Inspection on 15/11/07 for Treetops Care Home

This inspection was carried out on 15th November 2007.

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 16/04/07

Treetops Care Home 01/08/06

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 Ann Davey Unannounced Site Inspection 08:00 15th November 2007 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.V349872.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.V349872.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 treetopsepping@yahoo.co.uk Epping Care Home Ltd 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.V349872.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) 16th April 2007 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. Epping Care Home Ltd owns the home 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 floor levels, which are serviced by passenger lifts. Premises refurbishment work is currently taking place. The home provides a residential care service for older people. The fees at Treetops Care Home range from between £550.00 and £600.00 per week. This information was provided on 15th November 2007. There are additional charges for items of a personal nature. These should be discussed directly with the home. The home has a Statement of Purpose and a Service Users Guide. Copies can be obtained from the home. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced site visit that started at 8am and finished at 5pm. On this occasion, two inspectors carried out the inspection. The last key inspection took place on 16th April 2007. Following that inspection, the Commission requested an Improvement Plan from the registered provider. Information about what has improved in the home and what regulatory shortfalls remain outstanding, are referred to below and within the body of the report. The home had completed and returned their Annual Quality Assurance Assessment (AQAA) to the Commission prior to the inspection. This document gives homes the opportunity of recording what they do well, what they could do better, what has improved in the previous twelve months as well as their future plans for improving the service. The home’s manager, deputy manager, an external social care consultant (employed/retained by the registered provider), staff and residents were spoken with during the inspection. Opportunity was also taken to speak with the registered provider who was in the home briefly during the morning. The Commission received completed surveys from one health care professional, four members of staff and eleven residents. Three of the surveys from residents stated they had been completed with the support of relatives and seven stated that they had been completed with the support of staff. Comments from these surveys have been included within this report. A partial tour of the home took place. Care practices were observed and a random selection of records viewed. A notice advising any visitors to the home that an inspection was taking place was displayed. The notice gave an open invitation for anyone who may like to speak with the inspector to make themselves known. Nobody took up this offer. All matters relating to the outcome of the inspection were discussed in full with the manager. In addition, the social care consultant and/or the deputy manager were present during most of these sessions. The manager and /or the deputy manager took notes so that development work could be started. Full opportunity was given to all parties involved in the inspection process to ask for further discussion and/or clarification both during and at the end of the inspection. At the end of the inspection the manager said that the inspection process had been fair. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A number of improvements have been made since the last inspection. The provision of a social care consultant has meant that management systems have/are being reviewed. Plans are in place for further management review and monitoring. There are no immediate plans for this arrangement to cease. The role and responsibility of one of the two deputy manager’s has been defined as ‘project leader’ for the premises refurbishment’. This has meant that there is a clear and detailed schedule of works in place and regular progress audits are undertaken. This arrangement is working well and residents when spoken with had an understanding of what was happening. Medication administration recording processes have improved, but further work is required Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 7 At this inspection corridors, walkways and communal areas have been cleared of all clutter and storage. The home feels lighter, brighter and more pleasant especially on the lower floor area of the home. The outside grounds had also been cleared and looked neat and tidy. Records containing what residents had eaten were available for inspection. The content of the home’s Statement of Purpose and Service User’s Guide has been reviewed and updated. Information about the home is now current. The atmosphere within the home seemed more relaxed and comfortable than at the last inspection. What they could do better: The inspection identified a number of regulatory shortfalls that must be addressed for the well being of residents. These shortfalls were identified from viewing a random selection of records, from discussion, from completed surveys and from direct observation. Some shortfalls have been outstanding for two/three inspections. Details of all shortfalls have been detailed within the body of the report and are summarised in this section. Care plan documentation does not detail assessed care needs, how they are to be met and who by. Risk assessment documentation identifies the ‘hazard’, but does not inform how the risk is going to be minimised and who will action it. The current activities programme provided by the home does not meet residents’ expectations. There is a general lack of creativity, experience and skill in this area. The standard of cleanliness and hygiene within the laundry and communal bathroom