Inspection on 28/05/08 for Treetops Care Home

This inspection was carried out on 28th May 2008.

CSCI found this care home to be providing an Poor service.

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 15/11/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH Lead Inspector Sharon Thomas Unannounced Inspection 28th May 2008 09:00 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.V365249.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.V365249.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.V365249.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) 15th November 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. 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.V365249.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. An unannounced visit to the home took place on 28th May 2008. On this occasion two inspectors undertook the visit. The last key inspection took place on 15th November 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. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as menus, staff rotas, care plans and staff files. Some completed surveys were received from members of staff, people living in the home and their relatives. The registered manager completed an Annual Quality Assurance Assessment with information about the home. This document will be referred to as the AQAA throughout the report. In addition we had the opportunity to speak with people living in Treetops, their relatives and a variety of staff living in the home. We take this opportunity to thank them for their cooperation and assistance throughout the day. The home’s registered manager is on long term sick leave and the inspection was undertaken with the assistance of the home’s acting manager and the consultant who is employed to support the home to reach the National Minimum Standards. On the day of the inspector’s visit the atmosphere in the home was relaxed and welcoming and we, the Commission for Social Care Inspection (CSCI), were given every assistance from the manager and the staff team. The visit included a tour of the premises, discussions with people living in the home, the acting manager, the consultant, members of staff and visiting relatives. Observations of how members of staff interact and communicate with people living there have also been taken into account. We found some issues within the home that gave us cause for concern, we issued the proprietor with an Immediate Requirement notice that requires the proprietor to address the concerns at once so as to minimise any risks and enhance the safety and welfare of the people living in the home. Treetops Care Home DS0000017984.V365249.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: This inspection identified a number of regulatory shortfalls that must be addressed for the well being of people living in the home. These shortfalls are 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. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 7 The home’s Pre-admission process does not fully identify and detail all aspects of individual care needs. Care plans used in the home must contain a full range of information that directs staff on how to provide care, within these documents risk assessments are in place but do not fully identify the risks that people experience. The medication systems used in the home are unsafe and this issue needs immediate and urgent attention to ensure that people in the home do not remain at risk or are not placed at risk. An immediate requirement notice was left in the service on the day of the visit and this will need the attention of the management team and proprietor to resolve the medication issues. Staff in the home do not always treat people with respect and care and were observed paying little attention to the people in their care. Care staff do not appear to understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact this has if not carried out. Interaction between staff and people living in the home was seen to be limited. People living in the home were, at some points of the day, ignored and their needs were not addressed in a consistent manner. People working in the home were not fully training in how to protect people in their care. Staff training in this area is poor and the home’s recruitment process does not uphold the safety of people living in Treetops by ensuring that staff are properly vetted. The health and safety of people living in the home needs to be reviewed and the management team in the home must ensure that the Health & Safety systems that are in place are used. Various issues relating to health and safety are identified in the body of this report. The home’s communal areas remain in need of major investment to make the environment a pleasant place to eat and live in. The home does not implement its own Quality Assurance system; therefore the views and opinions of the people living there cannot be fully identified or acted upon. The registered provider and the manager submitted an AQAA (see above) after the last inspection and before this inspection. Some of the information within the document was not found to correspond with what we found on the day of the visit. 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 Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Treetops Care Home DS0000017984.V365249.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.V365249.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, 3 and 6 Quality in this outcome area is adequate. Overall people choosing to live at Treetops know that they will receive information about the home before they move in and that their needs will be assessed before admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre admission assessments for the two newest people to be admitted to the care home, were inspected. Information recorded was noted to be basic and in a ‘tick chart’ format and included supplementary information from the individual’s placing authority, as part of the assessment process. It was difficult to decipher as to how the management team of the home had made the decision that it could meet the needs of the prospective resident, based on the information available. The acting manager was advised to consider devising a more comprehensive and detailed pre admission assessment format as it is important for prospective residents and their Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 11 representatives to know that the home they are admitted to can meet their needs. The acting manager was also advised to ensure that information recorded within the pre admission assessment document concurred with information from the placing authority e.g. the pre admission assessment for one person recorded their hearing ability as being satisfactory, however information from the placing authority recorded they were hard of hearing. Additionally, confirmation from the home to the resident and/or their representative verifying that it can meet the person’s needs must be recorded as these were not available for the two people case tracked. No information was available to indicate that either resident and/or their representative were given the opportunity to visit the care home prior to admission. Treetops does not provide intermediate care. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 12 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. Limited care planning documentation in the home exposes potential risk and inconsistency of care. People who use this service cannot be sure that staff are fully aware of all their needs or that the care and support they require will be delivered in a structured and personalised way. Medication systems are not well managed in the home and this has the potential of placing people at risk. People are not always treated with the respect that This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of this inspection six care plans were inspected. These records show that further development of the care planning and risk assessment process is required so as to ensure that individual’s needs are fully recorded and include the care that staff need to give so as to guarantee the correct and safe delivery of care. For example records for one person indicated they suffered with Parkinson’s disease. There was no care plan devised identifying how their Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 13 physical condition impacted on their daily life, the symptoms it presented, or the staff interventions required to provide appropriate support. Another person’s care records made reference to their medical condition, however no care plan was devised and there were no records to evidence that staff/management of the home were monitoring the person’s condition or the impact this has on their wellbeing. There were no records clearly identifying what interventions were to be adopted by staff should the person’s health deteriorate. We found that another person’s care plan contained a care plan for all aspects of what the person needed but the information was limited. The care plan did not contain enough detail to explain to staff how to look after for the person in the way that they needed or wanted. In addition, the risk assessment that works alongside the care plan did not identify all of the risks that the person experienced. This has the potential of placing vulnerable people at increased risk, as the care staff do not have all of the information available to them to identify risks and make people safe. Medication Administration Records (MAR) for the above person indicated that they refuse some of their prescribed medication on a regular basis. The risk assessment dated December 07 recorded that staff should make sure that the resident takes their medication regularly and for the GP to be contacted if the medication was refused. It was of concern that there were no records to evidence that staff or the management team of the home had liaised with the person’s GP and/or another healthcare professional to ensure the person’s safety and wellbeing. Additionally, care records must be regularly reviewed to reflect individual resident’s changed needs and how this affects their daily life. The majority of medication was noted to be managed through the Nomad system. Administration of medication to residents was observed during the inspection and this was seen to be satisfactory. The designated place for the storing of medication within the home was observed to be secure. It was noted that oxygen cylinders were being stored within the medication room. The acting manager confirmed that at the time of the site visit, no resident was requiring the use of oxygen and these, needed to be returned to the supplier, however no warning signs alerting people to the above was evident. The acting manager was advised to ensure that as part of good practice procedures, the temperature of the room/s where medication is stored is recorded. This will ensure that medicines received at the home are stored at the correct temperature and do not lose their effectiveness. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 14 Medication records were not up to date as there was no record of some medicines having been given to the individual when they were due, as the entries on the Medication Administration Record (MAR) had been left blank and not signed/initialled by staff. Where some people consistently and/or regularly refuse medication, no evidence was available to indicate this was proactively being managed, that advice from a healthcare professional had been sought, or that the individual person’s care plan had been updated to reflect the above. The MAR record for one person indicated that they self-administered one of their medications (tablet). The care plan did not reflect the above and recorded “[resident’s name] is unable to self medicate and senior carer must administer all medication as per MAR chart”. There was no assessment to evidence the person’s ability to carry out the task and no risk assessment/competency assessment was evident within the care file. On inspection of the dedicated fridge used for medication, 2 bottles of Amoxicillin Syrup (250ml) were noted. A label on both bottles recorded an expiry date of 14/5/08 and “discard remaining liquid after four days”. It was evident at this site visit, that the above instructions were not followed. This is not good practice and could lead to the above medications being given to other people, which could affect their wellbeing. Additionally there were no records to document the temperature of the dedicated fridge. The acting manager was advised this should be monitored daily so as to ensure that medicines that require cold storage are kept cool and do not deteriorate. It was also noted that there was a container of yogurt transferred from its original pot being stored within the dedicated fridge. Staff