CARE HOME ADULTS 18-65
Two Trees 33 Milehouse Road Milehouse Plymouth Devon PL3 4AF Lead Inspector
Brendan Hannon Unannounced Inspection 24th November 2005 09:30 Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 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 Two Trees DS0000003510.V252370.R02.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 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. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Two Trees Address 33 Milehouse Road Milehouse Plymouth Devon PL3 4AF 01752 561189 01752 558181 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) Mr Roger Festin Gliddon Mrs June Ann Gliddon, Mrs Paula Marie Pillage Mrs Paula Marie Pillage Care Home 28 Category(ies) of Learning disability (28), Physical disability (28) registration, with number of places Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 5 residents maybe over the age of 65yrs Learning disabled adults some of whom may have a physical disability Date of last inspection 17th May 2005 Brief Description of the Service: The home is located in three combined large terraced houses, on the end of a terraced row of houses, in the Milehouse area of central Plymouth. A full range of amenities and facilities are within walking distance, the home has its own vehicles and the central shopping area of Plymouth is easily accessible by bus. The home can accommodate up to twenty-eight residents. The home has one main entrance from which all parts of the home may be accessed. There are residents bedrooms on the ground floor and the home is partially wheel chair accessible. There are five communal bathrooms and one communal shower. There are no shared bedrooms. Due to the age of the building all the ceilings are reasonably high giving an additional feeling of space in the home. There are seven communal areas in the home including lounges, dining areas and activity rooms. There is a large area of patio space to the rear of the building that has been made accessible to all the residents. This area can be accessed either from the lane to the rear of the building or from the rear of the ground floor. The service offered by the home is for men and women with a learning disability over the age of 18 and perhaps over the age of 65. The present group of residents are of a mixed range of ages and abilities but are in the main very active within the home and in the community. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. Preparation for the inspection included analysis of the previous inspection report and correspondence with the home over the last 6 months. The inspector was in the home from 9.30am to 4.00pm. The inspector paid particular attention to the needs of three residents whose care was looked at closely. The registered providers and manager were spoken to during the inspection. Care planning files, care delivery records, communication books, and health and safety records were inspected. A focussed inspection was carried out covering specific issues and areas of service delivery in order to look at areas of development from the last inspection and areas not covered during the last inspection. What the service does well: What has improved since the last inspection?
The management of the home has worked hard to upgrade the residents care plans. So far half of the 28 care plans have been upgraded. Similarly the individual residents risk assessments are being upgraded so that they become comprehensive and detailed. So far approximately two thirds of the residents risk assessments have been upgraded to this level. Improved care planning will help to further improve the delivery of care. There has been ongoing investment in the home, continually improving the quality of the living environment for the residents. The management of the
Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 6 home are in the process of fitting radiator covers on all the radiators in the home to eliminate risk. The Registered Manager stated that all the bedroom window openings above ground floor have now been restricted. Some additions have been made to the management systems in the home including a more resident focussed quality assurance system, individual supervision meetings for care staff and more in depth induction training for staff. These changes will further improve the quality of the care delivered to the residents. 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. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 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 Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,4 The home provides adequate information about the service to allow a new resident, and their representatives, to make an informed decision to use the service. EVIDENCE: Both the service users guide and the homes statement of purpose were available. The information in these documents would enable potential new residents and their supporters to understand the service provided by the home. A pre admission assessment is carried out by the home using a standard format for all prospective residents to ensure that the service provided can meet their needs. There were records of initial visits to the home. The policy on trial visits states that prospective residents may come for visits and overnight stays. These initial visits will help to inform potential new residents and make their move into the home an easier transition. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The delivery of resident’s care is good but is hampered by limited care planning and risk assessment for some residents. Residents are not given choice over how to spend all of their personal money allowances. EVIDENCE: Resident’s care plans were sampled. All the residents’ files had a care plan and risk assessments in place. However the information held in the care plan document should be comprehensive to cover all the issues affecting the resident and should also be more detailed. The home is introducing a new care plan format. Since the last inspection in May 2005 the homes management has worked hard to successfully upgrade approximately half of the care plans into the new format. When a detailed and comprehensive care plan has been developed for each resident the quality of their care support will be further improved and this should therefore improve the resident’s quality of life. There were individual risk assessments in resident’s care plans. However in some cases these were limited and were not comprehensive. In these cases they did not identify all the risks and agreed restrictions, including support with personal money, that affect the resident and they also did not address the identified risks in enough detail. Since the last inspection the home
Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 10 management has worked hard to successfully upgrade approximately two thirds of the residents risk assessments. The Registered Manager stated that each resident’s benefits pass through a Two Trees Residents account. This account is used purely to receive benefits paid to the residents monthly and none of the residents money is stored in this account. At present only the residential care allowance is passed to the resident. Other personal money within these benefits, i.e. the mobility element of Disability Living Allowance (DLA), is charged by the home to pay for the running of the homes minibuses. However charging all of the mobility element of DLA from every resident who receives this benefit, does not allow the resident to choose how to spend their money. This management system for DLA mobility has effects on residents’ choice. For example it restricts residents choice of annual holiday, and availability of money to buy clothes, personal furnishings, videos, music, etc. Any charges made by the home upon residents DLA mobility allowance should only be made after an individual agreement has been agreed with the resident with if necessary the support of a representative from outside the home. This agreement will show how much is to be charged and what the money is being charged for. It is important to note that there are numerous examples of the service working hard to be creative and successfully support residents to establish and maintain a good quality of life. Activities participated in by the residents ranged from traditional day care, through activity centre groups, to one to one supported activities with staff members. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Residents have enough appropriate activity in the home and in the community to ensure a good quality of life while living at the home. Residents receive enough, varied, good food. EVIDENCE: The manager described activities that are enjoyed by the residents. This information was supported to some extent by care planning, residents’ daily diary sheets, the homes communication book and a log held by the activity centre. The home has an activity centre area. The home employs an activity centre coordinator to support the residents’ use of it. The centre keeps a log of the activities that have been participated in by residents. The availability of both this facility and coordinator has made a real difference to the quality of the resident’s lives and is commended in this report. It could be seen from the menu plans, food provided records and from the various stocks of food and drink in the home, that the residents are supplied with enough, good quality food of a type that they like. There was a four week menu plan, the residents food likes and dislikes and a record of the choices made by the residents regarding their meals were in the main kitchen. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 12 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): 18,19,20 Residents’ health is maintained by: meeting the residents’ personal care needs, through the thorough administration of their medication and by supporting the residents’ access to health services. EVIDENCE: Some of the residents in the home have complex health needs and the home is successfully meeting these needs. Individual chart records relating to personal and health care needs are in use wherever they are required to monitor progress, and these records were being maintained thoroughly and consistently. Where there is frequent involvement from health professionals this information helps the delivery of better health care and helps to maintain the residents health. The resident files sampled showed that health service input was actively being sought and then supported by the home. This support ensures that the residents receive their right to a full health care service from the national health system. Due to the number and complexity of health needs of some residents in the home the medication system is a considerable undertaking for the service. Two Trees has a substantial system of medication that is managed effectively. The record of medication administration was well maintained. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 13 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): 22,23 Complaints are properly managed by the home protecting the welfare of the residents. EVIDENCE: There is an adequate complaints procedure and this is clearly displayed in the main hallway. The contact details for the CSCI are given within this procedure. The home has all the required adult protection policies in place and members of the staff team have attended adult protection training. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 14 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): The residents benefit from a homely, comfortable, clean and well maintained building that has been appropriately adapted to meet their needs. EVIDENCE: The quality of the living environment is generally good. There are a wide variety of communal areas with unusual rooms such as the activity centre and a music room. There is jukebox, disco lighting and a dance floor in the music room. In the lounge areas and dining rooms there was good quality seating and furnishing. To the rear of the building is a large patio area, which has been made as accessible as possible to allow its use by all of the residents in the home. Garden furniture is placed around the area in the spring and summer months and barbecue facilities have been built into the scheme. The bedrooms varied in the level of personalisation depending on the wishes of the resident. The quantity of furniture also varies dependant on the wishes and needs of the resident who uses the room. At present there is a system of star key locks on bedroom doors. This system does not give adequate privacy because it is too complicated. In order to lock the door a key must be put in the lock from the inside. Also star keys do not provide adequate security because any star key can unlock the resident’s room from the outside. All bedrooms should be fitted with a lock that can; be locked from the inside to ensure the resident’s privacy, from the outside through the use of an individual
Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 15 key to ensure the security of the residents personal belongings, and all these locks should be supported by a single master key to enable ease of access in an emergency. Some residents make use of the offer of lockable storage facilities in their room. The laundry had been newly renovated to provide plenty of room, easily washable surfaces and space for an industrial washing machine and dryer. The bathrooms and toilets are in good condition and there are enough facilities to meet the needs of the residents. A working override lock is in place on all the toilet and bathroom doors lock allowing the residents privacy and safety. The needs of the present residents have required the service to adapt to meet much greater physical disability and health needs. Impressive developments and alterations had been made to meet the needs of specific residents. Three ceiling track hoists had been fitted in the building as well as shower facilities. The level of concern, design and implementation that had been carried out to meet physical needs is commended in this report as exceeding the standard required under standard 29. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 16 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): 33,35,36 Resident’s needs are met by enough competent, properly vetted and trained staff. EVIDENCE: The Registered Manager stated that there is always an adequate number of staff on duty to meet the needs of the residents. Residents are asked for their opinion of potential new staff and the views expressed are taken into account as part of the interview process. The appropriate checking of new staff ensures the safety of the residents. A substantial training programme is delivered to the staff at Two Trees to ensure that the level of qualification of the staff team is maintained. Due to the ongoing needs of the residents the home has made training in dementia care a core training area. A large group of staff received dementia training in the home during this unannounced inspection. In general the care staff team at the home are well trained ensuring that they are competent to meet the needs of the residents. A structured induction regime is in place for new members of staff. This system is basic and does not comply with the National Training Organisation (NTO) specification for induction. The home should aim to become compliant with the NTO specification. The management have begun individual supervision of staff but this is not yet being delivered as frequently as necessary. These supervision sessions should take place regularly for all care staff. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 17 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): 37,39,41,42 The management of the home continues to ensure that the needs of the residents are met. EVIDENCE: The Registered Manager of the home is Paula Pillage. She has completed both her NVQ 4 in care and the Registered Managers Award. The Registered Manager is supported by an assistant manager and a senior care officer. The homes management has developed a new quality assurance system. This system has been reviewed to develop a system that is more focussed on the residents’ views. A new questionnaire has been designed for residents, using widget symbols to make it more accessible. New questionnaires have also been designed for relatives and professionals. The quality assurance system will next be used in May 2006. Records are well maintained and the use of charts to monitor health related issues were particularly impressive. The recording of medication administration was well managed. The record of food provided demonstrated not only, what was on offer, but also the choice made by the residents. The quality of the record keeping in the home is good. Reliable consistent recorded information
Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 18 gives a strong basis for the successful delivery of care to the residents. The quality of the recording in the home is commended in this report as exceeding the standard required by standard 41. The following section relates to Health and Safety issues. The Environmental Health Officer’s last report found no problems. Fire protection and accident records are well maintained. Fire training is carried out regularly. The residents are encouraged to join in fire protection training so that they are aware of the fire evacuation procedure. The management was advised to write a procedure listing the issues covered in internal fire training. Hot water temperatures have been turned down at the boiler but this cannot ensure that the temperature at the tap is not more than the recommended temperature of 43 degrees centigrade. The home has thermometers to test and record the temperature of bathwater and the Registered Manager stated that all baths are run by staff and tested before use. The home is advised to consider installing fail-safe valves at the baths and showers in the home to prevent the risk of scalding from hot water. Where the hot water taps available to residents have not been adapted to reduce the water temperature a detailed risk assessment should be in place for each hot tap to identify that the situation is safe. Where radiators have not been covered, and there remains a possible risk of pressure burn, each radiator has been risk assessed to identify that the present situation is safe. The homes management was advised to renew this risk assessment. The home has decided to cover all the radiators in the building and this programme is progressing. The Registered Manager stated that all the bedroom windows above ground floor level have had their openings restricted. The management are happy that the situation is safe for the remaining bathroom and toilet windows due to small windows and the difficulty of access. However while these potential risks remain each unrestricted window should be individually risk assessed to identify that the residents are safe. Comprehensive safety checks have been carried out including gas appliances and electrical equipment. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 2 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Two Trees Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 4 2 X DS0000003510.V252370.R02.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action 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 YA7 YA9 Good Practice Recommendations All the residents should have a careplan in place which is comprehensive and detailed. All the residents needs should be identified and how the staff are to meet these needs. Any charge made by the home upon a resident’s personal money, should be formally agreed by the resident with if necessary the support of their representatives. All the residents should have a comprehensive and detailed individual risk assessment. This assessment should include all restrictions of choice or personal freedom agreed to be in the residents best interests. All bedrooms should be fitted with a lock that can be locked from the inside to ensure the residents privacy, from the outside through use of an individual key to ensure the security of the residents personal belongings, and all these locks should be supported by a single master key to enable ease of access in an emergency. The structured induction should be developed in line with the National Training Organisation specification.
DS0000003510.V252370.R02.S.doc Version 5.0 Page 21 4 YA16 5 YA35 Two Trees 6 7 YA36 YA42 All care staff should receive regular recorded, one to one, supervision meetings. The building risk assessment should be expanded to include an individual risk assessment for each un adapted hot water outlet, and each unrestricted window opening above ground floor level. Two Trees DS0000003510.V252370.R02.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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