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Inspection on 16/04/07 for Treetops Care Home

Also see our care home review for Treetops Care Home for more information

This inspection was carried out on 16th April 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents looked well cared for. Those pre admission assessments available were in good order, as were daily care records. Interaction and rapport between residents and staff was good. Staff looked professional in their uniforms. Lunchtime food looked good. Breakfast and lunch was unhurried. The `feedback` in terms of the home`s cooperation with local authority staff and community nurses was positive. Staff spoken with had a good understanding of residents presenting care needs.

What has improved since the last inspection?

There is now an `organised` activity each weekday afternoon for the more able residents. Some redecoration and refurbishment work has started. Mandatory staff training has improved. Staff had a better understanding of suspected Adult Abuse reporting procedures.

What the care home could do better:

Pre admission assessments must be undertaken and appropriate documentation should be completed at all times. Care plan and risk assessment documentation remains inadequate. Residents rights to dignity should be reviewed. Some aspects of medication practice requires improvement. There must be a better approach to an appropriate social and leisure activities/programme especially for the less able residents.The environment remains in the main tired and worn. The home remains in need to of a complete internal maintenance and refurbishment programme. Some aspects of the home remain grubby in appearance and were not homely. There were a number of physical hazards in the home and was a lack of risk assessments. Some staff continue to work `double shifts`. Although staff supervision is reported to take place, there was little evidence that management provides `hands on` supervision. Some shortfalls were known to the manager but had not been addressed and/or monitored, whilst others had not been `picked up` by the management.

CARE HOMES FOR OLDER PEOPLE Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH Lead Inspector Ann Davey Unannounced Key Site Inspection 16th April 2007 08:50 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.V335130.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.V335130.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 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.V335130.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) Key inspection – 1st & 21st August 2006 Random inspection 15th November 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 £550.00 and £600.00 per week. This information was provided on 16th April 2007. Items not covered by additional costs were not identified in the home’s current brochure. It was understood that most of the beds within the home are contracted with social services. Treetops Care Home DS0000017984.V335130.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. Two inspectors carried out the inspection. A partial tour of the home was made. Staff on duty were spoken with and time was spent with some of the residents accommodated. In addition a visiting community nurse was spoken with and the views of a local authority team leader was sought. Care practices were observed and a random selection of records was viewed. The Commission would acknowledge the cooperation of the home concerning the completion and returning of the pre inspection questionnaire in a very short time frame. The Commission also received 13 completed positive anonymous surveys from residents. It was understood that these had all been completed by a member of staff following her consultation with residents. The home had also placed surveys in the main entrance hallway for relatives to complete if they wished. The home was friendly, hospitable and cooperative towards the inspectors. The inspection process was carried out with no problem and the cooperation of all those involved was appreciated. On the day of inspection there were 35 residents accommodated. In December 2006, the Commission received a document from the home stating that care plan documentation would be improved through staff training by November 2006, this was not evident at the inspection. The poor standard of furnishings, décor and maintenance was also noted at the last inspection and the document from the home gave assurances that ‘a complete refurbishment of the home will take place shortly’. Although some work has begun, much of the home in terms of decor, furnishings and maintenance does not meet registration standards. The document also stated that ‘new risk management plans’ would be introduced into the home by November 2006. It also said that ‘senior staff have been trained in their use’. This was not the findings on inspection. All matters relating to the outcome of this inspection were discussed with the registered manager and deputy manager and they took notes. Full opportunity was given for discussion and/or clarification both during and at the end of the visit. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Pre admission assessments must be undertaken and appropriate documentation should be completed at all times. Care plan and risk assessment documentation remains inadequate. Residents rights to dignity should be reviewed. Some aspects of medication practice requires improvement. There must be a better approach to an appropriate social and leisure activities/programme especially for the less able residents. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 7 The environment remains in the main tired and worn. The home remains in need to of a complete internal maintenance and refurbishment programme. Some aspects of the home remain grubby in appearance and were not homely. There were a number of physical hazards in the home and was a lack of risk assessments. Some staff continue to work ‘double shifts’. Although staff supervision is reported to take place, there was little evidence that management provides ‘hands on’ supervision. Some shortfalls were known to the manager but had not been addressed and/or monitored, whilst others had not been ‘picked up’ by the management. 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.V335130.R01.S.doc Version 5.2 Page 8 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.V335130.R01.S.doc Version 5.2 Page 9 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 & 3. Standard 6 does not apply to this service Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Initial assessment documentation ranged from good, to not available. Therefore staff did not have adequate information to provide care. The home’s Statement of Purpose/Service Users Guide/Brochure does not reflect the current arrangements regarding residents’ personal allowances. EVIDENCE: Three pre admission assessments were requested and sampled. Two were adequately detailed, but there was no documentation for the third. It was understood that the third resident had been admitted under a ‘private arrangement’. Any resident admitted to the home regardless of status or funding arrangements must be properly assessed to identify care needs and for the home to consider whether or not the identified care needs can be provided. The home should also ensure that resident’s wishes, preferences and views are clearly recorded on pre admission documentation. This was not evident. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 10 The home’s Statement of Purpose/Service User’s Guide/Brochure requires a review and update to reflect the current arrangements regarding residents personal allowances. At present, residents can only access their full personal allowances Monday – Friday 10am – 4pm. And this is not clear in current documentation. The home does not provided intermediate care. Treetops Care Home DS0000017984.V335130.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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans did not always identify care needs or how identified care/health needs could be met. Therefore, staff did not have adequate information to provide the required care. Community health care support links are accessible. Medication practices in the main were adequate. Privacy issues were observed to be upheld. EVIDENCE: Four residents case records were tracked and a further five were also assessed. Records evidence that there are adequate community health care support links. Identified care/health needs on the pre-admission documentation had Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 12 not always been recorded on care plans. For example, one resident was on Warfarin (blood clotting medication) yet there was no reference to this on the care plan. Another resident is insulin dependant, but the care needs associated with this medical condition had not been recorded. One resident was known to be suffering from depression on admission, but this care need was not recorded adequately on the care plan. The National Minimum Standards is very clear about what aspects of care need to be considered when forming records i.e. 13 various elements, yet plans of care seen covered as little as only three aspects. Risk assessments were not adequate. For example, there were no risk assessment for the resident who was on Warfarin, no risk assessment for a resident who had a bed rail in place, no risk assessment for the resident who had previously had pressure sores. One resident in an attempt to negotiate three steps was observed on four occasions to ‘throw’ her walking aid down the steps and with two hands holding onto the banister, negotiated the steps. To get back up, the procedure was reversed. No risk assessment was available. This was discussed with the manager who said that she was aware of this practice. One resident was known to have a challenging behaviour pattern, yet there was no evidence of any aggression management techniques in place. Neither was there any reference in the care plan to help staff provide an adequate response when this had been necessary. Accident records had been completed, but not linked with care plan documentation. For one resident was noted to have a swelling and a GP intervention was considered necessary. No final outcome was recorded. In another accident record, an injury happened to a resident who was on a drug which could affect the blood clotting mechanism, yet nothing had been recorded to reflect that this fact had been considered. It was noted that the home’s daily personal records on each file tracked was good in detail and the home was complimented on this. This was also reflected in the inspector’s conversation with a local authority’s team leader. However, information on care plans, risks assessments and the general cross-referencing of personal care/health information was poor. The current situation places residents at potential risk because identified care/health needs have not been adequate recorded and therefore staff have no written guidance or instruction about how to meet the needs. Many of the above