areas in particular is very poor. The management of infection control and cross contamination measures is totally inadequate. It is not acceptable for the home to be without an adequate hot water supply from mid morning until mid afternoon. This leaves residents at potential risk of infection/viral infections and denies them choice of when to bathe. There have been improvements where management support has been provided. In areas where this has not happened, shortfalls remain. It is important that the current management structure is further reviewed and appropriate management training is provided to ensure that regulatory shortfalls are addressed. The registered provider and the manager submitted an AQAA (see above) after the last inspection and before this inspection. Information within the document was at variance with the findings during the inspection. Details are within the body of this report. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 8 Following the last inspection, the registered provider and the manager provided an Improvement Plan. This document provided dates when shortfalls identified at the last inspection would be addressed. Information within the document was at variance with the findings during the inspection. Details are with the body of this report. The home has not met its own stated timescales. 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 Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 9 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.V349872.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (standard 6 is not applicable in this home) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their care needs assessed by the home prior to admission to ensure that their needs can be met. Residents can expect to receive current information about what the home can provide. EVIDENCE: Two sets of pre assessment records were viewed. Both records contained information from the placing authority and the home’s pre admission assessment documentation was in place. The manager acknowledged that some aspects of home’s pre admission format had not been completed in full. For example, social care needs. The manager reported that the home’s Statement of Purpose and Service User’s Guide has been reviewed and amended to ensure that the information within these documents is current. On this occasion, the inspectors did not view these documents. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that their care plan documentation will identify all their care needs. Neither can they be assured that their risk assessment documentation and/or their medication administration instructions will be robust. Residents can expect to have their health care needs met. EVIDENCE: Two sets of care plans and risk assessment documentation were viewed. The first care plan contained text under the following four headings, ‘medical conditions’, ‘mobility’, ‘personal care’ and ‘elimination’. The information recorded did not make reference to all aspects of care as detailed in the national minimum standards (standard 7). For example, there was no reference to social activity or specific diagnosed medical conditions as referenced on the pre-admission assessment. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 12 The pre-admission assessment recorded that there was a risk of falls. There was no risk assessment in place. Documentation identified that there was also a risk of this residents injuring their legs on the wheelchair footplate but there was no risk assessment in place. On the second care plan, the headings used were ‘medical conditions’, ‘mobility’, ‘toilet care’, ‘personal care’ and ‘breathing (oxygen)’. As on the first care plan, these aspects did not reference all aspects of care. This resident required the input of a community nurse, but the reason for this had not been recorded on the care plan. There was conflicting verbal information and recorded information about tissue viability. The risk assessment(s) in place for the use of bed rails and the use of oxygen were inadequate. The risk assessment documentation identified the hazard but did not provided any control measures. For example, the degree of risk and who was at risk, and how the risk could be minimised/eliminated. It was noted that these care plans had not been endorsed by the respective resident and/or a relative. The current situation as referenced above places residents at potential risk. Documentation does not identify all known care needs and information about how to manage known risks is inadequate. Without full and detailed information staff may not know what the care needs are, how to meet the needs and/or how to manage known risks in a safe manner for the wellbeing of residents. The manager and the consultant viewed both sets of records with the inspectors. It was agreed that the findings were accurate. The home’s Improvement Plan advised that systems to ensure that satisfactory care plan and risk documentation would be in place by October 2007. The manager advised that the care plan and risk assessment documentation seen on the day had been completed by herself. Within the home’s AQAA, under ‘what we do well’ was recorded ‘develop care plans that take account of the parameters as laid down in standard 3.3’ and ‘care plans that are factual and explanatory’. These were not the findings of the inspectors during the inspection. Within care plan documentation there is a place to record visiting health care professionals visits. There had been recent entries. The manager said that the home has a good working relationship with all health care professionals. An assessment of medication practices on the ‘middle floor’ was undertaken. The senior member of staff who accompanied the inspector and demonstrated a good understanding of medication practices. Since the last inspection, one aspect of medication practice has improved. This is with regard to handwritten medication administration entries that are now being endorsed by two Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 13 