This inspection was carried out on 24th July 2009.
CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH one star adequate service 20/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Love Date: 2 4 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH 01992573322 01992570241 treetopsepping@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Epping Care Home Ltd care home 52 Number of places (if applicable): Under 65 Over 65 52 old age, not falling within any other category Conditions of registration: 0 Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 52 persons) Date of last inspection Brief description of the care home 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 manager is Hayley Dawkins. 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.
Care Homes for Older People Page 2 of 12 2 0 0 4 2 0 0 9 Brief description of the care home The fees at Treetops Care Home range from between 550.00 and 600.00 per week. There are additional charges for items of a personal nature. These should be discussed directly with the home. Care Homes for Older People Page 3 of 12 What we found:
This was a focused random inspection to look at medication practices and procedures, care planning processes and to monitor actual care practices by staff. The visit took place over one day by one inspector and lasted a total of 4.5 hours. Medication practices and procedures were examined by a specialist pharmacist inspector. We looked at the medication and medication records for several people resident in the home. On the whole these are much improved. However we found that when medication is given in variable doses e.g. one or two tablets the actual quantity given is not always recorded clearly and when it is not given if it is not required there is an inconsistent and confusing method of recording this. This does not give a clear record of medication administered (or not) and could put people at risk of receiving too much or too little medication. We also noted some omissions in the records made when medicines are given to people and in one case it was difficult to assess whether this was a recording error or a failure to administer the medication as we couldnt tell when staff had started to use the container. It is important to ensure that medication can always be accounted for and a requirement has been made about this. When hand-written changes or additions to instructions for medicines are made these are now signed and dated and checked by a second person so the recommendation made about this at the last inspection has been considered. Some people regularly refuse their medication and although this had been picked up by the homes own audit procedures there was no record that this had been reported to their GP although we were told that it had. We consider that the requirement made on the last inspection that when this occurs it must be reported to the residents GP without delay has been met but have made a new requirement about the need for this to be recorded along with the results of any such discussions. At the last inspection we saw that when medication was given at different times to those printed on the medication record form the time it was given was not recorded accurately and so a requirement was made about this. At this inspection we looked at such records for 4 people and found the records now show the correct time; this requirement has therefore been met. Two people look after and take their own medicines and although the risks associated with this had been assessed for both, one of the risk assessments was undated. We consider the requirement made on the last inspection about this to have been met and expect the home to ensure such assessments are clearly dated. As part of this site visit we looked at 3 peoples care files (2 in full for people newly admitted to the care home and 1 care file in relation to the persons specific healthcare needs). Records showed that admissions are not made to the care home until a full needs assessment has been undertaken. Records showed that for both people newly admitted to Treetops, a pre admission assessment was completed by the management team of the home prior to their admission and information recorded was noted to be detailed and
Care Homes for Older People Page 4 of 12 informative. There was evidence to show that both people and/or their representative were offered the opportunity to visit the care home prior to admission and following the formal assessment being undertaken, a letter was forwarded to the prospective person to confirm that their needs could be met. Care plans examined showed that information recorded was much improved. Care plans were observed to be detailed, clearly recording individuals care needs and providing guidelines for staff as to how the person should be supported. Records showed that efforts were being made by the management team of the home to ensure that the care plans were person centred and included individuals personal preferences, likes and dislikes, strengths, abilities and weaknesses. However, care must be taken to ensure that other members of the management team and staff team are empowered and enabled to participate in the care planning process, as currently all care plans are compiled and written by the manager. We also advised that some elements of the care plan for each person was not always signed and dated by the person completing the documentation and should be done as part of good practice procedures. Where changes to individuals care needs had taken place, this was not always reflected within the actual plan of care. For example the care file for one person recorded that their blood sugar levels had been unstable. Healthcare records showed that the