spoken with, were unaware as to how or who had placed this within the fridge but confirmed that it was not being used to give medication covertly to residents. The MAR record for one person recorded the reason for medication not being administered as “meds awaiting delivery”. Further investigation from the acting manager confirmed that the cassette of medication was delivered by the supplying pharmacy to the care home but went missing. There was no audit trail to show the actions taken by senior staff/management team to check what would happen if the person missed their dose of medication. Several hand written MAR records did not always include a record of the quantity of medication received or the date this was received. The staff training matrix submitted to inspectors, indicated that several people who administer medication to people, require refresher training. No records were available to indicate that in addition to refresher training for staff, competency assessments were being undertaken. The acting manager was advised that it is there responsibility to assess a care worker’s ability/competence to administer medication to the people that live in the care home. Staff spoken with confirmed that they had not received a competency assessment. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 15 The managers AQAA states that the service: “will improve the role of key workers and give care workers training in care planning. Individual health and physical needs accommodated. Detailed records kept in the home and training programme appropriate to the needs of staff and residents”. People spoken with stated that overall they are given care and attention, two people spoken with stated that they find that staff “always need to be reminded about my needs and they don’t always know what I like”. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 16 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. People living in Treetops have opportunities to participate in activities that are appropriate to their needs and they are supported to build and maintain relationships. People are not always treated with respect and their privacy and dignity is not always upheld. Staff do not always offer people choice in their day to day activities. People have varied diet that they enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a part-time activities coordinator (23 hours per week), who arranged a variety of activities during the week. These comprised of individual and group activities (e.g. bingo, games, quizzes, art & crafts, etc.). An activities plan for the week was available to the people living in Treetops. The coordinator states that she records the activities that have been provided. We looked at these records and found that although the activity for the day had been noted, the records did not provide evidence that people actually undertook the activity that was on offer. Care plans that we looked at did not always include evidence that people’s interests had been discussed with them Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 17 and a life history recorded. They did not always record in sufficient detail individual’s social needs based on their previous hobbies, interests and personal preferences. Additionally there was little information identifying how people’s current social needs are to be met or supported. Relatives spoken with and who have completed surveys had varying opinions about the activities at the home. Comments made were: “Staff are not given the money to provide for outings and special events”; “Usually good activities attended by most of the residents” and “ sometimes my [mother] is bored by the activities that are on offer as they always seem to do the same thing”. People spoken with said that their friends and relatives could visit at any time, and they could meet with them in private in their rooms. We found that peoples’ bedrooms were personalised, showing that people could bring their own possessions into the home with them. All rooms had locks and individuals were able to have keys to their room should they wish. The communal area of the home was large and has two televisions in it. On the day we saw that both televisions were on and the volume was high, therefore people could not hear either one properly. People in wheelchairs were placed in a row in front of one of the televisions; two people had not been asked whether they wanted to watch the television. When we questioned staff about the lack of choice we were told that “we don’t ask them, because these people always watch television in the morning”. Interaction provided to people by some staff members was observed to be poor and in some instances residents were ignored and their needs/wishes not taken seriously. One person called for assistance for a considerable time with care staff walking past this person for the good part of half an hour. For much of the day we watched staff speaking to each other but not interacting with the people living in the home. We observed that if staff were not undertaking a care task that they were talking to each other and excluding the people that they were working for. We discussed this with the acting manager who stated that she had not been aware of this poor practice. We observed a district nurse taking blood from a person while sitting in the lounge area; it was not until this was pointed out by the inspector that any action was taken by staff to stop this continuing. We suggested that she spend some time on the floor observing the interactions between care staff and the people living in the home, review the communication and identify where staff may need to have some refresher training regarding respect and dignity for older people. People spoken with stated that overall staff are polite but could (at times when they were busy) be off hand and dismissive toward them. One person said “ the staff are always doing something so a lot of the time we have to wait for them to get to us”, and “staff are very cool toward some of us, we don’t like to Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 18 upset them”, however other people stated that staff are “caring and kind” and “do their best”. Both inspectors observed the lunchtime meal within the main dining room and small lounge area. Dining tables were laid with tablecloths and condiments and a choice of drinks were available. Staff interaction with people at lunchtime was