members of staff. One record stated that a resident ‘self administers’ three medications. A risk assessment document format was in place, but on it was recorded ‘resident is not self-medicated’. The documentation in place and the current practice was contradictory. This practice places residents at potential risk. The senior member of staff could provide no explanation. The manager said that they were unaware of the situation. The home’s Improvement Plan advised that a system would be in place by October 2007 to ensure that medication practices met regulatory requirements. This was not the finding of the inspectors. Medication administration recording sheets and the storage of medication were in good order. Care practices during the morning period were observed. Staff were assisting residents with their breakfast that was being served in their respective bedrooms. Conversations were warm, respectful and friendly. Care practices were undertaken in sensitive and appropriate manner. During the lunchtime period staff were attending to residents in an appropriate manner. Information within a health care professional’s survey indicated that in their opinion, residents are supported and the care in the home has improved since the last inspection. It was recorded that the home seeks necessary health care advice and there was a good working relationship. The same survey also recorded that staff need more information and training sessions on pressure care, catheter care, mental stimulation and outings. Information within staff surveys indicated that some staff thought there was ‘sufficient verbal and documented information given about resident’s care’, whilst others did not. Some staff recorded that care needs are not fully assessed prior to residents being admitted. Information within residents’ surveys was mixed. For example, some thought there was ‘sufficient support from staff’, whilst others did not share this view. All felt that they receive good medical support and that staff listen to them. Terminology within care plan documentation was dignified and respectful. However, the terminology used within records associated with activities provided by the home was not. This has been referred to in the next section of this report. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 14 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. 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. Residents can expect to receive a balanced diet but cannot be assured that the home’s activity/social programme will meet their expectations. EVIDENCE: There was little evidence that much progress has been made by the home on providing a varied, stimulating and meaningful social activities programme for residents. The manager said that some progress has been made in that the activities coordinator now spends some time with the more dependant residents on a one to one basis. The manager acknowledged that staff have not received any specific training in this area. Clearly some corporate activities take place such as ‘bingo’ and ‘watching a DVD’, but records demonstrate little in the way of imagination or creativity. One resident said’ I do whatever the organiser is doing, sometimes it’s cards or bingo’. One resident said that they liked to play Scrabble but had been unable to do so for some time now, another resident confirmed that they receive a daily newspaper. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 15 Corporate records show that the main activities are bingo, card games, snakes and ladders and watching a film. Records did also show that some residents had been supported by staff to visit the local shops. As referred to in the previous section of this report, some terminology was inappropriate in the activity record. Entries such as ‘X stayed in (their) room moaning’, ‘general conversation, well educated’ and ‘still annoying staff this pm’ were noted. This style of recording signifies a lack of respect for residents and these comments are not dignified. These findings were discussed with the manager who said that they took responsibility for the monitoring of this record. There was evidence that family and friends of residents visit the home. During the inspection a number of visitors were around. Within staff, the health care professional’s and residents surveys, all indicated that activities within the home did not meet expectations. The home advised within their Improvement Plan that a full audit of activities would take place and would ensure that all residents have an activity plan by October 2007. The document also states that there would be ‘ clear recording and documentation of activities programme which demonstrates equal opportunities and identifies unmet needs’. Within the home’s AQAA under ‘evidence to show what we do well’ it was stated ‘social care assessment’. The inspectors’ findings on the day did not support the information within the submitted AQAA. Within residents’ surveys, there were comments such as ‘lack of activities’, ‘no external outings’, ‘just sit in lounge all day and bored’. Through observation of practice during the day, residents were offered choice about what food they preferred. It was difficult to assess the degree of choice and control residents have over other aspects of their lives within the home. This was because this aspect of care was not adequately detailed on care plan documentation. Breakfast served to residents in their bedrooms and they reported that they were happy with this arrangement. Breakfast looked appetising and there was choice. For example, there were drinks, sandwiches, toast, jam/marmalade, porridge, tea/orange or cornflakes. There was hot or cold milk. At the last inspection it was noted that a member of staff was holding a piece of toast in their uncovered hand whilst putting a topping on it. The same practice was observed at this inspection. At lunchtime, residents had a choice of fish or cottage pie. The presentation of food looked appetising. Staff were observed to be assisting residents in a sensitive manner. Positive comments such as ‘the food is very good, you can’t Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 16 fault it’, ‘we always get a choice and it’s hot’ and ‘I always have breakfast in my room, it is lovely porridge’ were received from residents. Information within residents’ surveys indicated that their expectations concerning the choice and quality of food provided was met. Following the last inspection, the manager said that there has been a review of how nutritional records are completed. The inspectors viewed the records for the current week. Apart from two anomalies, records were in good order. The manager acknowledged that it is important that these records should monitored more closely to ensure that they are kept in accordance with regulatory requirements. