Inspection on 07/01/08 for Treetops Residential Home

This inspection was carried out on 7th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 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 08/01/07

Treetops Residential Home 25/01/06

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 Jenny Elliott Unannounced Inspection 7th January 2008 10:00 Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treetops Residential Home Address Old Ipswich Road Claydon Ipswich Suffolk IP6 0AE 01473 830829 01473 833057 sheila@cephas-care.co.uk 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.V357360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8th January 2007 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 is 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. Treetops provides day services 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. The manager reported that at the time of the inspection charges at Treetops was £750 to £1,500 per week. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The information contained in this report was gathered from a visit to the home. During that visit a tour of the premises was undertaken. In addition time was spent with people who live at the home as well as with a visitor and staff working at the home. Records belonging to three people who live at the home were inspected in detail along with records relating to the recruitment, supervision and training of staff. Documents regarding the safety of the home, including certificates of inspection and maintenance checks were also seen. What the service does well: What has improved since the last inspection? Since the last inspection the home has improved the records it keeps about people who come to work at the home, this helps to make sure they are suitable people to provide care. The home had also made sure that records kept about medication were complete, this helps to make sure that medicines are used safely. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Prospective users can expect that their individual aspirations and needs are assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had not admitted any new residents since the last inspection. Processes remained the same as the previous inspection. At this point the inspector described the admission assessments and process as good. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. People who live at the home can expect to be given opportunities to make day to day decisions about their lives. They cannot be confident that this will be fully reflected in plans of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records belonging to three people who lived at the home were inspected. These included care plans, behaviour management plans, risk assessments and documents for monitoring behaviour. As many service users are unable to articulate fully their feelings and wishes, it is important to monitor changes in behaviour. These can be used to judge levels of satisfaction with the service being provided. A number of documents were undated and unsigned, making it difficult to assess how up to date they were. Others had been completed in February 2007 and indicated they should be reviewed in May or August 2007, but there was no evidence that the review had taken place. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 10 Generally the care plans focussed on the behaviours of the people living at the home and did not address goals or aspirations. It was clear though, from discussion with staff and managers that steps had been taken to improve the quality of life of the people living at Treetops, and where behaviours indicated this was not what was wanted, changes had been made. This was not reflected in the paperwork. During the day of the inspection staff were observed giving service users the opportunity to make small decisions. Staff were also observed interpreting the behaviours of residents into requests and providing reasoned verbal responses to those requests. This is important because some of the people living at the home repeatedly request the same thing, through speech or actions, and a consistent, clear way of responding helps to promote dignity. Risk assessments were in place for key activities undertaken by people living at the home. Staff were also clear about risks posed from some of the behaviours used, and this was covered in behaviour management strategies. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. People who live at the home can expect the service to support them to maintain links with the community and their families, and that the routines of the home will not overide their individual wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had experienced some difficulty in accessing meaningful occupation outside the home for the people who live there. However since the last inspection they had identified a centre that provides appropriate opportunities and put people forward for a range of activities. They were waiting to hear if these had been successful. The home had identified an opportunity for one person living at the home at a another service, and although this had not worked out long term it was a positive approach to try and meet that persons needs. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 12 Daily logs, which hold information about each persons activities, showed that a number of service users maintained regular contact with family members. This included regular weekend visits to families. On the morning of the inspection one person was returning from such a visit. The relationship between staff and the family member was good, and the family member was happy with how staff kept them up to date about the wellbeing of their relative. The daily logs also showed that people used the local facilities including shops and pub. When the inspector arrived at the house one of the people who lives at the home was out with staff getting the weekly food shopping. The atmosphere in the home was relaxed. One of the people who lives there got up late, and staff said this was what they preferred to do. Other people used their bedrooms or the shared lounge or dining area as they wished. The lunchtime meal was observed. Some people had aids that helped them maintain their independence at this time, and staff encouraged people where appropriate. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 7 20 Quality in this outcome area is adequate. People who live at the home can expect their health to be promoted by staff, but this will not necessarily be reflected in care planning documents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were not sufficiently detailed to describe how individuals preferred to receive personal support. This is particularly important where people are unlikely to be able to articulate their wishes. For example one section of a care plan, under Dentist, read 6 monthly visits [name] does not enjoy the dentist. There was no associated guidance about how this person should be prepared for visits, or reassured during visits. Another entry gave a general statement about the persons overall needs in respect of help with taking a shower, and an associated entry stated a program needs to be discussed and implemented. There was no evidence that this had been done. The Intensive Support Team from the local health service had been contacted to help the home better support one person. This is a positive use of such a resource. Someone from the team had visited the person once before Christmas, and further visits were planned. There was no indication from the Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 14 care plan or associated paperwork why this decision had been made. Staff were able to tell the inspector about the advice received from the first visit, but this was not recorded in the care plan. Some practices in the home did not promote privacy and dignity, for example, continence pads and instructions to staff on display in one bathroom. The home also uses a Baby monitor to monitor one service user at night. On the day of the inspection this was left on while the person was being helped in the morning, the receiving part of the unit was in the kitchen where people living in or visiting the home could hear any movement or conversation, taking place. The daily logs did provide evidence of medical services being contacted if anyone living at the home was unwell. It was evident from the discussion between the family member and staff that information about health was appropriately shared. None of the people living at the home were able to self-medicate. The administration records for one person were inspected. There were no gaps noted in those records. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. People who live at the home can expect to be protected by the practices, policies and procedures of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This service works with people who are likely to find it difficult to articulate complaints. Care practice observed during the inspection showed that staff understood and responded well to requests, whether verbalised or asked through behaviour, from the people who live in the home. It was also noted that staff and family members worked well together to promote the wellbeing of people living in the home. Neither the Commission nor the home had received concerns or complaints about the care provided since the last inspection. Staff had completed training in the protection of vulnerable adults. The recruitment practice in the home helps to ensure that people working there were safe to do so. The home also works well with other professionals who can support them in ensuring practices promote the safety and wellbeing of residents. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. People who live at the home benefit from its generally homely style and levels of cleanliness as well as the ameneties available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken during the inspection. The home has a large lounge. This is sparsely furnished (due to the behaviours of some people living at home). The furniture in the lounge didnt match, one settee had no covers on the seat cushions, staff explained this was due to continence problems and not having spare covers. This gave the room an institutional feel. In her response to the draft inspection report the manager advised that replacement covers were a available. The Deputy manager showed the inspector details of more suitable furnishing that had been identified, but not yet purchased for the room. The bedrooms seen, were of an adequate or good size, pleasantly decorated and with pictures or other items that reflected the interests of people living in the home. Bedrooms and communal areas were clean and there were no offensive odours in the home. A number of sinks Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 17 were badly discoloured, with what looked like limescale encrustation. In the bathrooms each service user had their own toiletries in a separate basket . A packet of continence pads was out on view in one bathroom, and a note to staff about what bathcream to use for one person was on public view. These detract from the privacy and dignity of people who use the home. The utility area, to rear of kitchen, houses the washing machine (with soil cylce) and clean clothes ready for re-distribution, as well as freezer. A risk assessment was in place to avoid cross-contamination. The home also has a Multi-sensory room and swimming pool available. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. People who live at this home benefit from the recruitment and training practices adopted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recruitment records for a member of staff who had joined the home since the last inspection were inspected. These showed that the home had obtained references and criminal record checks as well as checked the person’s identity before employing the person. The home has also developed an induction programme that meets with the Skills for Care requirements and is completed when someone begins work. Staff were enthusiastic about the amount of training on offer one person said there was loads and another tons. Staff were also very positive about the staff team, they described a supportive management structure and good staffing levels. One member of staff had previous experience of working with people on the autistic spectrum. Training provided by the home for staff included First aid, Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 19 Protection of Vulnerable adults and de-escalation techniques. Staff also had the opportunity to complete a National Vocational Qualification (NVQ) in care and for some courses to become skilled at delivering training for other staff. The homes Training policy makes reference to annual training and how to access additional training. The organisations training manager monitors this to ensure all training is updated. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,41,43 Quality in this outcome area is good. People benefit from living in a home that is well run. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has been registered by the Commission and is considered to have the experience and qualifications to run the home. The manager advised the inspector that a quality assurance process was in place. The process included the use of surveys to secure views, but a copy of annual report not available in the home. The manager provided a copy of the questionnaires used in the home. The questionnaires used symbols to help people understand the questions. The manager also provided a summary sheet 9again including symbols) that told people what would be done with the information gathered through questionnaires. This is good practice because it Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 21 shows people that their views have been listened to. The inspector discussed with the manager and deputy manager how service users views are taken into account on a day to day basis. As many people living at the home would be unable to complete a questionnaire it is important that this way of securing views is incorporated into the annual quality review process. Where the owner of a home is not in day-to-day control, they are required to visit premises monthly and report on how it is run. The manager advised that these are carried out by the manager of a sister home, copies were available for inspection. The Fire file, held in the home included an evacuation policy that described day and nighttime routines and / or issues for each service user in terms of evacuation. This is very useful information where people may exhibit very anxious behaviour in a situation requiring emergency evacuation. Records were available to demonstrate that the Fire alarm and emergency lighting systems had been fully checked in the preceeding twelve months and that different elements of the Fire alarm system were checked weekly by a member of staff. The temperature of water at hot water outlets was also regularly tested to reduce risks from scalding. The home held Pocket money for most service users. Records of expenditure with receipts or petty cash vouchers attached and a running total of the balance were up to date. The manager advised that where money held rises to above about £50 the excess is transferred to a savings account, these details are kept at head office. The home was not in a position to advise people of the balance in these accounts without contacting head office. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 3 X 2 X 3 3 x Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 12(4) Requirement The home must ensure it does not compromise a persons privacy or dignity through the use of listening devices, or the public display of personal information. The home must ensure that sinks available for the use of people living in the home are of a satisfactory standard. Timescale for action 15/02/08 2. YA24 16 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA18 YA19 YA24 YA41 Good Practice Recommendations The home should ensure that care plans include sufficient detail about how to provide personal care and meet the aspirations of people living in the home. The home should purchase more suitable furniture for the shared lounge. The home should maintain up to date information about the level of savings held for people living in the home. Treetops Residential Home DS0000024514.V357360.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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