Inspection on 21/02/06 for Treetops Nursing Home

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Treetops Nursing Home 25/09/06

Treetops Nursing Home 23/09/05

Treetops Nursing Home 08/02/05

Treetops Nursing Home 02/11/04

Treetops Nursing Home 03/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Treetops Nursing Home Carthage Street Oldham Lancashire OL8 1LL Lead Inspector Mrs Fiona Bryan Unannounced Inspection 21st February 2006 09:10 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 Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 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 Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Treetops Nursing Home Address Carthage Street Oldham Lancashire OL8 1LL 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) 0161 628 6811 0161 628 6811 Mrs Christine Ann Shaw Mrs Christine Ann Shaw Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (33), Physical disability of places over 65 years of age (33), Terminally ill (3) Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 33 places can be used for nursing care, which may include one person under the age of 55 years in the category PD. No other service user under 55 years to be admitted to the establishment. 8.00 a.m. - 5.00 p.m. 2 registered nurses; 5.00 p.m. - 10.00 p.m. 1 registered nurse; 10.00 p.m. - 8.00 a.m. 1 registered nurse. 23rd September 2005 Date of last inspection Brief Description of the Service: Treetops has 33 beds in total, all of which can be used to provide nursing or personal care. The home can also provide care for up to three terminally ill service users within the total numbers. The home is owned and managed by Mrs Shaw, who is a registered nurse. Treetops is a purpose built home, situated a short distance from Oldham town centre. Accommodation is provided over two floors and consists of 27 single rooms and three double rooms. None of the rooms have en-suite facilities but toilet and bathing facilities are located nearby. Access to the first floor is provided by a lift. There are two communal areas within the home that allow service users to socialise together and participate in activities as they wish. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 21st February 2006 and was the second inspection of the year. It was undertaken by one inspector who spent time talking to residents, visitors and staff. At the last inspection in September 2005 the home was performing satisfactorily in many areas so the purpose of this inspection was to review progress in the areas that were identified as needing improvement. This was mainly related to how residents’ care needs were assessed, how care plans were developed and reviewed, the arrangements for the provision of social activities and stimulation and the provision of health and safety training for staff. Six key standards, which have to be assessed at least once year were not examined at the last inspection, and were therefore considered at this inspection. These standards included how the home dealt with staff recruitment and residents’ personal finances, the management of medicines, how residents’ choices and rights are upheld and the training and qualifications of the manager and staff. Standards which were not assessed at this inspection, were considered to be satisfactory at the last inspection. For further information about how the home met these standards please refer to the report of the inspection on 19th September 2005. What the service does well: One resident said he felt very happy at the home. One resident, when asked what the best thing about the home was, said the staff were very nice – “I really do like all the staff”. One resident said there was nothing she would want to change about the home. She was very settled and had fun with the staff. This resident said the home was nice and clean and she had a lovely bedroom and she had been helped to put pictures on the walls and had all her “bits and pieces” around her. Over 50 of the care staff have achieved a National Vocational Qualification. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 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. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 7 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 Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Although assessments are undertaken for all residents, in some cases a lack of detail could lead to needs not being identified. EVIDENCE: Since the last inspection the assessment record has been revised and provides space to include details about all aspects of prospective residents’ activities of daily living. Although the amount of detail had improved, there were still some shortfalls in, for example, the assessment of nutritional risk, and identified needs did not always have associated care plans. In discussion with the manager and deputy manager it was apparent that the vast majority of documentation was undertaken by them and other registered nurses were not taking on the responsibility of maintaining the records throughout their own shifts. This is something the manager recognised and is seeking to address. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 9 Residents felt that staff understood their needs well and they were involved in determining the care they required. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 The residents’ care plans do not always set out all of their health, personal and social care needs, leading to the potential risk that needs may not be met. Staff adhere to medicine management procedures thereby ensuring that the safety of residents is maintained. EVIDENCE: Examination of a selection of care files indicated that care plans did not always address all the needs of the residents, for example, there was no wound care plan for one resident with pressure ulcers. Also, the wounds had not been photographed which would be good practice to aid the evaluation of treatment. Care plans for pressure care did not contain specific details about the type of mattress required for the resident. This should be included together with the pump setting if appropriate, so that staff can ensure the mattress is working effectively. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 11 Although residents had been weighed they had not always had nutritional risk assessments completed. Since the last inspection the home has changed its pharmacy supplier. Examination of a number of residents’ medication administration records indicated that medicines were generally managed satisfactorily at the home. A record is maintained of all medicines received and sent for disposal by the home. The home utilises resident photographs as a formal system of identification prior to medication administration. Controlled drugs were stored, administered and recorded satisfactorily. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 The home has worked hard to provide a variety of opportunities for social pastimes but still needs to consider how the needs of the more highly dependent residents can be met. Residents’ individual rights and choices are recognised and the home strives to adhere to their wishes. EVIDENCE: Since the last inspection a carer has been allocated to undertake social profiles with all the residents in order to obtain more detailed information, which can be used to provide more person-centred activities. Some relatives have also been asked to help complete social histories and this has provided ideas for entertainment, for example it was discovered that one resident used to play in a brass band so a brass band was invited to the home to play for the residents. The development of social profiles and associated care plans has not yet been fully completed; therefore there are no strategies for providing social stimulation for some residents, especially those that are more highly dependent. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 13 On the day of the inspection the aromatherapist was visiting the home, attending several residents. A minister from the local Church visits the home once a month to offer communion to residents, and will visit them individually if required. One resident said the routine of the home was free and easy and they could go to bed, get up and spend the day as they wished. This resident said they felt they were able to act exactly as they would at home and felt the care home was their home. It was reported that another resident had very strong views about their future treatment and end of life care and the Terence Higgins Trust had been accessed for them to support them to make a living will. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section were assessed. EVIDENCE: Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section were assessed. EVIDENCE: Although the standards in this section were not formally assessed it was noted that the home was clean, tidy, warm and comfortable. Work that had been planned at the last inspection had been completed such as the redecoration of the main reception area and stairway, the fitting of the conservatory blinds and the purchase of new curtains for the lounge/dining room. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 The home exceeds the standards for the percentage of care staff who have completed NVQ training, providing staff who have the skills and knowledge to care for the residents competently. Recruitment practices protect the residents. Staff have not had training updates in some mandatory topics; this presents a potential risk to residents. EVIDENCE: Nine of the 14 care staff working at the home have an NVQ level 2 and of these, one carer has also successfully completed NVQ level 3. A further three care staff are currently working towards the NVQ level 2. Therefore, the home has exceeded the target to meet this standard. The home has a very low staff turnover and therefore no new staff had commenced employment at the home recently. Examination of two staff personnel records indicated that staff had been recruited via a thorough vetting and recruitment procedure. As no new staff have commenced employment at the home in recent months no induction training has taken place. However, some mandatory training in health and safety topics is due. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 35 and 38 The manager has the skills and knowledge to properly manage the home, but a failure on the part of other nurses in the home to accept their responsibilities could lead to inconsistencies in how care is provided to residents in the absence of the manager and the deputy manager. Procedures are in place to ensure residents’ finances are safeguarded. Further staff training is needed to ensure that the health, safety and welfare of residents and staff are protected. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 18 EVIDENCE: The manager has completed the registered manager’s award. Staff, residents and relatives said the manager was very approachable and accessible. However, as stated elsewhere in this report, although the manager is very ably supported by the deputy manager, both acknowledged that other nurses within the home do not always demonstrate an awareness of their roles and responsibilities. The majority of residents are assisted with their finances by their families. If necessary, the home may contact Age Concern to act as an advocate on behalf of a resident. Records and receipts are maintained of all transactions made on behalf of the residents. The home’s maintenance person undertakes weekly and monthly checks on the building and equipment in respect of health and safety. An environmental health inspection was carried out at the home on 9 February 2006. Five recommendations and one requirement were made and the manager confirmed these had all been addressed. The home has received information about the new training being provided in respect of food – “Safer Food, Better Business” and intends to enrol two staff to attend. Although some staff still require updates in health and safety topics, staff were observed to be using safe working practices. Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 19 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 2 Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered person must ensure that assessments of residents prior to their admission to the home include all the details stated in NMS 3.3. (Previous timescale of 30/11/05 not met). The registered person must ensure that care plans are developed to meet all the assessed personal, social and health care needs of residents. The registered person must ensure that a nutritional risk assessment is undertaken for each resident on admission. The registered person must ensure that staff receive training updates in all mandatory health and safety topics. Timescale for action 30/04/06 2 OP7 15 30/04/06 3 OP8 14 30/04/06 4 OP30OP38 18 30/06/06 Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 21 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 OP8 Good Practice Recommendations The registered person should ensure that photographs are taken of residents wounds, with the resident’s consent and according to the home’s policies and procedures in order to assist in assessing the effectiveness of treatment. The registered person should ensure that care plans include specific details about the type of pressure mattresses being used and the pump settings if applicable so that staff can ensure they are working properly. The registered person should ensure that further consideration is given as to how the social care needs of the more highly dependent residents can be met. The registered person should ensure that all staff are fully aware of their professional duties and responsibilities and are clear about how they are expected to perform their jobs within the home. 2 OP8 3 4 OP12 OP32 Treetops Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 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 Nursing Home DS0000025457.V283815.R01.S.doc Version 5.1 Page 23 - 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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