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their complaints taken seriously and be protected by the home’s safeguarding adults from harm procedures. EVIDENCE: The complaints procedure was displayed but not viewed by the inspectors on this occasion. At the last inspection the manager was asked to review and amend the complaints procedure to bring the content in line with the Commission’s current guidance. Staff spoken with said that they knew how to deal with any complaint a resident might make. The manager said that no complaints have been received by the home since the last inspection. All residents (with the exception of one resident) and staff within their respective completed surveys indicated that they knew how to make a complaint. From observation of discussions between staff and residents on the 1st floor during breakfast time, residents were speaking freely to staff. There was no sense of residents not being happy to speak up for themselves. Staff spoken with knew how to respond appropriately to any suspected safeguarding adults from harm incident. There were no negative comments from residents on the day about how they are treated by staff. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home where improvements to the décor and furnishings are being made. Residents cannot be assured that all areas of the home are clean and hygienic. EVIDENCE: On arrival a partial tour of the home was made. It was positive to note the improvements since the last inspection. Corridors, doorways and stairwells were clear from storage, clutter and obstruction. The ‘garden’ floor in particular was much more orderly. Those bedrooms seen were personalised and comfortable. The dining area was made up of tables for 4/6 residents rather that a refectory style arrangement as on the previous visit. Many areas of the home were brighter and more orderly. Linen and towels were tidy and organised in cupboards. Window opening restrictors are now functional in the dining area. The home was free from any unpleasant odours. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 19 Some aspects of the home still need attention. For example in the staff room, there were 10 televisions piled up and there was an ‘unguarded’ radiator on a stairwell. There was a yellow ‘wet floor’ caution notice cone placed in the middle on the top step that is a designated fire exit route. The manager agreed that the walls around the home particularly in communal areas, are cluttered with notices, some are outdated. The manager assured that as part of the refurbishment, this practice would be reviewed. The outside area to the front, rear and side of the home had been cleared and the grounds were neat and tidy. There was evidence of building upgrade work in progress. By the end of 2007 the home will have a new hallway, new reception/entrance area and a new office. Following completion of this work, the deputy manager (who has specific responsibility for the building project) advised that a schedule of works is in place to refurbish and redecorate the whole home. The deputy manager regularly audits progress on the work that is due for completion in Spring 2008. The home has also employed the services of an interior designer. During the tour of the home the following was noted and/or established. Staff advised that there is usually no hot water in the home after 10am until late afternoon. The temperature of hot water tested in bathrooms at around 9am was no warmer that 38 degrees centigrade. Staff said that some residents are unable to have a bath until later in the day. The manager confirmed the findings and said that it had been a problem long before the commencement of the building work. This situation is not acceptable as there are hygiene implications and residents cannot choose when to have a bath. A bathroom selected at random on each floor was viewed. In each bathroom the sealant around the tiles and bath area was missing or in a poor state of repair. Ingrained dirt was evident along the skirting boards. In one bathroom there was no toilet seat, the toilet pan was dirty and there was no lid to the bin. Tiles were damaged and the window could not be closed. In a bathroom on the lower floor, there were wooden chairs with stained and dirty seat cushions to sit on. There was a bin with a bright yellow bin with the word ‘HAZCHEM’ on it. In the room that houses medication, the sealant around the sink was in a poor condition, the tile grouting was ingrained with dirt and there was no lid on the waste bin. Used medication pots had been left in an unclean sink. The laundry area was untidy, unkempt and dirty. Staff in the laundry area confirmed that there are no infection control, cross infection polices or safe working practice documentation in that area. The laundry person was wearing a cloth tabard and said that although plastic aprons are available, they are not worn. There was a basket containing a pile of communal net supports for Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 20 keeping incontinence pads in place. Washing powder was left uncovered and the sink was stained and dirty. The floor and work top surfaces were unclean and strewn with items such as odd clothing garments, hangers, pieces of tissue and spilt washing power. The second