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Inspection on 04/02/08 for Treetops High Dependency Centre

Also see our care home review for Treetops High Dependency Centre for more information

This inspection was carried out on 4th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

Treetops provides a friendly, family type atmosphere where residents` relatives and friends are made welcome. The environment is fully accessible to wheelchairs and aids and adaptations are provided to meet the complex needs of residents. Assessments are undertaken with full involvement of the multi-disciplinary team prior to admission to ensure residents` needs are appropriately met at the home. Care planning is closely monitored and reviewed. Standards of personal care are good and there is good access to healthcare services. Residents are enabled to be actively involved in day-to-day decisions about life at the home. There are regular social events organised that residents are encouraged to take part in. The quality, variety and choice of meals provided are good with nutritional intake and regular weight monitoring undertaken. When asked what the service does well, a healthcare professional who completed a survey stated `Promote independence, prevent disability becoming a barrier to clients meeting their potential, provide high levels of care and give support and encouragement`.

What has improved since the last inspection?

There had been redecoration of residents` rooms in full consultation with them. A second minibus for use to transport residents to day centres, colleges and outings had been purchased with charitable funds. Recording of administration of prescribed creams had improved and a new drug refrigerator had been purchased. Appropriate checks for CRB disclosures were obtained prior to appointment of any new staff.

What the care home could do better:

There were some medication issues that need to be addressed although the general standard of medicines administration and recording was good overall.