seen to be inconsistent, some staff offered choices of meal and drinks to people and sitting down to assist individuals with support to eat their meal. While other staff told people where to sit, did not offer an alternative when one person did not want the meal presented to them, we saw one member of staff stand up while assisting people to eat their meal. Additionally two members of staff were observed to outpace residents when assisting them to eat their meal. This refers specifically to staff hurrying residents to eat and placing another spoonful of food into their mouth without waiting for them to swallow. These practices are not respectful of either peoples’ dignity or their capabilities. Those people who require a pureed/soft diet were observed to have food items portioned separately on their plate/bowl, however some staff were observed to mix this together prior to assisting the resident to eat. During lunch one member of staff who was assisting a person with their meal, stood up announced that it was their break time and left the table without finishing the meal with the person. This example was one of many where it appeared that staff were not aware of their own poor practice and senior staff did not monitor this. The meal served on the day appeared well cooked and the people eating the meal were complimentary of the quality of the food saying that “the food is nice we have a choice and there is always something to eat if you want it”. The cook had made delicious home made cakes that were served with mid afternoon tea. The managers AQAA states that the service: “we provide social activities every day Monday to Friday. We provide communion and multi denomination church services to people”. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 19 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 poor. Overall people living in Treetops can be confident that their views will be listened to and acted upon. People can expect staff to respond appropriately to allegations of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints policy/procedure was seen. The policy included information on how to make a complaint and the expected timescales for response from the home. Details were also included on how to contact the registration authority and the local Social Services office. No complaints had been recorded by the home since the last inspection. Relatives spoken with on the day said that they were aware of whom to make a complaint to if they needed and they felt confident that their concerns would be listened to. Two people living in the home also confirmed to us that they knew who to speak with if they were unhappy with the care that they receive. Staff spoken with were fully aware of what to do with any complaint that was passed to them by anyone living or visiting the home. The manager’s AQAA states that: “our current policies and procedures fully support us in our management of complaints and protection”. The home’s policy and procedure for Safeguarding Adults is clear and gives staff clear direction on how to deal with an allegation of abuse. The staff Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 20 training records indicated that of 40 staff members 29 of them had not received Safeguarding Adults training or were well overdue for refresher training. Staff spoken with knew how to respond to any allegation of abuse should one be made by an individual in the home. The staff were also aware of the home’s Whistleblowing policy and two members of staff said that they felt confident to use this if they needed to. The home’s recruitment procedure was not as robust as it should be and some of the information that is necessary to make sure that people employed by the home are satisfactory to do so, was not in place. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 21 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 and 26: Quality in this outcome area is adequate. People living in Treetops can expect to live in a home where improvements to the décor and furnishings are being made. People cannot be assured that all areas of the home are clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full tour of the premises took place on this visit. We looked at all of the communal areas, bathrooms and toilets as well as a number of people’s bedrooms. Corridors and lounges look tired, furniture in communal areas is arranged in an institutional manner, and some parts of the home has problems with odour. The home has had some improvement since the previous inspection visit. There is a newly refurbished hallway, reception/entrance area and a new office, these areas have been decorated to a high standard and are a welcoming space to people living in the home and those visiting. The acting Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 22 manager sated that all bedrooms in the home apart from 2 had been redecorated. The home advised the CSCI through correspondence that all refurbishment work would be complete by Spring 2008. This work has not started and major areas of the home remain in need of major investment to make it a pleasurable experience to those living there. One visitor said that “the care here is good but the home is tatty and worn out” and “the home needs to be invested in”. Treetops submitted an Improvement Plan to us and it was recorded that the manager would complete full audits to ensure that the home is clean. The acting manager said that audits are carried out by in person on a daily basis. The home’s previous AQAA states that all bathrooms are cleaned daily. Bathrooms were not particularly clean at the time of this inspection. Information taken from staff surveys says equipment is not always in good working order and hoists need to be replaced or serviced on a regular basis. The laundry area is clean and well organised it has two washing machines with a sluice cycle to ensure that soiled clothing and linen are washed at the correct temperatures. Throughout the home we found cleaning materials in reach of vulnerable people, a urine sample was left unattended in a communal area, and generally the communal areas were in need of a deep clean. The managers AQAA states: “ they have redecorated 40 bedrooms, improved the standard of odour, built a new reception. People living in the home said that they “liked [their] bedroom” and “my bedroom is really nice but the lounge is not a nice place to sit for very long”. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 23 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. People are generally in safe hands however the skills staff have could be developed further by an improved training programme. The home’s recruitment procedure is not thorough and has the potential of placing people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection 35 people were living in the home. 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 individuals living there. The staffing rota indicated that there were enough staff on duty both day and night. A clear staff rota was available for the presenting week. The acting manager confirmed that there is a minimum of eight senior/care staff on duty between 7.30am – 9pm, seven days a week. The rota indicates that there a four waking night staff on duty in the home. Domestic staff are employed 7am – 2.30pm seven days a week. In addition, the rota recorded the hours worked by a receptionist, the manager and the deputy managers. Staff on duty during the day reflected the information on the rota. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 24 It was understood that the deputy manager’s role and responsibility was to manage the overall refurbishment of the premises. However, since the registered manager’s absence the deputy manager had stepped into the role on a full time but temporary basis. The acting manager has the support of the external consultant. The manager’s AQAA states that 70 of care staff have achieved NVQ level 3 or above. Records examined on the day indicated that 55 of care staff employed in the home had achieved an NVQ Level 2 or above. This number meets the minimum standard of 50 of care staff trained to NVQ Level 2 that is required of care services. Two relatives spoken with commented, “they could do well if they had more staff”. “Too many clients seem to need more help than they get” and “Some of the staff try to do well with what is a difficult job” and “while I appreciate the difficulties, more staff would allow more time to talk to and treat individuals as we would like to be treated”. Staff training records were looked at on the visit. The records indicated that a variety of training is provided including: health & safety, medication, fire safety, food hygiene, manual handling and infection control. Although the training matrix identified that the training was provided as previously identified Safeguarding Adults training had not actually been provided to all staff. The training programme did identify what members of staff needed training and refresher training but did not state when this would be given. Staff spoken with knew many of the needs of the people in their care, however these were the basic needs of the person and when asking about the history of the person or questions about their social or emotional needs the staff were unable to answer. The staff’s knowledge of the people they care for was somewhat limited and the care they provided tended to be task orientated as opposed to centred on the individual. Staff recruitment files were examined for five people employed in the home. The majority of records had been sought and received however some gaps were noted in relation to no evidence that staff are recruited with both required references, a POVA 1st for one person was received after they commenced employment, no evidence of experience for two people, no written references for one person and evidence of inductions was limited. The manager’s AQAA states that: “the home has robust recruitment” this was in contradiction to the evidence presented on the day. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 25 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. People living in Treetops can expect to live in a home where some management systems are improving and/or developing with the benefit of additional external support. On the whole people cannot be confident that all aspects of their day-to-day care are managed thoroughly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated in the summary the registered manager is on long-term sick leave. The deputy manager has stepped in to the role on a temporary basis and she now works 5 days a week and is on call when required. The acting manager has many years experience of managing residential care services. However she has taken over a service that has many areas that need to be developed and Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 26 improved. Following previous inspection requirements the registered provider employed the services of an external consultant. It was explained by the acting manager and the consultant that this is to support the manager in reviewing practices and implementing systems to ensure that the home meets regulatory requirements. Aspects of management in the home continue to remain unsatisfactory. Care plan documentation following an admission to the home is poor, the monitoring of terminology within activity records is not robust and medication administration recording system audits have continuing shortfalls. All these matters have been required on previous inspections and are referred to within the body of this report. The manager’s AQAA reports that these systems are in place. However the inspectors’ findings, the review of evidence, and the observations on the day confirm that not all of the information we received in the AQAA is not accurate or up to date. The outcome is this is that people live in a home were the day-to-day management systems are not thorough and have the potential of placing people at risk. The manager’s AQAA states that people living in the home are surveyed to find out how the home is doing and if it providing the care that people need. This self-assessment takes place on an annual basis. On the day of the visit the acting manager could not locate the service user / relative surveys, the action plan, or the latest annual report. The records of four individuals’ personal monies held by the home were examined and this and their accounts were satisfactory. The acting manager said that the arrangements for accessing monies is documented within the home’s Statement of Purpose and Service User’s Guide. Both the acting manager and the consultant advised inspectors that they are aware of issues highlighted throughout this site visit and are themselves concerned with some members of staff’s attitudes and poor care practices. It is of some