been put on the rota for the night duty. It was also noted that some staff members were completing long hours of double shifts. i.e. one staff member worked double shifts from 7.30am until 9.00pm five days in a row, making a total of almost seventy hours in one week without a break. Another care worker completed nine consecutive shifts without a day off. Four of the resident surveys received by the Commission stated that they always received the care and support they needed by the staff within the home. The remaining residents stated that this was not always the case. One comment received said that sometimes they wanted to go out into the garden, but that the staff forget to take them out and another stated that the staff are not always available when needed, because “sometimes they are too busy”, a third comment stated that they had pressed the bell, but had “been left a very long time”. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 19 One relative comment card received by the Commission was concerned that there was not a member of staff available at all times on each floor within the home: “I feel the presence of a member of staff, at all times, on each floor would give an awareness of residents movements and safety”. Four staff files were looked at and these demonstrated that recruitment within the home is mainly robust. All of the specified information was contained within the staff files sampled, except for one staff member, who had started employment on 26/01/04 but their CRB was not completed until 04/10/05. Training records were examined during the course of the inspection and these demonstrated that twenty-five staff member’s had undertaken induction training. Other training completed by staff members included infection control, medication, food hygiene and first aid. Ten staff members had completed medication training and these are senior staff members. The registered manager explained that only those staff member who administer medication complete a workbook that has been devised based on the Royal Pharmaceutical Society’s guidelines. She also stated that the home has ‘trainee senior staff’ positions. Recent induction paperwork was examined and this was in line with TOPPS standards. The staff that completed this induction had completed comprehensive written notes. The section ‘understanding the principles of care’ was examined. The registered manager stated that she is prepared for the new Skills for Care induction standards. One of the staff files examined had evidence of comprehensive training, however, another staff member who started one month later had limited training. According to the training records, twenty-two staff members had valid manual handling training. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager at Treetops is fit to run the home. The home is not adequately run in the best interests of the residents. Staff supervision is not adequate and the health and safety of residents is not satisfactory EVIDENCE: The registered manager at Treetops Care Home is a registered nurse and has therefore completed a qualification equivalent to an NVQ level 4. She has a lot of experience of managing care homes. The manager has not completed her NVQ4 registered managers award and stated that she does not intend to do so. Two staff members spoken with stated that they found the registered manager approachable and that they felt supported by her. One staff member stated that she had only met her at interview, but that the staff team were supportive. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 21 A supervision file was examined during the inspection and this showed that eleven staff members had been supervised in July 2006. The registered manager stated that there is a rolling two monthly supervision system in place. One of the staff members spoken with stated that they had occasional supervision and another stated that they received supervision three of four times each year. Collated information regarding relatives’ questionnaires sent out by the registered manager was examined. Although the information had been put into percentages, there was no action plan in place detailing how any short fallings were to be addressed i.e. 70 of relatives stated that they were satisfied with the amount of time and attention paid by carers, but there is no plan relating to how this figure will be improved upon. The manager said that questionnaires are due to be sent in September 2006 and that this time they will be for residents as well as relatives. A report of these findings and the accompanying action plan must be forwarded to the Commission. The registered manager was able to demonstrate through the production of certificates that all relevant safety checks were regularly undertaken, except for the PAT testing, which was out of date and which she was in the process of ensuring was completed. The accident and incident book was examined. One resident was seen to have had five falls during July 2006 and there was no risk management plan in relation to this. The registered manager explained that the resident has Parkinson’s disease and that the GP has reviewed her medication, however, nothing further was put in place within the home to address this issue of how to manage and minimise her falls. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X 1 X X X X 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 Requirement The registered person must ensure that the care plans within the home are drawn up to demonstrate how individual residents needs in respect of health and welfare are to be met. This is in relation to care plans not containing all of the necessary information as detailed in the initial assessment. The registered person must ensure that all residents are registered with a GP of their choice and that they receive the necessary treatment and advice. This is in relation to the GP stating that not all residents are registered with the surgery and to complaints from relatives regarding residents healthcare needs not being adequately met. The registered person must ensure that the home is conducted in a manner, which respects the privacy and dignity of residents. DS0000017984.V305279.R01.S.doc Timescale for action 30/11/06 2. OP8 13(1) 31/10/06 3. OP10 12(4)(a) 30/09/06 Treetops Care Home Version 5.2 Page 24 4. OP12 16(n) This is in relation to one resident stating that the night staff can be upsetting, to residents waiting a long time for the callbell to be answered and to care staff talking amongst themselves rather than interacting with residents in the lounge area. The registered person must ensure that a programme of activities is arranged and that facilities for recreation are provided. This is in relation to only 15 hours of activity co-ordinator time being provided within the home, and to the lack of meaningful occupation provided in her absence. The registered person must ensure that care plans are updated to contain information on choices that are made and the action to address these needs. This is a repeat requirement with the previous timescale 31/03/06 not met. The registered person must ensure that any complainant is informed of the action taken in relation to that complaint within 28 days of the complaint being made. This is in relation to a concern expressed to the Commission by a recent complainant, that they have not received a response within the 28 day period which was on 01/09/06. The registered person must make arrangements, by training staff or by other measures, to prevent service users being DS0000017984.V305279.R01.S.doc 30/11/06 5. OP14 12(2) 30/11/06 6. OP16 22(4) 31/10/06 7. OP18 13 (6) 31/10/06 Treetops Care Home Version 5.2 Page 25 harmed or suffering abuse or being placed at risk of harm or abuse. This is in relation to one staff member not knowing the POVA procedure within the home and to an allegation of abuse not being reported or recorded. This is a repeat requirement with the previous timescale 31/03/06 not met. The registered person must ensure that the premises are kept in a good state of repair both internally and externally. This is in relation to the interior of the home being tired and worn and in need of complete refurbishment. The registered person must ensure that all parts of the care home are kept clean and reasonably decorated. This specifically refers to the odour and institutional feel of the bathing and toilet facilities. This is a repeat requirement with the previous timescale 30/06/06 not met. The registered person must make suitable arrangements by training staff or by other measures to keep the care home free from offensive odours. The registered person must ensure that odorous carpets are replaced. The home’s level of hygiene must be assessed and any shortfalls addressed. This is in relation to an apparent odour on the second inspection site visit, to clinical waste being Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 26 8. OP19 23(2)(b) 31/12/06 9. OP21 23(2) 31/10/06 10. OP26 13(3) &16(2)(k) 31/10/06 exposed in bathrooms, to food being ground into the carpet and furniture and to the general level of cleanliness within the home. This is a repeat requirement with the previous timescale 31/03/06 not met. The registered manager must ensure that at all times there are suitably qualified persons working at the care home in appropriate numbers for the health and safety of residents. This is in relation to a number of resident s stating that the staff are sometimes too busy to attend to their needs and to long waits for the call bell to be answered. The registered person must ensure that all staff members are appropriately trained. This is a repeat requirement with the previous timescale 31/03/06 not met. The registered person must ensure that all of the specified documents are in place prior to a new employee beginning work within the home. This is in relation to one of the staff files examined showing that the employee began work prior to their CRB check. The registered person must establish a system for reviewing the quality of care provided at the care home in consultation with service users and their representatives. The registered person must supply the commission a report in respect of any review of the Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 27 11. OP27 18(1)(a) 30/10/06 12. OP28 18(1)(c) 30/11/06 13. OP29 19 Sch 2 30/09/06 14. OP33 24(2)(4) 31/12/06 quality of care provided at the care home. This is a repeat requirement, which has been partially met. An action plan needs to be drawn up demonstrating how improvements will be made and this must be forwarded to the Commission. The registered manager must ensure that all care staff members receive regular formal supervision and that this is documented appropriately. This is in relation to there being evidence that eleven staff members had received supervision during 2006, but to there being no further evidence to demonstrate that other care staff had received formal 1:1 recorded supervision. This is a repeat requirement with the previous timescale 31/01/06 partially met. The registered person must ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. This is in relation to risk assessments being too brief and not being accompanied by thorough risk management plans. It is also in relation to residents with a high amount of falls not having a risk strategy implemented to address this. 15. OP36 18 (2) 31/01/07 16. OP38 13(4) 31/10/06 Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 28 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 OP9 Good Practice Recommendations The registered person is advised to ensure that in line with The Royal Pharmaceutical Society guidelines, all handwritten medication profiles are overseen by two people and signed accordingly by the two people involved. Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Treetops Care Home DS0000017984.V305279.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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