matters were raised at the last inspection. The visiting community nurse said that in her opinion, the standard of care provided by the home had improved in recent months. Staff spoken with did have an adequate understanding of resident needs despite the lack of detail Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 13 within documentation. Care practice observed during the day was sensitive and natural. It was also positive to observe the good rapport between staff and residents especially over the lunch time period. Those residents spoken with were happy with their care. During the afternoon staff were engaging well with staff in the main lounge area. However, staff were not observed to routinely attend to residents who were using the bedrooms during the daytime period. The main activity with staff/residents was in the main lounge area. Medication storage was appropriate and an audit of the controlled drugs held by the home was satisfactory. However, the home must review some medication administration recording practices. For example, handwritten (by staff) medication administration instructions had not been signed, ‘PRN’ (as/when necessary) protocols were not available, a risk assessment for selfadministration of medication was not available and the ‘quantity’ column on the administration records had not been completed. Records state that staff that have a responsibility for drug administration have received training. Therefore, the home is advised to review training and/or reassess staff competencies. Current practice places residents at potential risk. The home will need to reconsider their polices and procedures in upholding residents rights to dignity. During the morning, one of the main communal toilets had no toilet paper in it and the facility next door had no hand drying facility. In the first facility, a pile of female underwear and personal items was left on the shelf all day. Around the home communal toilet/bathroom facilities had items of personal clothing and possessions left on shelves and windowsills all day. At mealtimes residents wore blue plastic aprons as a means to protect their clothing. These practices are not dignified. Treetops Care Home DS0000017984.V335130.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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improved, the current of activities is not sufficient to meet all residents’ needs. Family links are encouraged. Records did not demonstrate that residents are asked about likes/dislikes/preferences etc The community is not easily accessible to residents. Food presented on the day looked good, but there are no records to demonstrate that an adequate and varied diet is provided. EVIDENCE: The home now has 2 part-time activity coordinators. This means that there is an organised activity in the home for the more able residents every afternoon Monday-Friday. This aspect of care was not however reflected in any care plan assessed. In speaking with one of the coordinators (and later the manager), there was some confusion about what activities/occupation is provided for the less able residents. There was a folder available with leaflets and brochures in about events etc, but the lack of any reference to the aspect of care on care Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 15 plans or any other form of record made the assessment of the standard very difficult. Suffice to say, the organised ‘bingo’ session during the afternoon was thoroughly enjoyed by the 13 residents sitting around the table. There was no evidence that residents are taken out into the community by the home or are asked if they would like to go out. There was no reference on any care plan seen that the home had considered residents spiritual preferences and/or wishes. One resident does attend church, but apart from this, there was no documentary evidence to support that the home considers this aspect of care. There was no reference on care plans that residents had been asked about preferences etc, therefore, how the home generally meets residents’ rights of choice and control was not clear. Routines in the home were observed to be task orientated, residents were not observed to be given any choice about what was going on/happening. Upon request for the home’s nutritional records, the inspector was given three records. These were in fact ‘choice of dish’ records. The manager said that the home does not keep any records to demonstrate that all residents are provided with an adequate and varied diet. This aspect of care was not recorded on care plans. There was no record to evidence how good/bad individual appetites were and the home could not provide any ‘fluid charts’ when requested. However on arrival, breakfast was being served to residents in the bedrooms. The process was unhurried, but one member of staff was observed to be holding toast in the hand whilst buttering it. The home should review their policies about handing food. Lunchtime was clearly a most pleasant and enjoyable experience for residents. There was choice and when one resident expressed displeasure about what had been served, the matter was quickly and sensitively dealt with and an alternative was presented. Portions were of a good size and the food looked appetising. Staff sensitively assisted residents and there was good rapport between staff/residents throughout the unhurried activity. It was also positive to observe that residents were asked if they would like some more. Tables had been laid nicely. Residents spoken with were happy about the food provided. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place. Staff have attended ‘Safeguarding Adults from Harm’ training courses. EVIDENCE: The home has a complaints procedure displayed on the wall. The content of this should be reviewed to bring it in line with the guidance sent to all homes by the Commission in recent months. The home has a designated record complaint book. Residents spoken with said that they would be happy to raise any issue of concern with a member of staff. Staff spoken with were familiar with current guidance should a suspected incident of abuse be detected. Records show that staff have attended training courses. The home has recently undergone a POVA (Protection of Vulnerable Adults) investigation because there had been 13 deaths in the home within a relatively short period of time. As part of the inspection process, the inspector spoke with the local authority team leader who is leading the investigation. The local authority is currently in the process of concluding the investigation and a report of their findings will be available. However, the local authority’s team leader said that the home managed the process of the investigation well and appreciated the cooperation of all those involved. The home has received a verbal feedback from the local authority’s findings, which indicates that no further action will be taken. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 17 This matter was discussed with the manager during the inspection. The openness of the home about this matter was appreciated. Treetops Care Home DS0000017984.V335130.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): 19,25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although some improvements have been made since the last inspection, the home is still not adequately safe, suitably maintained or comfortable in the main for residents. EVIDENCE: On arrival a partial tour of the home was made. A further partial tour was made during the afternoon. On the day of inspection, the home accommodated 35 residents. It was positive to note that during the day no malodorous smell was detected. The Commission would acknowledge that the standard of décor, maintenance and furnishings varies from floor to floor. The top floor was of an adequate standard, but other areas were not. The findings were discussed with the manager who agreed their accuracy. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 19 Apart from the very top floor, the rest of the home in the main is grubby, tatty, tired, worn out, unappealing and not homely. There was evident that as bedrooms are being emptied, some recordation and refurbishment is going on. No work was being undertaken on the day of the inspection. Bathrooms and toilets in the main were tatty and poorly decorated. Many had frayed towels, items of personal clothing, pieces of broken/old furniture in them. Bathrooms were not homely and often looked grubby. Many bedrooms still have ‘hospital style’ beds in them. Décor and furnishing throughout the home in the main was poor. Tables and chairs in the communal areas were tired and worn. Throughout the home in communal areas, bathrooms, toilets, stairwells, garden area, bedrooms, corridors etc, there are mattresses standing on end, bedsteads, broken pieces of furniture, wheelchairs, walking aids, boxes and/or piles of fayed towels and blankets, open cupboards etc. The home is totally cluttered with items of all shapes, sizes and descriptions. There is a complete lack of storage. There was no evidence of anybody managing the situation for the safety and wellbeing of residents or staff. The manager was told that the current situation is totally unsatisfactory as some areas of the home particularly corridors and doorways, have become so cluttered that there is a serious potential risk of obstruction in the event of a fire and/or a serious injury to a resident or member of staff. Furthermore, with so much stuff around, there is also the potential risk of accidental fire. The manager was advise to seek advise from the fire authority about the current situation which has occurred in the main because of the redecoration and refurbishment. However, in the meantime, Treetops is a registered care home for older people and must be maintained to an adequate safe and homely standard. The manager said that immediate remedial steps would be made. This matter was raised at the last inspection. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 20 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 & 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 care staff on duty was adequate to meet the recorded needs of current residents. Not all care needs were identified. The home’s recruitment practices were adequate. Staff training has improved. Staff were pleasant and care practice observed was good. EVIDENCE: On the day on inspection 35 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 current number of residents. Care plans did not adequately identify residents care needs, so the inspector was not sure how the home ensures that sufficient staff are on duty at any one time to meet all the needs of residents. Furthermore, all residents social/recreation needs have not been assessed/identified within care plans. Rotas demonstrate that some staff continue to work double shifts on a regular basis. The manager said that if staff want to do this, then it is allowed. As on previous inspections, the manager was advised that whilst there may be personal reasons for staff wishing to work such long