concern that the manager and registered provider had not effectively picked up and dealt with the identified areas where the home is not complying with regulation sooner. The acting manager was advised that staff within the home do not appear to work cohesively as a team and this is having a major impact on the day-to-day running of the home and actual care delivery to individuals. The acting manager/proprietor was issued with an immediate requirement notice on the day of the site visit relating in particular to the mismanagement of medication in the home. The recording of health and safety procedures remain goods. A maintenance folder is in place alongside the Health & Safety folder, which contains certificates relating to systems within the home. Records examined confirm that water temperature checks are being carried out regularly and there are recent certificates in place relating to hoists, the lift, portable electrical appliances and fire equipment. The lift has had a number of breakdowns in the Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 27 weeks prior to the inspection and although there was evidence that this situation was dealt with speedily there was no risk assessment available to ensure that any member of staff could continue to deliver care in a safe manner until the situation is resolved. The lack of a risk assessment for this issue may result in people who live in the home not having their care delivered in a manner that protects them. Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 28 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 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.V365249.R01.S.doc Version 5.2 Page 29 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 12,13,15. Timescale for action Every person choosing to live in 31/07/08 the home must have a detailed pre-admission document in place. This document must include all aspects of health and welfare, medication administration, adequate risk assessments and demonstrate that people and or their relatives have been consulted about their personal choices, wishes and preferences to make sure that their assessed needs are identified and addressed. Previous timescales 31.05.07 and 31.01.08 not met. Care planning at the home must 31/07/08 identify, and be effective in meeting all peoples’ assessed needs and ensure that these are regularly updated/reviewed to reflect the most up to date information. The previous timescales 31.05.07, 31.1.08 and 15.11.07 not met. Risk assessments must be 31/07/08 completed for all areas of DS0000017984.V365249.R01.S.doc Version 5.2 Page 30 Requirement 2. OP7 15(1)(2) 3. OP7 13(4) (C) Treetops Care Home 4. OP8 12(1)(a) assessed risk so that risks to people can be minimised and staff can offer safe care to people. All aspects of care that is 31/07/08 provided must ensure that the health and welfare of individuals is promoted and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to provide all appropriate and satisfactory interventions. Staff must also be able to identify poor practice, report this and act upon the information. The previous timescales of 31.1.08 and 15.11.07 are not met. Ensure that people are protected 28/05/08 from harm by having medication administered safely and in accordance with the prescriber’s instructions. Records of medicines 28/05/08 administered to individuals must be completed. This will show that they receive the medicines prescribed for them. The current presenting social 31/07/08 activity programme must be reviewed to ensure that people are consulted about what they would like to do and have the opportunity to participate according to ability and choice. The previous timescales of 31.1.08 and 15.11.07 are not met. Every resident must have a 31/07/08 detailed current care plan in place. This document must include all aspects of health and welfare, medication DS0000017984.V365249.R01.S.doc Version 5.2 Page 31 5. OP9 13(2) 12(1)(a) 6. OP9 13(2) 17(1)(a) 7. OP12 16 (2) (n) 8. OP9 12,13,15 Treetops Care Home 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 timescales of 31.1.08 and 15.11.07 are not met. The people living in Treetops 31/07/08 must be protected by the home’s Safeguarding adult’s policies and procedures. Particular attention must be paid to making sure that all staff have received Safeguarding Adults training. The recruitment procedure in the home must be tightened up to ensure that the home has gathered all relevant checks on staff prior to them starting employment. The home must be maintained to 30/12/08 a standard that ensures that people living there have a pleasant, homely and welldecorated place in which to live. The home’s recruitment 31/07/08 procedure must be robust and all information regarding the potential employee must be obtained prior to employment. Staff employed by Treetops must 31/07/08 be provided and undertake training that is relevant both to their role and the people that they care for. Management systems must be in 31/08/08 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 the people living there. DS0000017984.V365249.R01.S.doc Version 5.2 Page 32 9. OP18 13 (6) 10. OP19 12, 13. 11. OP29 19 12. OP30 18 (1) (a) (c) 12 (1) (a) 12,13,15, 16,18 and 23 13. OP31 Treetops Care Home 14. OP33 14, 15. The previous timescale of 31/05/07 and 15/11/07 to meet these requirements has not been achieved. The manager should continue to develop the Quality Assurance system so that when they seek the views of people living in the home and other interested parties, the information is used to form a development plan, which demonstrates that people’s views are being acted upon. 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP10 OP12 Good Practice Recommendations Care staff should be aware of their own practice in relation to ensuring that people living in the home are treated with respect and their dignity is maintained. Staff in the home should ensure that people loving in the home have had their social care needs assessed. This information should then be used to plan the activities provided in the home. Staff should take every opportunity to support people to make choices regarding every aspect of care provided in Treetops. 3. OP14 Treetops Care Home DS0000017984.V365249.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V365249.R01.S.doc Version 5.2 Page 34 - 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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