CARE HOME ADULTS 18-65 Treetops High Dependency Centre 94 Treetops Victoria Gardens, Highwoods Colchester Essex CO4 4YE Lead Inspector Diana Green Unannounced Inspection 4th February 2008 10:30 Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 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 High Dependency Centre DS0000070239.V358967.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 Adults 18-65. 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 High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treetops High Dependency Centre Address 94 Treetops Victoria Gardens, Highwoods Colchester Essex CO4 4YE 01206 844121 01206 842716 mancolchester@johngrooms.org.uk www.grooms-shaftesbury.org.uk Grooms-Shaftesbury 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) Sheila Patricia Flynn Care Home 20 Category(ies) of Learning disability (20), Physical disability (20) registration, with number of places Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing – Code N to service users of the following gender: whose primary care needs on admission to the home are within the following categories: Learning Disability – Code LD Physical Disability – Code PD The maximum number of service users who can be accommodated is 20 This was the first inspection of the care home since registration following the merger between John Grooms and Shaftsbury Care. 2. Date of last inspection Brief Description of the Service: Treetops High Dependency Unit provides nursing and personal care for 20 adults with physical disabilities. The home can also accommodate people who have a learning disability. The unit is purpose built, constructed in 1990. Each person has their own room that is equipped with a small kitchen area and an en-suite bathroom with shower. 18 rooms have direct access to the garden. There are gardens at the front and the rear of the property and ample parking. The home is located in a residential area of Colchester with easy access to the town centre. The fees range from £1,141.00-£1,709.17 weekly. Additional costs apply for chiropody, toiletries, hairdressing and newspapers. This information was provided to the CSCI on 4/02/08. Treetops High Dependency Centre DS0000070239.V358967.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 3 star. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection lasting 6 hours. The inspection process included: discussions with the acting manager, the administrator, the physiotherapist, the activities coordinator, two residents, five care staff, two relatives and feedback from health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry and the sluice-rooms; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Twenty-five standards were inspected and one requirement and one recommendation made. The acting manager and staff were welcoming and helpful throughout the inspection. What the service does well: Treetops provides a friendly, family type atmosphere where residents’ relatives and friends are made welcome. The environment is fully accessible to wheelchairs and aids and adaptations are provided to meet the complex needs of residents. Assessments are undertaken with full involvement of the multi-disciplinary team prior to admission to ensure residents’ needs are appropriately met at the home. Care planning is closely monitored and reviewed. Standards of personal care are good and there is good access to healthcare services. Residents are enabled to be actively involved in day-to-day decisions about life at the home. There are regular social events organised that residents are encouraged to take part in. The quality, variety and choice of meals provided are good with nutritional intake and regular weight monitoring undertaken. When asked what the service does well, a healthcare professional who completed a survey stated ’Promote independence, prevent disability becoming a barrier to clients meeting their potential, provide high levels of care and give support and encouragement’. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based on sampled standards 1 & 2. The home ensured prospective service users had the information they needed to make an informed choice about where to live. The home met the needs and aspirations of people living there through comprehensive multi-disciplinary assessment and consultation with the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a Statement of Purpose and Service User Guide that were comprehensive documents and had been updated for the newly merged organisation. Both documents were viewed as part of the inspection. Four relatives who completed surveys stated they received sufficient information about Treetops to enable them to make a decision prior to admission. Four of the five people living at Treetops said they were able to choose whether or not they lived at Treetops and one stated the decision had been made on their behalf, as they were too ill at the time. A full multi-disciplinary assessment of care needs was undertaken for potential residents prior to admission to ensure their needs could be met. This was also confirmed in a completed survey received from a health care professional. The care records of one person viewed confirmed that they had stayed overnight as part of their planned admission and met their key worker to help them feel welcomed into the home. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 6, 7 & 9. People living at Treetops are in control of their lives and are fully involved in planning their care and independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some issues were reported with the computerised care planning system that had recently been introduced, for example: not all staff needing to access the care plans had been issued with a code; some staff were not sufficiently skilled in use of a computer; care plans and daily records could not be viewed at the same time; it was time consuming (up to 2 hours to update records). Clearly this was having an impact on the time staff had available to spend with residents. The manager explained the system and provided a display screen demonstration. Care plans for different elements of care (communication, eating and drinking, elimination, family, moving and handling/mobility, expressing sexuality, emotional needs etc.) were seen. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 10 Each resident’s care plan was printed off to enable they or their representative to confirm their agreement by signature. The system prompted when a review was due to enable any changes to be made and ensuring that they received care appropriate to their needs. Each resident had a contact list for access to GP, consultant, emergency call out, and physiotherapist, occupational therapist and wheelchair clinic. Four residents care plans were viewed. All included good detail of the residents’ care needs and had been regularly updated. The manager stated that all residents had a key worker allocated to them who was responsible for updating the care plans and liaising with relatives/representatives of service users. One relative who completed a survey said ‘having a key worker is very important as this give one to one support’ and ‘I am always kept informed of their care needs’. Residents spoken with said their right to make decisions was respected, for instance having their room door locked, and where/how they spent their day. Where others made decisions the reason was recorded in the residents’ records. Information on advocacy services was provided. Most residents had their own bank account or post office account. Systems were in place to ensure that residents received the appropriate allowances. Two residents managed their own financial affairs and another with assistance from their key worker. The remaining residents had a relative to manage their finances on their behalf. The administrator was appointee for four residents and records viewed confirmed that all incoming and outgoing payments were recorded. Individual risk assessments (for example smoking, unable to move.) were undertaken for each resident demonstrating that they were supported in taking responsible risks and that risks were minimised as far as possible. Residents were enabled with staff support to have experiences outside their usual routines such as going on holidays and outings. Policies and procedures in place demonstrated the home’s commitment to minimising identified risks and hazards and promoting the health and safety of residents. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 12, 13, 15, 16 & 17. People living at Treetops can expect to have their lives enhanced by the support and encouragement they receive to maintain contact with friends and family and to engage in educational and social activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at Treetops were not able to enjoy employment opportunities due to their complex needs. However some residents attended college and day centres: it was reported that two residents were attending a computer course, four residents were attending craft/sensory activities sessions and two attended a Day Centre for Brain Injuries. Staff spoken with said they provided support and advice on financial benefits where possible. The home had two activities co-ordinators who planned activities and outings in consultation with residents. One coordinator spoken with explained that a Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 12 weekly schedule of activities was planned but this was flexible as resident’s involvement was dependant on how they were each day. Two shows had been booked for five residents to attend in Colchester and Ipswich. A theatre company had also been booked to come to the home and themed events were also organised e.g. ‘A night of eastern promise’ with belly dancers and eastern food served. Various activities were provided including music, singing, quizzes, boardgames, bingo and hand massage. It was reported that one resident had benefited from a snoozelum session during the morning of the inspection that had a calming effect on his mood/behaviour. Relatives who completed surveys confirmed that there were regular outings arranged that their loved ones could go on and one said that their loved one ‘was encouraged to do whatever they wanted if at all possible’. Visiting was open access and the home’s statement of purpose referred to the visiting policy and respecting residents’ rights. Feedback received from relatives indicated they were always welcomed into the home and could visit at any time. Residents spoken with confirmed they were supported in keeping in contact with their friends and relatives. Comments were received from several residents in completed surveys: one said ‘I feel very much part of the family at Treetops’ and ‘we are always made very welcome’. One resident also said that ‘I could not be in a better place. I’ve made good friends, and have become part of a family’. A relative spoken with confirmed that they were encouraged to attend social events and said of their loved one ’I’ve never seen ….so happy.’ The home’s daily routines were observed to be very relaxed. Residents spoke of staff as being very friendly whilst respecting their privacy and dignity. Feedback from a health professional stated that ‘staff encourage residents to be as independent as possible’. Residents were seen to spend time alone in their rooms or with others, as they preferred. Comments were received from residents who completed surveys: ‘I am always encouraged to make my own decisions’. All residents’ individual rooms had locks although it was reported that only one resident liked to have his room kept locked. Menus showed that a variety of nutritious food was provided and choices were offered to the people living at Treetops. Residents’ care plans viewed confirmed that a nutritional assessment was undertaken on admission and food and fluid intake was monitored as appropriate. Meals were served in the dining room where it was observed to be an opportunity for social interaction between residents and staff with no pressure on time. Various functions throughout the year included barbecues and other meals (e.g. the eastern meal that was being planned). Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 18, 19 & 20. People living at Treetops can expect to have their personal and healthcare needs met with dignity, respect and privacy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents had their own key worker who was responsible for taking care of their general needs and updating the care plan. A relative spoken with said their loved one had been pleased to be able to choose their own key workers and ‘they are excellent, they really care’. Those spoken with said their personal care needs were discussed with them and their care provided as they chose and with respect and dignity. Residents’ physical and emotional needs were met through regular discussion and support of the multi-disciplinary team, with specialist support as needed. Some individuals following assessment were provided with technical aids to aid communication and specialist equipment for maximum independence. The home had a designated GP with specialist experience in meeting disability needs that held regular sessions at the home and also attended as needed. The care records viewed confirmed that residents were seen regularly by Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 14 health care professionals (e.g. occupational therapist, physiotherapists, specialist nurses, chiropodists, dentists etc.). Arrangements were also made for residents to attend hospital outpatient appointments as necessary. Healthcare professionals who completed surveys stated that where client needs are beyond what can be met routinely ‘staff actively work with professionals to find an appropriate solution and ‘Treetops provides a high standard of care tailored to each individual to maximise their potential’. One comment was also received that ‘occasionally management question the need to promote quality of life for people with severe disability where resources are concerned’. Comments were received from relatives in completed surveys: ‘I am extremely happy with the care’ and the support they get is ‘second to none’. The home had new medication policy and procedures for staff guidance that included as required (PRN) medication and had been provided for the new organisation. There was also a list of homely remedies that were agreed on an annual basis with the retained GP that could be given to residents for general ailments. Medication was stored in a medication trolley secured to the wall situated in the clinical room. A Controlled drugs (CD) cupboard for storage of controlled drugs was available that met requirements. A new drug refrigerator had recently been purchased. Monitoring and recording of room and refrigerator temperatures was undertaken and recorded and were found to be within safe limits. The home received supplies of medicines through a local pharmacy via a monitored dosage system and in individual containers. Prescriptions were seen by the home for checking and were returned to the pharmacy for dispensing. The home had a contract for safe disposal of medicines. Registered nurses administered all medication. One had undertaken an advanced care of medicines course during 2004. The medication and records of administration (MAR) for four residents were inspected. Their medication supplies and records were inspected. All were present and correct apart from one liquid pain relief medication that was not available and had been provided from the same medication that had been prescribed to another resident. One resident was self-administering as part of a risk assessment and had been provided with a lockable container. Prescribed creams administered to residents were included on a list held in their room. Advice was given to make reference to this on the MAR sheets as well as the care plan to ensure regulations were met. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 22 & 23. People living at Treetops can expect to have their concerns and complaints listened to and acted upon and to be protected by safeguarding adult procedures that are adhered to by well-trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints policy and procedures that included timescales for a response. The manager stated that a copy of the procedure was provided to new residents on admission to the home. No complaints had been received by the home or the CSCI since the previous key inspection. All of the four residents who completed surveys stated that they knew who to speak to if they were unhappy and how to make a complaint. All indicated they were happy with the service they received. One relative stated ‘I have never needed to complain and cannot envisage this ever happening’. Another relative said their loved one was very content with their life at Treetops. The home had a protection of vulnerable adults policy and procedures and a whistle blowing policy. Regular updated training was provided for all staff on safeguarding vulnerable adults and confirmed from the training schedule seen. From discussion with senior staff it was evident they were proactive in ensuring that residents were protected by safeguarding procedures. Two allegations of abuse had been made since the previous key inspection and both had been referred appropriately in line with the homes and Essex local authority procedures and the CSCI kept informed. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent based upon sampled inspected standards 24, 29 & 30. Treetops provides residents with a clean, bright and homely place to live with their room being decorated and furnished to suit their lifestyle and to promote independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were clean and bright with regular redecoration undertaken. There was full access to wheelchairs throughout the home and gardens with ramps provided as needed. Residents spoken with confirmed they were encouraged to have their rooms decorated as they chose and were enabled to bring their own furniture. All rooms were spacious enabling full wheelchair access with individual kitchenettes provided for their individual use. The home had two minibuses to enable access to local amenities, transport to day centres and outings. The records and staff practices confirmed that the building complied with the requirements of the local fire service and environmental health. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 17 A tour of the premises was made and communal and some residents’ rooms inspected. All rooms were single with en-suite facilities and kitchenette facilities. All residents’ rooms were above average size with access for wheelchairs and specialist equipment and residents were encouraged to have their own television, music system, computers etc. Overhead hoist and other specialist equipment (e.g. communication and environmental control systems) were provided for assessed needs on admission to the home and to meet residents’ changing/developing needs. The records viewed confirmed that regular maintenance of equipment was undertaken as required. The premises were observed to be clean and free from odour. A relative who completed a survey stated that they would consider a care home’s cleanliness and care poor if there were any smells on entering the home, but ‘this has never been the case’. The laundry room was clean and well organised. Sluice facilities were provided and were being refurbished. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines; washing machines had the capacity to carry out sluice wash cycles. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon sampled inspected standards 32, 34 & 35. Staff are competent, skilled and clear of their role and responsibilities, giving confidence to residents they will be well cared for. However staffing levels were not always sufficient to ensure residents’ needs could be met without having to wait. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were twenty residents at the home. Staffing levels comprised two registered nurses and seven care assistants. From observation and the records inspected care staffing levels were appropriate to meet the personal, healthcare and social needs of residents and to enable staff to receive training and supervision. The manager, cook and kitchen assistant, two activities coordinators, maintenance person, administrator, administrative assistant and five domestic assistants were also on duty. Staff are always open and polite, clients appear happy and well cared for. Another comment received was ‘care staff have a friendly and caring approach to residents. They deal with them sensitively’ and ‘they appear to work well as a team’. All of the six surveys completed by staff apart from one included positive comments on the level of support, supervision and training they received. One Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 19 stated they had not received an induction and several said that more staff could be provided. A relative also stated that short staff can sometimes be a problem when assistance with toileting is needed. The recruitment records for two recently recruited staff were inspected. Relevant checks had been undertaken prior to employment for both (two satisfactory references, Identification, full employment history, Criminal Records Bureau Disclosure (CRB) and POVA first check). Records confirmed that induction was provided to Skill for Care standards. The organisation had a training officer who provided regular training for all staff employed at Treetops and this was confirmed from the training records viewed. The training records for the two recently appointed staff were inspected and confirmed that training had been provided in health and safety, fire safety, Protection of Vulnerable adults, infection control, disability equality, personal relationships, basic food hygiene, moving and handling, tracheostomy care, correct positioning and Parkinson’s Disease. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon sampled inspected standards 37, 39, 41 & 42. People living at Treetops can expect the home to be well managed with good standards of health and safety that protects them and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since registration of the home, there had been some changes in the registered manager’s role. During this time an acting manager, a registered nurse, had been covering the management of the home and was in charge on the day of inspection. The acting manager had attended updated training sessions in line with her responsibilities and confirmed from the records viewed. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 21 Since the recent merger there had been no audits undertaken apart from internal audits undertaken by the manager. These included health and safety, medication, environment/premises and discussion with residents to obtain their views. Reports were available as required under regulation 26 and confirmed from those viewed. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. Records viewed at this inspection included: care plans, medication records, statement of purpose, service user guide, staff recruitment and training records, residents personal allowances, maintenance records and fire safety records. The home had a health and safety policy and procedures for staff guidance. The records viewed confirmed that new staff received health and safety training and regular updated training was provided. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electricity certificates, hoists, annual PAT testing etc.), and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g checks on fire equipment and door closures, fire alarms and emergency lighting, hot tap water temperatures, etc.). Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 4 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 3 30 X STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X 3 3 x Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 YA20 Regulation 13(2) Requirement 1.Medication must be available for all residents as appropriate to ensure they receive it as it has been prescribed. 2.Where the administration of prescribed cream is on a separate form, reference to this must be made on the MAR sheet for accuracy. 3. The date of opening must be recorded on individual containers of medicines with a limited shelf life to ensure they are not given past their expiry date. Timescale for action 30/04/08 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 Refer to Standard YA6 Good Practice Recommendations The computerised care planning system should be reviewed to enable all relevant staff access and to ensure this does not impact unduly on the time staff have available to spend with residents. Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Treetops High Dependency Centre DS0000070239.V358967.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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