Inspection on 23/09/05 for Treetops Nursing Home

This inspection was carried out on 23rd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 21/02/06

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 Carthage Street Oldham Lancashire OL8 1LL Lead Inspector Fiona Bryan Unannounced 23 September 2005 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 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 F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Treetops Address Carthage Street, Oldham, OL8 1LL Telephone number Fax number Email 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 C A Shaw Mrs C A Shaw CRH - Care Home 33 Category(ies) of OP - Old Age (33) registration, with number PD - Physical Disability (33) of places PD(E) - Physical Disability over 65 (33) TI - Terminally Ill (3) Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. 8:00am to 5:00pm two registered nurses; 5:00pm to 10:00pm one registered nurse; 10:00pm to 8:00am one registered nurse. Date of last inspection 8 February 2005 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 F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by one inspector, who spent time talking to five residents, four visitors and four staff. Four residents were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and residents’ records were examined including records of care and staff duty rotas, and a tour of the building was carried out. At the time of the inspection the manager was not on duty so the deputy manager assisted with the inspection. One complaint had been referred to the CSCI since the last inspection and whilst it was not upheld the manager used the opportunity to make some changes to practices within the home to reduce the risk of similar circumstances happening again. What the service does well: Treetops is clean, homely and comfortable. Staff appeared professional and friendly. Residents appeared relaxed, at home and content. Residents and relatives were very positive about the home. Comments included “you can’t fault the staff”, “Treetops feels like home not a home”, “staff are brilliant”, “staff are second to none”, “staff have a good approach and nothing is too much trouble”. One resident said the best thing about the home was the “attention, kindness, kind words”. One relative said the home was “absolutely marvellous” and her relative was very happy. One relative said the resident they visited got on very well with the staff and had a good relationship with them. When asked what the best thing was about living at the home one resident said “you know you are safe and there is someone to look after you. I have never had any request refused by staff – there is no downside to living here”. One relative who had worked at the chemists which supplied the residents’ prescriptions stated that they had always been impressed with the efficiency of Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 6 the home in ordering medicines and liaising with the GP’s and chemist. They had formed an impression that the staff were very competent in their roles. During the inspection the deputy manager was very enthusiastic and well motivated. Lots of ideas were discussed and the deputy manager seemed willing to try new approaches to further improve the service. Staff felt that they were treated well by the manager and this leads to a good working atmosphere. One resident said “you can quote me happy!”. 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 F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 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 standard(s) 3 More detail is needed when undertaking the assessment of residents’ needs. EVIDENCE: Examination of four residents’ care files indicated that assessments had been obtained from the residents’ care managers prior to their admission. However, in some cases not all the information had been transferred to the home’s own admission documentation and was therefore not readily accessible. Assessments lacked some details such as information about the resident’s sleeping pattern, communication needs and spiritual, emotional and social needs. Staff were very knowledgeable about residents’ physical needs and daily routines and residents said they felt staff knew them well and understood what their care needs were. However staff had limited knowledge about some of the residents’ social histories, previous hobbies and interests. It was reported that relatives were given social history forms to complete when a resident was admitted but they did not always return them. Discussion took place about Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 9 ways in which staff could become more involved in helping residents to describe important life events as a means of viewing residents in a more holistic way. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 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 standard(s) 7, 8 and 10 Care plans do not fully identify the social care needs of the residents and more rigour is needed to ensure that risk assessments are accurate and up to date. The health care needs of the residents are met. Staff treat residents with respect and maintain their privacy and dignity. EVIDENCE: Care plans were generally in place for residents’ physical and healthcare needs but did not address social care needs and staff tended to be less sure about how these would be met. Care plans were sometimes vague stating “ensure adequate fluid intake” without saying what would be considered adequate and how it would be monitored. The risk assessment for one resident’s mobility had not been reviewed since February 2005 and was inaccurate in that it stated that the resident was independently mobile when the hoist was actually used to move them. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 11 One resident said staff would tell him if he needed new medication or there were changes to his care. Three residents confirmed that chiropodists, dentists and opticians had seen them. One resident said staff treated him very well and respected his room as being his own space for privacy if he wished. Two relatives said residents always looked well cared for, clean, tidy and well presented. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 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 standard(s) 12, 13 and 15 Further consideration is needed as to how the home meets the social and recreational needs of all its residents, especially the residents who are more infirm. Visitors are encouraged and welcomed in to the home. Meals suit most residents’ tastes. EVIDENCE: Some activities were advertised on a notice board in the reception area, such as a potpie supper being held at Halloween and a fireworks display on Bonfire night. One resident talked about a trip they had been on to Martinmere and described a VE Day party, which they had enjoyed. One resident said he did not like to do much and was happy watching television and going to watch football every fortnight with a relative. One resident said they liked to read the papers and were able to go out to the local shops independently. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 13 Three residents said routines in the home were flexible and they could move around the home as they wanted and get up and go to bed as they wished. These residents also said that their visitors were always made welcome and one relative said they were always offered a cup of tea when they visited. Many of the residents at Treetops are quite highly dependent and have complex health care needs, which create challenges for staff in trying to meet their need for social stimulation. As discussed elsewhere in this report increased efforts to complete social histories and obtain further information about residents’ former interests and occupations may provide points for conversation with residents and offer ideas for other meaningful activities. Lunch was fish, chips and peas, which looked appetising. Staff were appropriately assisting those residents who needed help. Staff said that the meal was discussed each day with residents and alternatives were offered – they had found this worked better as sometimes residents forgot if they were asked to make a choice too long before the meal. One resident said the meals provided were very good and an alternative was always offered. Two residents said the meals were variable but there was a choice and one resident said he spoke with the chef every day. Three residents confirmed that hot and cold drinks were offered between meals and said they were served toast and horlicks for supper. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 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 standard(s) 16 and 18 Residents and relatives are confident that any complaints will be dealt with satisfactorily. Residents are protected from abuse. EVIDENCE: Residents and relatives stated that if they had any concerns they would speak with either the nurse in charge, the deputy manager or the manager and they felt that any problems would be dealt with appropriately. A record of complaints is kept, detailing the action taken to address any issues. Since the last inspection one complaint has been made which was followed up by the CSCI. Although the complaint was not upheld the manager had taken the opportunity to review practices within the home. All new staff undertake a half day course in prevention of abuse and it is then covered again in NVQ training. One member of staff said they would report any suspected abuse. One qualified nurse was not fully aware of the procedures and was unsure of which external agencies could be contacted for advice and support. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 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 standard(s) 19, 24 and 26 The home is well maintained, safe, clean, comfortable and pleasant for residents to live in. EVIDENCE: It was reported that the main reception area and stairway is to be redecorated and the carpet is being replaced. Arrangements had been made for the conservatory to be fitted with blinds on 2/10/05. The lounge/dining room was in the process of being redecorated and new curtains had been purchased. A rolling programme is in place for the replacement of bedroom furniture. The majority of beds are supplied with soft form pressure relieving mattresses. Two residents who shared a room had lots of personal possessions and had been able to bring some of their own furniture into the home. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 16 The home was very clean, tidy, homely and comfortable and residents said they liked their rooms. Relatives and residents said the laundry and cleaning services were very good. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staffing levels meet the needs of the residents. Staff have received training which is relevant to the care they need to provide but had not attended training in health and safety topics. EVIDENCE: Examination of staff duty rotas indicate that staffing levels are sufficient to meet the needs of the residents. One resident said staffing levels were satisfactory and that staff attended to them promptly when they asked for assistance. Two residents said that there were usually enough staff on duty apart from on occasions when staff were off sick or on holiday. It was reported that in these instances agency staff are employed where possible. One relative stated that there was always a member of staff to speak to when they visited. Records of staff training provided evidence that staff had undertaken training in a variety of topics, such as gastrostomy care, emergency resuscitation, dementia care, optical awareness, compression bandaging, tissue viability and wound care. Although mandatory training in fire safety and moving and handling had been arranged very few of the staff had attended. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The views of residents are sought about how the home meets their needs. Further staff training is needed to ensure that the health, safety and welfare of residents and staff are protected. EVIDENCE: A staff meeting was held on 6th June 2005. One member of staff said the meetings provided opportunities to suggest improvements or changes to the routines and practices within the home. A residents’ meeting was held on 8th June 2005, which was well attended. The deputy manager reported that another meeting was due to be held in the near future. Minutes were available of all meetings held. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 19 Questionnaires had been distributed intermittently to residents and the results analysed. Seven residents had responded since the last inspection and all had been positive and made favourable comments. As discussed elsewhere in this report although mandatory training had been arranged in moving and handling and fire safety the majority of staff had not attended. Staff had not participated in fire drills. Two residents said staff sometimes lifted them instead of using the hoist. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? 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 3 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 The registered person must ensure that care plans include the action which needs to be taken to meet residents social care needs. The registered person must ensure that risk assessments are reviewed regularly and are accurate. The registered person must ensure that service users are consulted about the programme of activities arranged on their behalf and must provide facilities for recreation to suit service users’ expectations, preferences and capacities. (Timescale of 31/3/05 not met). The registered person must ensure that staff receive mandatory training in health and safety topics. The registered person must ensure that staff participate in fire drills and a record is kept of each drill and which staff F54 F04 treetops U s25457 v248141 230905 stage 4.doc Timescale for action 30/11/05 2. 7 15 31/12/05 3. 7 13 30/11/05 4. 12 16 31/12/05 5. 30, 38 18 31/12/05 6. 38 23 30/11/05 Treetops Version 1.40 Page 22 members attended. 7. 38 13 The registered person must ensure that residents are moved appropriately and according to their risk assessment. 30/11/05 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 18 Good Practice Recommendations The registered person should ensure that further explantion and clarification is given to staff about the role of external agencies in adult protection work. Treetops F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne, 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 F54 F04 treetops U s25457 v248141 230905 stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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