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Inspection on 27/02/06 for Treetops Residential Home

Also see our care home review for Treetops Residential Home for more information

This inspection was carried out on 27th 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.

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 good standard of care for residents. There was a warm, calm, welcoming atmosphere. Residents spoken to on this occasion again said how much they like living at the home. Staff are enthusiastic about their work, have a good understanding of residents` care needs and have developed a good rapport with the residents.

What has improved since the last inspection?

A bedroom had been redecorated with new carpet fitted, providing an attractive and homely environment. A new foot operated pedal bin has been provided to safely store clinical waste and prevent the spread of infection from the handling of soiled articles. The owners have been carrying out regular monthly visits to assess the home and have provided the commission with copies of their reports. This shows that they monitor the standards of the home, consult with residents and make sure that anything needed is attended to straight away.

What the care home could do better:

At the last inspection some commendable standards were seen in the way that the home had been managed and how the care had been provided to residents. Although good things are still apparent, at this inspection, it was identified that improvements in staffing numbers and medication systems were needed. There were not enough staff on duty to safely meet residents` needs and deal with any visitors to the home, or other unforeseen situations that may arise.The storage and way medications are dealt with needed some review to fully ensure safety. The registered provider responded promptly with written confirmation that the necessary improvements had been made in a timely fashion.