persons GP had been notified and measures undertaken by the healthcare professional to address the issue, however this was only reflected within their healthcare records and not updated within the plan of care and/or risk assessment. Each care file examined also included detailed risk assessments for all areas of assessed risk. Documentation was seen to be much improved, detailing the specific risk and measures put in place to minimise the risk. We spoke with staff and they were able to demonstrate an awareness and understanding of individuals care needs and their personal preferences. Two people case tracked confirmed they are treated well by staff and receive appropriate care which meets their specific care needs. Staff interactions with people living at the care home were observed to be much improved and positive. We noted that there was more staff presence within the main lounge and staff were verbally interacting with people more frequently. People were observed to enjoy the interactions and the atmosphere within the lounge was calmer. During the morning people were offered the choice of tea and coffee. People were offered more drinks and no one was hurried and/or rushed to finish their drinks. Where people required assistance to have a drink, this was provided with care and respect by staff. While we did not observe the dining experience for people in the home, we noted that several people did not know what was available for lunch as the menu was not clearly displayed and people were not reminded by staff as to the options available. During our visit and on a tour of the premises we noted that the use of wooden wedges to keep residents bedroom doors open was still happening. This is a repeat requirement and was highlighted at the previous key inspection in April 2009 to the home. The timescale for action/compliance was 31st May 2009 and has not been met. Care Homes for Older People Page 5 of 12 We also observed that several fire doors within the home did not close properly, posing a potential fire risk to people living at the care home. In addition we noted that 2 fire exit doors on the garden floor were not locked and neither door was alarmed. This poses a potential risk to people living at the care home as they can leave the building undetected and can access both the rear and front of the building car parking areas, which allow easy access to a main road. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 8 17 Where people are at risk of losing weight, maintain appropriate nutritional records. Not inspected on this occasion. Previous timescale 15/5/2009. So as to ensure peoples safety and wellbeing. 24/07/2009 2 12 16 All people who live at the 24/07/2009 care home must be given the opportunity to engage in a varied programme of activities. This refers specifically to those people who have poor cognitive ability and who spend the majority of their day in bed. Not inspected on this occasion. Previous timescale 1/6/2009. So as to ensure that people are enabled to maximise their potential. 3 19 23 People who live at the care 24/07/2009 home must be provided with a sufficient supply of hot water at all times. Not inspected on this Care Homes for Older People Page 7 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action occasion. Previous timescale 18/5/2009. So as to enable people to have a wash, bath and/or shower in the knowledge that the water will be at a reasonable temperature for their comfort. 4 19 23 Adequate precautions must be undertaken against the risk of fire after consultation with the fire authority. This refers specifically to residents doors being wedged open. Previous timescale of 31/5/2009 not met. So as to ensure peoples safety and wellbeing. 5 29 19 Ensure that robust recruitment procedures are adopted at all times and all records as required by regulation are sought. Not inspected on this occasion. Previous requirement 15/5/2009. This will ensure that residents and others feel assured that they are safeguarded by the homes procedures. 6 29 18 All staff employed to the care 24/07/2009 home, receive structured induction training and there are records to support this.
Page 8 of 12 27/07/2009 24/07/2009 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Not inspected on this occasion. Previous timescale 15/5/2009. This will ensure that staff feel supported and able to carry out their role. 7 30 18 Staff receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. Not inspected on this occasion. Previous timescale 1/7/2009. This will ensure that staff have the competence, confidence and ability to meet residents care needs and people will feel assured that their care needs will be met by suitably trained staff. 24/07/2009 Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 19 23 Ensure adequate precautions 27/07/2009 are undertaken against the risk of fire after consultation with the fire authority. So as to ensure peoples safety and wellbeing. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 The results of any discussions with health professionals about the care of residents must be clearly recorded. This will ensure that people receive the required care and protect them from harm. 31/08/2009 2 9 13 There must be a clear audit trail to account for all medicines in use. This will ensure peoples medication is used correctly. 15/08/2009 Care Homes for Older People Page 10 of 12 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Care plan dcoumentation should be signed and dated. So as to clearly determine when records have been compiled and written. Where the needs of individuals have changed the plan of care and/or risk assessment must clearly reflect this. 2 7 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
