Inspection on 25/01/06 for Treetops Residential Home

This inspection was carried out on 25th January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Treetops Residential Home 03/12/08

Treetops Residential Home 07/01/08

Treetops Residential Home 08/01/07

Treetops Residential Home 30/06/05

Treetops Residential Home 07/02/05

Treetops Residential Home 14/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Treetops Residential Home Old Ipswich Road Claydon Ipswich Suffolk IP6 0AE Lead Inspector Helen Fontaine Unannounced Inspection 25th January 2006 02:00 Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 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 Residential Home DS0000024514.V280739.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 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 Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Treetops Residential Home Address Old Ipswich Road Claydon Ipswich Suffolk IP6 0AE 01473 830829 01473 833057 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) Mrs Jane S Hewson Mrs Sheila Mildred Gillians Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: Treetops provide care and support to seven adults with learning disabilities whose behaviour can be challenging. The home was first registered in March 1996 and is owned by Mr and Mrs Hewson under the name of Cephas Community Care. Mr and Mrs Hewson jointly own a number of residential homes for people with learning disabilities within Suffolk. Treetops are a detached two-storey “dorma” style bungalow, set well back from the road and situated at one end of the village of Claydon. Service users can easily access the amenities within the village and the home is also a few minutes from the A14 allowing easy access to the other main towns within the east of Suffolk. All service users are provided with single room accommodation, which is furnished and decorated to individual tastes and needs. The home has the advantage of an indoor heated swimming pool and snoozelum. Treetops provides day service to the service users which is created around personal interests and learning skills. The home has its own transport and all service users are therefore able to access local community facilities in the east Suffolk area. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Treetops took place over four hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Three standards have been partly met and new recommendations have been set to take account of this. One new requirement and one new recommendation have been set at this inspection. The manager assisted the inspector, a tour of the home and documents were looked at. All the residents at the home joined in various parts of the inspection and did where they were able express their views about living in the home. The inspector would like to thank the residents, for their help and interest in the process of the inspection and for making the inspector so welcome. What the service does well: The residents in the home have high care needs and challenging behaviour, but all the residents have made steps forward in being able to socialize in the community. Some simple things like being able to go for a walk, or have regular haircuts, which were completely unachievable before, are now regular events for residents. The home allows and encourages residents to make choices and when a resident does communicate that they wish to do something, every effort is made to help them achieve what they want to do. The home has a swimming pool and during the inspection two residents were taking advantage of the snoezelen. The home have a craft room and various models and paintings were in the room, where residents had been busy. The home is addressing residents challenging behaviour and the manager and deputy manager were discussing with the inspector some achievements around this area. The staff training was looked at and found to exceed the National Minimum Standard. The home a good training programme that lays out what training the staff have done, what they need to do and some choices around what they would like to do. The home have a file divided into each member of staff, containing their certificates of training. Each member of staff had a high number of training certificates and the resident’s benefit from a well-trained staff team. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home is in the process of developing a new residents contract and the home must send the Commission for Social Care Inspection a copy. The homes initial assessment for the newest resident had been undertaken, but the area manager had done a referral form for the home and this had not been fully completed. The homes own staff had been out and done an initial assessment, which was quite in-depth, however the home must have all the areas in both the referral and the initial assessment completed in full. The home had a Pharmacy Inspection on the 1st July 2005 and they received a number of requirement and recommendations from the Pharmacist Inspector. The manager said that they had not received a copy of the Pharmacy report; they were aware of the requirements but had not seen the recommendations. The home has made some progress in meeting the requirements and work on these is still on going. However the home must make every effort to meet all the requirements and address the recommendations as quickly as possible. In this report this has been put as a recommendation in appreciation of the home saying they did not get a copy of the report. The home must now make sure that all the issues raised are addressed in full and documented and ready for further inspection. As unmet requirements impact upon the welfare and safety of service users. The staff files also need urgent attention and is a repeat requirement. All staff especially new staff needs to have a file set up and not have loose paper work. The issue over the registered provider not giving the manager necessary information must be addressed. The home had a recommendation at the last inspection that the staff supervision should take place. This is still an issue for the home and has been made a requirement at this inspection. Please contact the provider for advice of actions taken in response to this Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 8 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 Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Residents can expect to have their needs assessed by the home and receive information about the home. EVIDENCE: The home has now sent the Commission for Social Care Inspection a copy of its Statement of Purpose. The home is in the process of receiving new contracts from the registered provider, although the manager has not seen them. The existing contract for resident was looked at during the inspection and had at the beginning an index of topics. This contract covered, welcome to your new home, allowances, holidays, complaints, the building and how you can influence what happens in the home. However the contract format does not enable the residents to understand what is written and they are dependent on someone else signing it or reading it to them. The documents for the newest resident were looked at and there was an initial referral and an initial assessment. This resident had come to the home for three weeks, as the home they were living at was having some refurbishment done. That home then assessed that they could not meet the needs of the resident and they became a permanent resident at Treetops. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 10 The area manager had done an initial referral assessment and this paper work was looked at. It was found that areas of this form were not completed and attached to this paper work was some vital information around medication. It was the opinion of the inspector that this information was important and could have been missed or lost. If the area manager is completing forms they do need to be fully completed and important information documented. The home did their own initial assessment and although when the staff went out to do this, they forgot to take the form with them it was a very thorough assessment. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Residents can expect to be able to make decision and take risks as part of independent lifestyle with assistance. EVIDENCE: All the residents have high care needs and have various issues around challenging behaviour. This means that any decision the resident makes even if is appears to be small is an achievement and has been reached with a lot of support from staff. One resident new to the home, has already started to go for walks. One resident goes to A12 industries if there is any packing work available. Another resident may be going to college to do a course on horticulture; this will necessitate a member of staff going with them. The manager said that it is not clear if the resident will understand what is required, but this is what they want to do. During the inspection the inspector sat with the residents in the home and it was observed that residents were choosing what they wanted to do. The staff then supported them. As an example one resident wanted to do puzzles. Puzzles were got out and assistance was available if they got stuck. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 12 There was then a dialogue about what the picture was about and this was done by signing and verbally. Encouragement was given and positive feedback was given, when a resident said a word that they had not used before. The manager was very clear that everything that happens in the home is based on what the residents want to do. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 16 and 17 Residents have opportunities for activities, personal development, rights and responsibilities. Residents can expect a healthy diet with choices and enjoy their meals and mealtimes. EVIDENCE: At the last inspection the home received a recommendation that the communication board should be repaired. During the inspection the mended board was seen and the member of staff whose project it was to complete this was spoken to. Now that the board is repaired the member of staff is planning to have a picture of each resident, with the morning and afternoon programmes on it in picture format. It is hoped that the residents will then learn to look and see what they are doing and have a choice of what they do. The resident’s rights are respected and one resident does not like curtains up at their bedroom window. Rather than deny the resident access to their room and leave the curtains up, the staff take the curtains down during the day and put them back up at night. The resident’s rooms are all personalized and no member of staff enters the room without permission. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 14 When the inspector wanted to look at a residents room, the manager went and got the resident and asked them if they wanted to show the inspector their room. If the resident declined the room was not looked at. The home’s kitchen is divided, with a table and chairs up one end and the cooking area at the other end. To divide the kitchen and keep the residents safe, there is a breakfast bar with a half door. The residents eat at the table and can see and interact with staff. The four-week rotation menu was looked at which showed that the residents are provided with a number of choices. The menu for the day of the inspection had Ice cream for sweat. However from discussion with the residents it was decided that it was too cold for this. The staff looked at the cookery books and again with discussion with residents both verbally and by signing, it was decided what they wanted for sweet instead of the ice cream. Residents now have new drinking glasses that are imitation glass, as none of the residents would be safe using glass. The old plastic cups are now used for water when the residents take their medication. The home do use ordinary china plates and dishes for meals. The fridge and freezer were both looked at during the inspection and foods were found to be stored appropriately. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Residents can expect to have their emotional and health needs met, but are not protected by the homes practices around medication EVIDENCE: During the inspection, one resident went with the deputy manager and another member of staff to the hospital for an outpatient’s appointment. The manager said that the home supports their residents to have regular contact with GP’s, District Nurses, Chiropody and the Community Psychiatric Nurse as well as the Intensive Support Team. The manager said that all the female residents have been offered medical checks, but the residents have all declined. The Commission for Social Care Inspection’s Pharmacist Inspector undertook an inspection in July 2005. The manager had documented at the time the requirements the Pharmacist Inspector raised, but said that they had not received the report and did not know that there were recommendations. The home is putting great efforts into trying to address these, but must make sure that all the requirements and recommendations in the Pharmacist’s report are met as soon as possible. The manager showed the inspector the medication cupboard. The manager confirmed that only they and a senior carer carry the key to the medication cupboard. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 16 The medication cupboard has had a new floor fitted and a new set of drawers had been put into place and the manager said that once a shelf had been removed another set of drawers would be bought. The manager was unable to locate in the medication cupboard the folder, which contained all the policies and procedures for medication. However the manager was able to show the inspector a copy in the office, but the red folder must be found and placed in the medication cupboard. It will be expected that at the next inspection all the requirements and recommendations will be met in full. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this visit. EVIDENCE: The above standards were not specifically inspected on this visit, as there were no outstanding requirements in relation to this standard. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 and 27 Resident’s bedrooms suit their needs and promote their independence. EVIDENCE: All the residents’ rooms were looked at in the presence of the occupant and were personalized and all suited their needs and promoted their independence. At the last inspection there were two requirements given around this area and these were about the curtains at a resident’s window and no door on the ensuite in a resident’s room. These two issues were looked at during the inspection and the resident showed the inspector their room. The manager said that the resident does not like curtains at the window of the bedroom and this was documented in the resident’s care plan. The resident did pull the curtains down if they are left up and rather than deny the resident access to their room during the day the curtains are removed. The staff replaced the curtains at night, giving the resident privacy when the light is on and they are in their room. The issue over the door to the en-suite was more difficult for the home to resolve. A door was fitted and found that this then blocked the door to the room and placed the resident and the staff at risk. A folding door was looked at and the manager said that this did not work at all. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 19 The home have fitted a curtain across the en-suite, this meet the need for the resident to have privacy but did not cause a further risk. The inspector did look at the curtain; this was seen as meeting the requirement. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 Residents can expect to have their needs met by appropriately trained staff, but are not protected by the home’s recruitment practices. EVIDENCE: The newest member of staff’s paper work was looked at, there was no file for this paper work and there was little in the way of evidence that the necessary checks had been done. The document did however give the Criminal Record Bureau (CRB) check number, but the Protection of Vulnerable Adults (POVA) first check and one of the references were not with the paper work. The manager said that the Registered Provider had not sent the necessary documentation through despite repeated requests from the manager. The manager said that she felt at a loss to know how to get the necessary paper work through, as there was no response to her request. The home must make sure that all necessary documentation is available for inspection. The home has some very good policies and practices around staff training and at the time of the inspection five members of staff were on Unisafe training. The manager has a file, which is divided into each staff member full of training certificates. The manager also produced a training programme that showed what training the staff had done, when it needed reviewing and what the staff would like to train in. As an example of the good practices in training, one of the new residents to the home had Tubercus Sclerosis Complex, which the staff were totally unfamiliar with. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 21 The home had arranged a representative to come from the Tubercus Sclerosis association and give training to all the staff. There was evidence in the training folder the certificates from the association, which confirmed that all the staff had received training. The home has been assessed as exceeding the National Minimum Standard in this particular standard. During the inspection the standard around staff supervision was looked at, as this was a recommendation. It was found that the staff are still not receiving regular documented supervision. The home must make sure that the staff receive regular documented supervision. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The residents can be confident that their views are taken into account in the development of the home. EVIDENCE: The home quality assurance and quality monitoring system was looked at and the inspector was informed that the current questionnaire is being replaced. The new questionnaire will be in sign and picture format that will give the resident’s an opportunity to express their own views. The questionnaire covered ten questions including how good are we? Do our staff act in a way that you like, then a choice of a,b or c answers to tick as a response. In the case of this question they were a) all the time, b) some of the time and c)never. Another question the form asked was, are you happy with the help you are given and again this had the same a,b and c answers to tick. The inspector looked through the questionnaire for the last quality monitoring exercise and there was some good positive feedback to the questions. The manager said that family, friends and staff had assisted the residents to complete these. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 23 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 3 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 3 27 3 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 4 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X X X 3 X X X X Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 24 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 YA36 Regulation 18(2) Timescale for action The registered manager must 24/04/06 make sure that all staff receive documented supervision. Requirement 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. 3. Refer to Standard YA2 YA20 YA34 Good Practice Recommendations The home makes sure that all areas of the documentation around the initial assessment are completed in full and additional information is attached securely. The home meets all the requirements and recommendations in the pharmacy report, as a matter of urgency. The registered provider makes sure that they forward all necessary paper work relating to the home as quickly as possible. Treetops Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Residential Home DS0000024514.V280739.R01.S.doc Version 5.1 Page 26 - 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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