CARE HOMES FOR OLDER PEOPLE Treetops Residential Home 3 Lower Northdown Avenue Cliftonville Margate Kent CT9 2NJ Lead Inspector Christine Grafton Unannounced Inspection 14:35 27 February 2006 th 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 Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 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 Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Treetops Residential Home Address 3 Lower Northdown Avenue Cliftonville Margate Kent CT9 2NJ 01843 220826 01843 220826 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) Gracefind Limited Mrs Wendy Hughes Care Home 24 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (23) of places Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To admit one (1) Service User with dementia whose date of birth is 03/06/1913. To admit one (1) Service User whose date of birth is 04/01/1942. To admit one (1) Service User whose date of birth is 20/03/1929. Date of last inspection 28th June 2005 Brief Description of the Service: Treetops is a three-storey detached building, with bedroom accommodation on each of the three floors. There are 18 single bedrooms (10 of which have ensuite facilities) and 3 doubles. There is a shaft lift to all floors. Each bedroom has a call bell and television point. There is a lounge and a separate dining room, with two additional lounge areas off each end, one of which may be used for people to smoke in. There is a secluded garden to the rear, laid to lawn, with 2 bench seats and a small patio with table and chairs, where residents may sit in warm weather. The home is situated in a residential part of Cliftonville, close to local shops and all public amenities. Public transport can be easily accessed and there is unrestricted on-street parking. Treetops has been under the same ownership for over 15 years. The staff team is lead by the Manager. They provide 24-hour care including a member of staff awake and one member of staff who does a split night shift that includes 3 hours sleeping in. According to its statement of purpose, the home aims to provide care and support to residents to help them live as independently as possible, consistent with their capabilities and disabilities. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection covered an afternoon period. It consisted of speaking with 2 staff members, 3 residents, looking round some parts of the home and checking some records. At the time of this inspection there were 24 residents. The key national minimum standards were assessed at the last announced inspection, therefore, this inspection mainly focussed on checking the 4 requirements and 2 recommendations from that inspection. As the report does not cover all the standards, the reader may wish to refer to the last inspection report, for a fuller overview of the home. What the service does well: What has improved since the last inspection? What they could do better: At the last inspection some commendable standards were seen in the way that the home had been managed and how the care had been provided to residents. Although good things are still apparent, at this inspection, it was identified that improvements in staffing numbers and medication systems were needed. There were not enough staff on duty to safely meet residents’ needs and deal with any visitors to the home, or other unforeseen situations that may arise. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 6 The storage and way medications are dealt with needed some review to fully ensure safety. The registered provider responded promptly with written confirmation that the necessary improvements had been made in a timely fashion. 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 Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 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 Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 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): None of these standards were assessed on this occasion. Standards 1 & 3 were assessed on 28/06/05. See previous report. EVIDENCE: Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 9 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 & 9 The care planning system is clear and consistent, providing staff with the information they need to meet residents’ needs. Residents’ personal and health care needs are being met. However, one care plan review record must incorporate important changes in medication treatments to avoid the risk that the resident’s health care needs might not be properly met. Medication systems are generally satisfactory, but some improvements are needed to fully protect residents and staff. EVIDENCE: Two care plans were checked and contained detailed, clear information covering all the needs identified in the assessment, setting out the staff actions needed to meet residents’ needs. Care plans are ‘person centred’ and had been regularly reviewed. From reading the care plans and talking to staff, it was clear that the home liaises with health care professionals to ensure that residents’ health care needs are met. Where a resident’s health had showed signs of deterioration, the care plan showed that staff had reported indicators, which the manager had followed up by involving health care professionals. When the person’s condition deteriorated, over a weekend, to a level that the staff member in charge Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 10 considered the home could not manage safely, s/he took the correct action that resulted in a hospital admission. The commission was duly notified of this. From the case tracking of this resident’s file and talking to the staff member, it was clear that the person’s health care had been managed in a competent manner. One resident had returned from hospital following eye treatment, but the care plan had not been updated to show a change in the treatment regime, even though a review had been recorded after the change occurred. From discussion with staff, it transpired that the treatment was being carried out and recorded on the medication sheets appropriately, but by not transferring this to the care plan, there is a potential risk that it could be overlooked. Since the last inspection a new drugs refrigerator and new controlled drugs (CD) cupboard have been purchased. The CD cupboard has been fixed to a wall in a poor position. Certain safety risks were identified, for example, when staff have to access the cupboard. Some gaps were noted on the medication administration (MAR) sheets. Some handwritten changes had been made to a MAR sheet that the staff member said had followed a verbal order from a doctor. No written confirmation of this change had been obtained from the doctor. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 11 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): None of these standards were assessed on this occasion. Standards 12 to 15 were assessed on 28/06/05. See previous report. EVIDENCE: Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 12 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): 18 Policies and procedures are in place for the protection of residents from abuse. EVIDENCE: The home has a detailed policy and clear written procedures on abuse and adult protection. The ‘whistle blowing’ and restraint policies have been seen at previous inspections and there is also a policy on the management of aggression. A staff member said that these policies are regularly discussed. The staff member stated that s/he would speak to the manager if concerned about anything that might indicate abuse and knew that any suspicions of abuse should be reported to care management and to the commission. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 13 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): 19 & 26 Residents are provided with a homely, well-maintained environment. Good systems are in place to keep the home hygienic, free from offensive odours and control the spread of infection. EVIDENCE: There is an ongoing programme for the routine maintenance and redecoration of the building. One bedroom was seen that had been redecorated and fitted with new carpet since the last inspection. Areas of the home seen on this occasion were clean and free from offensive odours. Liquid soap and paper towels are available for staff hand washing in bathrooms and other areas where soiled items are handled. A foot operated pedal bin has been obtained, since the last inspection, for clinical waste. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 14 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): 27 The number of staff on duty, at the time of this inspection, was not sufficient to meet the needs of residents, provide them with adequate protection and maintain the safety of the home. EVIDENCE: There were two care staff on duty during the afternoon of this inspection. An afternoon cook came on duty at 16.00 hours, but between 14.35 and 16.00 hours there were only two staff on duty to care for 24 residents and deal with the inspection. The manager had gone to visit a resident in hospital. The carers were observed assisting residents in a calm, competent manner. However, while they were assisting one resident, who needed two carers for moving and handling, the doorbell rang and could not be answered until the task had been completed and one of the carers could safely leave the resident, wash their hands and answer the door. A second incident was observed, whereby one carer was busy in the kitchen and the other carer was answering the telephone. The doorbell rang and the carer had to leave the telephone to answer the door and return to continue the conversation with the caller on the telephone. A carer said the home has “a lovely atmosphere and there is a nice team spirit.” Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 15 As the manager was not available and the senior staff member did not have access to staff records, the recruitment procedures could not be checked. Therefore the standard 29 requirement from the last inspection has been carried forward. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 16 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): None of these standards were assessed on this occasion. Standards 31 to 33, 35, 37 & 38 were assessed on 28/06/05. See previous report. EVIDENCE: Standard 33 was not assessed, but since the last inspection the registered providers have submitted monthly reports to the commission on the conduct of the home. That requirement has therefore been met. Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 17 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 18 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 OP9 Regulation 13(2) Requirement The registered persons must make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The position of the controlled drugs cupboard to be reviewed and action taken to ensure security and safe access for staff. Action plan to be submitted. The registered persons must ensure that at all times there are enough suitably qualified, competent and experienced persons working at the home, on duty, in such numbers that are appropriate for the health and welfare of Service Users New staff must not be employed unless they are fit to work at the care home and information is obtained as specified in Schedule 2. Recruitment procedures must ensure that gaps in employment are checked out and CRB/POVA checks are carried out for all employees prior to their start DS0000023613.V266048.R01.S.doc Timescale for action 30/04/06 2 OP9 13(2) 30/04/06 3 OP27 18 21/03/06 4 OP29 19 30/04/06 Treetops Residential Home Version 5.0 Page 19 date. (Previous requirement from 28/06/05 not checked so carried forward). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP22 OP27 Good Practice Recommendations That a set of sit on chair scales is obtained to weigh residents with mobility problems who cannot stand unaided. (Carried forward from 28/06/05). That the managers hours are added to the worked rotas to provide supporting evidence of the times worked supervising and training staff during the evenings, nights and weekends. (Not checked and carried forward from 28/06/05). Treetops Residential Home DS0000023613.V266048.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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