hours, Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 21 the home’s primary concern must be for the welfare of residents not for the convenience of staff. Care work is physically exhaustive and demands mental concentration at all times. The manager was reminded again that the current situation is not good practice. Until the full care needs of all residents are assessed and known, it would be difficult for the home to demonstrate that sufficient staff are on duty at all times. Clearly, the domestic arrangements in the home are not adequate because many areas were grubby and unkempt. Staff looked clean and tidy in their uniforms. All very friendly, polite and courteous. The rapport between staff and residents was warm and natural. Staff took time to not only ‘talk’ to residents, but also to ‘discuss’ various matters with them. This was particularly evident during the lunch time period. Residents spoken with were positive about the current staffing group. The recruitment records of two staff were assessed. Both sets of records were in good order. Induction records were available, but had not been completed/signed by the respective member of staff. The home has updated its training programme and the matrix presented indicated that the home promotes good training opportunities. Whilst staff had a relatively good understanding of residents care needs, this is not supported by the homes documentation system. Staff do not have sufficient written information about residents needs and therefore must be unable to provide a totally holistic approach to care. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 22 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not run in the best interests of residents. Arrangements for the safety of residents are not adequate. Current arrangements for residents accessing their personal allowances are not adequate. Given the findings of this inspection, the management need to be more proactive. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager of the home is a registered nurse. At this inspection (as on the previous inspection), the manager stated that she does not intend to complete the Registered Manager’s Award. Considering the findings of the previous inspections, management systems within the home clearly need review, as matters identified at previous inspections then remain outstanding. When matters were brought to the attention of management by the inspectors, the manager gave the impression that individual members of staff had let the home down. The manager said these staff had received training. However, there was little evidence that much ‘hands on’ supervision, monitoring and assessing directly by management is taking place. If there is, then the effectiveness of this process needs review. On other occasions, the management was aware of shortfalls but had not rectified them. Issues such as inadequate care plans and very evident visible safety matters pose a serious potential risk to residents, yet there was no evidence of a management strategy to manage these matters. This is concerning as it has a direct impact on the way the home is run which at present can not be in the best interest of residents. Staff spoken with said that they found management approachable and supportive. A staff supervision programme was made available, but clearly the process of this needs to be reviewed. The home was able to demonstrate that is has an established Quality Assurance programme in place and hopes to develop this further in due course. The manager said that the registered person makes arrangements for a representative to undertake Regulation 26 Visits (visit by person in control), but couldn’t produce any reports because the home didn’t have any. These were later faxed to the Commission by the home. It was noted that those seen for this year were extremely brief in content and detail and therefore is the view of the Commission that they are not fully compliant with regulatory requirements. In the light of the findings from this inspection and the previous two, it is important for the best interests of the home (particularly the registered owners and registered manager) that this regulatory function is carried out effectively and efficiently. The inspector looked at the latest ‘gas safety record’ to find that the detail recorded didn’t relate to Treetops Care Home. The management agreed to clarify the situation. A copy of a ‘gas safety record’ was sent to the Commission two days later and it was noted that the date recorded for the test was 18/4/07, two days after the inspection. It was also noted that this was not a ‘service/maintenance record’, only a ‘safety record’. When asked for the latest Portable Appliance Test (PAT) certificate, the only document available expired July 2006. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 24 Management agreed to sort this out and a copy of the current document was received by the Commission on 19/4/07. There was some confusion about records demonstrating that the home’s emergency lighting, call bell system and fire fighting equipment is tested to ensure that everything is in good working order. Initially the inspector was given service agreements etc, it then transpired that the handyman undertakes these checks, but the records weren’t available. The manager sent copies of outstanding documentation to the Commission the next day. Records were available to demonstrate that the fire alarm system is checked regular to ensure that it works effectively and there was documentation is evidence that the passenger lift was serviced in January 2007. A discussion took place about how residents access their personal allowances that are held in safe keeping by the home. At present, residents cannot access the full personal monies other than Monday – Friday between 10am – 4pm. Residents have a right to access their full personal monies at any time. If for any reason this right cannot be upheld, then full details of the arrangement must be clearly detailed in the Home’s Statement of Purpose and Service User’s Guide. There are some clear safety issues within the home and the home could not produce adequate risk assessments. For example, ‘accidents’ are not being followed up, the windows in the lounge area (overlooking a lower ground area) open wide enough for a residents to fall through and corridors, communal areas etc are not hazard free. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 25 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X 1 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 Requirement No resident should be admitted to the home unless a full pre admission assessment had been carried out and the home has confirmed in writing to the resident/representative that the assessed care needs can be met. Every resident must have a detailed current care plan in place. This document must include all aspects of health and welfare, adequate risk assessments and demonstrate that residents has been consulted about their personal choice, control and preference. Documentation such as accident records, nutrition records, recreation/social records, community nurse, GP visits and daily activity records should all cross reference and have a direct link to the main current care plan. The previous timescales to meet this requirements of 31/03/06 & 30/11/06 have not been met. Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 27 Timescale for action 31/05/07 2 OP7 OP14 12,13,15 31/05/07 3 OP9 13 4 OP12 16 Current medication practices must be reviewed to ensure that all practices are in line with legislation and guidance. Full details of the presenting shortfalls are contained within the report. The matter relating to 2 staff countersigning (the home’s) handwritten entries in the recording sheets was raised at the previous inspection, but remains outstanding. 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 home will also need to demonstrate that this regulation is being met. This will also have implications for staffing levels. 31/05/07 31/05/07 5 OP15 16 6 OP19 23 The previous timescale to meet this requirement of 30/11/06 has not been met. The home must maintain a form 31/05/07 of record to demonstrate that residents are provide with food and drink (fluids) which are in adequate quantities, suitable, wholesome, nutritious and varied. The must home must be kept in 31/05/07 a good state of repair both internally and externally. There is no written programme of decoration, repair or refurbishment. The home must be safe and free from hazards, be kept clean and have adequate storage facilities. Large areas of the homes interior remain tired, tatty and worn and Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 28 in need of complete redecoration and refurbishment. There is no written programme of decoration or refurbishment. Parts of the exterior garden area are being used for the storage of old bedsteads, mattress, broken pieces of furniture. This is unsightly for residents. Internal corridors and communal rooms are cluttered with old pieces furniture, mattresses, boxes, piles of towels/bedding etc, this poses a potentially serious risk of harm to residents and staff. The home must be clean, pleasant and hygienic. The previous timescales to meet this requirement of 30/06/06 and 30/11/06 have not been met. 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. To achieve this, areas of responsibility and lines of management and authority need to be clear and understood by the registered provider, registered manager and those appointed by the registered provider to carry out the Regulation 26 visits. Risk assessments must be in place identifying risks and how they are going to be minimised, managed and/or eliminated. DS0000017984.V335130.R01.S.doc 7 OP31 OP33 12,13,14, 15,16,23 & 26 31/05/07 8 OP38 13 31/05/07 Treetops Care Home Version 5.2 Page 29 There still remains a complete lack of risk assessment documentation and this places residents at serious potential risk. Details of those risks identified during the inspection have been detailed within the body of the report. The previous timescale to meet this requirement of 30/11/06 has not been met. 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 OP1 OP35 Good Practice Recommendations Current arrangements regarding residents not having access at all times to their personal allowances which are kept by the home, should be reflected on the Statement of Purpose and Service Users Guide/Brochure. The practice of residents wearing blue plastic aprons and leaving piles of underwear in various communal bathrooms/toilets should be managed better to ensure that residents are cared for in a dignified environment. It is good practice to ensure that the respective member of staff signs their own induction record. Also, the level of competence should be recorded. 2 OP10 3 OP29 Treetops Care Home DS0000017984.V335130.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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.V335130.R01.S.doc Version 5.2 Page 31 - 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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