floor kitchenette facility is in the process of being refurbished and had a sign on the door to say that the room was out of service. The door was open and inside there was an assortment of building and decorating equipment. This posed a risk to residents’ safety. Within the Improvement Plan it was recorded that the manager would complete full audits to ensure that the home is clean. These audits were to be in place by August 2007. The manager said that audits are carried out by in person on a daily basis. The home’s AQAA states that all bathrooms are cleaned daily. Bathrooms were not clean at the time of the inspection. Information taken from staff surveys indicated equipment is not always in good working order and the sluice ‘is not good’. Residents in their surveys said that furniture was left in a dirty state and food was left down chairs. Mention was also made of the ‘state of the building during building work’. A resident also mentioned to the inspector during the inspection about how noisy the building work was. A full discussion took place with the manager about these findings. The Commission acknowledges that there are plans to upgrade many aspects of the building. However, the registered provider and the manager have a statutory obligation to ensue that all areas of the home are managed in a hygienic manner and that infection control/cross contamination measures are in place. The manager advised that premises audits are undertaken but acknowledged that they should be more robust. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 21 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. 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. Residents can expect to be cared for by a team of established staff. Residents cannot be assured that staff will be aware of their assessed needs. EVIDENCE: On the day of inspection 42 residents were accommodated. There was evidence on the day of inspection to indicate that the staffing levels were sufficient to meet the immediate presenting needs of the current number of residents. As noted in the daily activities section of this report, care plans and risk assessments did not identify the full range of care needs each resident is know to have. For example, being given a choice of meaningful social activities both within the home and outside in the wider community and being able to have the flexibility of taking a bath when they wish. A clear staff rota was available for the presenting week. The deputy manager confirmed that there is a minimum of seven senior/care staff on duty between 7.30am – 9pm, seven days a week. The home employs a laundry person seven days a week, a handyman is employed 8.30am – 2pm five days a week and cooking staff and/or kitchen assistants are employed 6.30am – 5.30pm seven days a week. An activities coordinator is employed 10am – 3.30pm five days a Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 22 week. Domestic staff are employed 7am – 2.30pm seven days a week. The duration of some shifts vary. A gardener is employed 9am – 2pm three times a week. In addition, the rota recorded the hours worked by a receptionist, the manager and the two deputy managers. Staff on duty during the day reflected the information on the rota. Unless the full needs of all residents are assessed and recorded, it would be difficult for the home to demonstrate that sufficient staff are/would be on duty at all times to meet the needs of residents. It was understood that one of the deputy manager’s role and responsibility was to manage the overall refurbishment of the premises. There was a clear audit trail demonstrating that this was being managed well. Staff reported that most have worked in the home for lengthy periods of time. This means that there is consistency of service delivery for residents. Staff also said that they had seen improvements in the home since the last inspection. Examples given were in connection with more training being provided and the ‘flow’ of information between staff is better. There was a staff training and development plan in place for the forthcoming year. Evidence was available to demonstrate what training staff had attended this year. Information was given on the document about moving and handling training due the following week and medication training due in December. The manager agreed that there is a clear need for (identified) staff to attend training in relation to activities for residents. This was raised at the last inspection, but there was evidence to show no progress has been made by the home. The manager reported at the inspection that 70 of care staff have achieved NVQ level 3. On this occasion, inspectors did not request evidence of this. The records of two recently recruited members of staff were viewed. Both records were in order and contained the required documentation. A discussion was held with the manager about the verification of reference by telephone. The manager advised that this was usual practice, but on these two occasions, it did not happen. Staff spoken with had an acceptable understanding of residents’ needs, but this is not supported by the home’s documentation system. For example, staff were aware that X could self-administer medication, but information on records concerning this matter this was conflicting (see standard 9). Staff do not have sufficient written information about residents needs and therefore must be unable to provide a totally holistic approach to their care (see standard 7). Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 23 Staff spoken with during the day were friendly, helpful and cooperative. All staff spoken with said they were happy to speak with the inspectors and indicated that they felt comfortable in doing so. Staff were observed to speak with residents in a friendly manner and assistance given was supportive and caring. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home where some management systems are improving and/or developing because of additional external support. Residents cannot be assured that all aspects of their day-to-day care are managed robustly. EVIDENCE: Following the last inspection, the registered provider has employed the services of an external consultant. It was explained by the manager and the consultant that this is to support the manager in reviewing current practices and implementing systems to ensure that the home meets regulatory requirements in the future. In addition, one of the two deputy’s main brief is to oversee the whole premises refurbishment. From various discussions with the Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 25 manager and deputy manager and through evidence in documentation, both these aspects have progressed since the last inspection. The inspectors met briefly with the registered provider. It was confirmed that a consultant from H.C.S. Management Consultants had been retained to assist with bringing the home up to regulatory standard. Other aspects of management in the home remain unsatisfactory. For example, care plan documentation following an admission to the home is poor, daily premises audits to ensure that the home is clean are not identifying issues, the monitoring of terminology within activity records is not robust and medication administration recording system audits have shortfalls. All these matters have been referred to within the body of this report. The manager reported that these systems are in place, but from the inspectors findings the audits and reviews being carried out are not effective. The outcome is that residents live in a home were the day-to-day management systems are not robust. The manager advised that apart from updating moving and handling training, there are no plans to undertake any further management training. The manager advised that the home carries out a quality assurance exercise twice a year. There was evidence that surveys have been received to feed into the next report. The manager was advised that staff should also be independently surveyed. The manager said that it was current management practice to talk about quality assurance issues during supervision sessions. The records of residents’ personal monies held by the home were viewed at the last inspection and were satisfactory. The manager said that the arrangements for accessing monies is now documented within the home’s Statement of Purpose and Service User’s Guide. Records demonstrated that the home undertakes regular checks on fire systems, emergency lighting systems, call bells and fire alarm tests. This ensures that the home knows that these systems are fully functional. There was a current Environmental Health report on file. The report highlighted some aspects of the home that were not clean during their visit. For example, the fridge, staff tea/coffee making area and electric fans. Universal environmental risk assessments were in place. For example televisions, gas boilers and light fittings. The home had a risk assessment for the laundry area and for ensuring that oxygen is stored safely. However, this information had not been transferred to the point of delivery. For example, the laundry and in the care plan/risk assessment for the resident was on oxygen. The registered provider retains the services of an external consultant to undertake the Regulation 26 visits (monthly visits to the home and a copy of a Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 26 subsequent report goes to the registered provider to inform of the conduct of the home). The inspectors obtained copies of the reports for May, June, July, August, September and October 2007. These records show that up to three visits to the home have been made during some months. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 3 3 2 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 12,13,15 Requirement Every resident must have a detailed current care plan in place. This document must include all aspects of health and welfare, medication administration, adequate risk assessments and demonstrate that residents has been consulted about their personal choice, control and preference to ensure residents’ assessed needs are addressed. The previous timescale of 31/05/07 to meet this requirement has not been achieved. The current presenting social/recreation/occupational programme must be reviewed to ensure that all residents are consulted about what they would like to do and have the opportunity to participate according to ability and choice. The previous timescale of 31/05/07 to meet this requirement has not been achieved. Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 29 Timescale for action 31/01/08 2 OP12 OP13 OP14 16 31/01/08 3 OP19 OP25 OP26 23 All areas and facilities within the home must be kept clean and hygienically maintained. There must be an adequate supply of hot water that is kept at an appropriate temperature at all times. Infection control and cross contamination measures must be put in place. The previous timescale of 31/05/07 to meet this requirement has not been achieved. Arrangements must be made for the home to provide suitably qualified persons working at the care home in sufficient numbers for the care, health and safety of residents at all times. Identified areas of the home were not clean for residents to use. Current staffing arrangements do not meet residents’ expectations concerning social activities. The previous timescale of 31/05/07 to meet this requirement has not been achieved. Management systems must be in place demonstrating that all matters relating to the health, care, welfare and safety of residents are managed, monitored, reviewed and addressed for the wellbeing of residents. The previous timescale of 31/05/07 to meet these requirements has not been achieved. 31/01/08 4 OP27 OP30 18 31/01/08 5 OP31 OP33 OP38 12,13,15, 16,18 and 23 31/01/08 Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Treetops Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Care Home DS0000017984.V349872.R01.S.doc Version 5.2 Page 32 - 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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