Inspection on 20/08/07 for Yew Tree Care Home

This inspection was carried out on 20th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Yew Tree Care Home 18/08/08

Yew Tree Care Home 05/03/07

Yew Tree Care Home 24/07/06

Yew Tree Care Home 06/02/06

Yew Tree Care Home 11/10/05

Yew Tree Care Home 20/12/04

Yew Tree Care Home 24/08/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Yew Tree Care Home 60 Main Road Dowsby Bourne Lincs PE10 0TL Lead Inspector Elizabeth Pinder Key Unannounced Inspection 20th August 2007 10:00 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 Yew Tree Care Home DS0000060593.V343954.R02.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 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. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Tree Care Home Address 60 Main Road Dowsby Bourne Lincs PE10 0TL 01778 440247 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) yewtree.gallac@btconnect.com Yew Tree Residential Care Home Limited Patricia Gallagher Care Home 18 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (6) of places Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th March 2007 Brief Description of the Service: Yew Tree Care Home is a former rectory and is situated next to the church in the village of Dowsby. It is six miles from the town of Bourne, in Lincolnshire, which has shops, banks, post office, pubs and leisure facilities. The home is registered to provide residential care for eighteen people of both sexes over the age of 65 years, twelve of whom may have the diagnosis of dementia. A single storey extension provides accommodation for ten residents; the first floor accommodation in the main building is accessed via a stair lift. There are twelve single rooms, two of which have en-suite facilities, and three shared rooms. The home is set back from the road and has large enclosed gardens with spaces for car parking. The home has a conservatory, which leads to the garden and patio. There were fourteen residents at the home at the time of inspection. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and formed part of a key inspection, focusing on all the key standards. Throughout this report the terms ‘we’ and ‘us’ refer to The Commission for Social Care Inspection (CSCI). The visit lasted just over six hours and took into account previous information held by us including the previous inspection report and improvement plan. An Annual Quality Audit Assessment (AQAA) has been requested from the provider and the manager said this will be returned by 31st August 2007. The main method of inspection used was ‘case tracking’ which involves selecting residents and tracking the care they received through looking at their records and observing staff that provide their care. One hour was spent observing the care given to a small group of people in the lounge. All observations were followed up by discussions with the manager and staff and examination of records. We also sat in the dining room chatting to people and observing lunch being served. One visitor was spoken with. No ‘Have your say about’ questionnaires were received. What the service does well: Information about this service is made available in the Statement of Purpose and Service User Guide, these are currently being updated to include information about costs and how people can access CSCI reports. The home is generally clean and well maintained, providing residents with a safe environment to live in. Residents observed during this inspection were relaxed with some positive interactions with staff. The meal was observed and it appeared appetising and residents were given choice, residents’ special dietary needs were met. A visitor spoken with was positive about the staff saying that ‘they are very kind’. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 8 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 Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People coming into this service have access to a range of information to help them make a decision about moving into the home and procedures are in place to ensure they are only admitted after a full needs assessment has been carried out. EVIDENCE: The manager confirmed that she usually visits prospective residents at home or in a care setting such as a hospital to undertake a thorough assessment of all their care needs. Records confirmed this. A visitor spoken with said she had received relevant information prior to her relative’s admission. Written admission documentation was clear and gave staff the information needed to meet the residents’ needs. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 10 Staff spoken with said they are not involved in the assessment process but the manager always gives them information about the person and they know the importance of making new residents and their families feel welcomed. The statement of purpose and service user guide are currently being updated to include detailed information about the fees and any additional costs as well as the day-to-day operation of the home and how people can access a copy of the last inspection report. These documents should also reflect how the service promotes equality and diversity. The home does not provide intermediate care. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans must continue to improve to ensure peoples’ needs are met. Medication policies are available and medication is given using safe procedures. Staff respect the wishes and preferences of people living in this home while maintaining their privacy and dignity. EVIDENCE: Care plans have improved since the last inspection and now detail medication needs as well as personal health care needs. However, some tick boxes are used and care plans would benefit from more detailed information being written about residents’ needs. Regular reviews are held, however, some read ‘no change’ and not all show residents and/or their representatives involvement and agreement. The home operates a key worker system and staff were knowledgeable about the residents they were key worker for. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 12 Records showed that residents regularly see their GP, practice nurse and, where necessary, consultant, opticians and dentists. A visitor said that her father’s health had improved since admission to the home some months ago. During the previous inspection a number of requirements were made regarding medication issues. An improvement plan had been requested and this details the action taken to meet these requirements. A discussion was held regarding the recording of medication coming into the home and medicines disposed of. The manager had been advised to record these on individual MAR (medication administration record) sheets but found that there is not always enough room on these, therefore records these in a separate book. However, a full audit trail can be followed using this process. The staff member giving medication to residents at breakfast was observed to do this, using safe, correct procedures. The last pharmacy visit was in June 2007 and there were no issues from this. During the observation period staff were observed to have a good relationship with residents, laughing and joking with them. They were seen carrying out their duties with kindness and sensitivity, especially when attending to their personal needs. However, one staff member was observed to ignore a resident who was speaking to her and when later asked about this she said she had not heard him. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ interests are generally accommodated and they are able to enjoy a lifestyle which is flexible and varied. Meals provided are well balanced and nutritional. EVIDENCE: Most residents are unable to join in organised events and prefer one-to-one activities. Outside entertainers visit the home regularly and arrangements are currently being made to appoint an activities co-ordinator to work three afternoons each week for two hours ensuring activities provided are appropriate to the needs and abilities of the residents. Residents observed during this inspection were relaxed with some positive interactions with staff. Care plans identified those residents who had spiritual needs and how these were to be met. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 14 Lunch time tables were nicely laid with tablecloths and flowers and the lunch was served in an appropriate way with staff encouraging residents to chose what to eat and drink and where to have their meals. One resident who prefers to be alone was able to have lunch in his own room. The meal looked appetising and nutritious and residents who required assistance were given it discreetly, however some staff were observed standing over residents whilst they were feeding them which may be intimidating for residents. A variety of space is offered for visitors to meet their relatives in and a visitor spoken with said that they were always made to feel welcome and kept informed about any changes in their relative’s care. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are confident that any concerns and complaints would be addressed appropriately. However, staff were unclear about the procedures for reporting allegations of adult abuse. EVIDENCE: There is a detailed complaints procedure available in the home and the manager said no complaints have been received since the last inspection. Staff spoken with were aware of how to support residents to raise complaints or concerns and a visitor spoken with said that she was very satisfied with the service and care provided but would speak with the manager if she had any concerns. All but two staff have recently undertaken training regarding safeguarding adults, however, this did not include the reporting process and one senior carer did not have a clear knowledge of the correct procedure to take should she need to report an allegation of abuse. This was discussed with the manager who has subsequently confirmed that she had obtained the new Lincolnshire County Council procedure and had made all staff aware of the procedures to take. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home live in a clean, pleasant and hygienic environment and they are able to personalise their rooms. EVIDENCE: The three bedrooms of residents ‘case tracked’ were viewed and all were clean and tidy and well personalised. People spoken with during the visit were satisfied with the cleanliness of the home and areas of the home seen were clean, pleasant and homely. An unpleasant odour was noted in one bedroom, however, the manager said that plans are in place to renew the flooring in this room. Since the previous inspection action has been taken to the requirements made, the dining room, lounge and corridors have all been decorated. New carpets Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 17 fitted in the lounge and corridors and a non-slip floor covering has been laid in the dining room. Exposed pipe work has been boxed in and curtains re-hung. The outside of the building is still in need of repair and repainting and the manager said the provider is aware of this and this work will be carried out as soon as possible. Staff were observed throughout the visit using gloves and aprons when undertaking personal care tasks ensuring good infection control. The laundry is sited away from where food is served ensuring that soiled laundry is not carried though these areas and so affecting residents. The Environmental Health Officer visited the home on 16/08/07 and has awarded a four star rating. No requirements were made. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in this home may be placed at risk as there are times when there are insufficient staff on duty to ensure the safety of residents. Recruitment practice is not always robust and places residents at potential risk. EVIDENCE: Four staff were on duty during the visit, all had been recruited from overseas through an agency. Although all had a ‘home office work permit’ and police check carried out in their home country, none had undertaken Criminal Records Bureau (CRB) in this country. This was brought to the attention of the manager who said that she had been informed that staff did not need these checks, after a further discussion with CRB and CSCI she agreed to action this immediately. The recruitment records of a member of staff due to commence employment were examined and although two references had been obtained these were both from family friends as this was the first job this person had taken since leaving school. A discussion was held regarding contacting the school for an additional reference and the manager agreed to do this. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 19 Four weeks staffing rotas were examined and these showed that there are usually three care staff on duty throughout the day. However, during weekends there has only been two staff on duty and currently there are two residents who are bedridden, one resident who prefers to stay in his own room and twelve residents with a diagnosis of dementia. During the observation period sufficient staff were seen to be able to support those residents who needed it. Eleven staff completed dementia awareness training in May 2006, however, there are a further six staff who need to complete this training. They have been given handouts on dementia care and the manager said she is due to speak with the trainer to book their course. Fire training has been booked for 23rd August 2007. The majority of staff are from overseas and are qualified nurses, however, they are unable to practice in this country until they have completed an adaptation course. All care staff have been given copies of The General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service is being well managed with procedures in place to ensure the health and safety needs of residents are met. EVIDENCE: The manager has the necessary experience and qualifications to run this home, she has been in post since January 2005 and has completed the Registered Managers Award. She has regular meetings with staff and her door is always open for staff to speak with her about care practice issues or raise any concerns, however, these have not been recorded as formal supervision and it was agreed to address this issue. The provider held the last staff meeting in Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 21 May 2007 where issues of concern were highlighted and the manager said she plans to hold another meeting as soon as possible, where an agenda will be put on display beforehand and staff will also have the opportunity to raise issues. Relatives were invited to an afternoon tea earlier this month where the manager was available for people to raise any issues or concerns. Regular questionnaires are sent to relatives, general practitioners (GP’s), district nurses and social workers to encourage them to give their views on improving the home. Comments taken from these include; the quality of care is ‘absolutely first class’, the cleanliness is ‘excellent’ and complaints are dealt with ‘immediately’. One negative comment read ‘some of the carers seem to have great difficulty in understanding the basic English language’. However, records showed that all staff recruited from overseas had passed an English test. During the last inspection a discussion was held regarding the role of the manager as this includes; organising all training, completing formal records, correspondence, staff rotas, supervision of maintenance work, enquiries and collection of medication. She currently works with no administrative or secretarial support and feels this limits the amount of time she is available to supervise staff and interact with residents. Although a recommendation was made for these arrangements to be reviewed, this has not yet been undertaken. Secure facilities are provided for the safekeeping of money and valuables on behalf of residents and those checked were found to be accurate. Records were seen that showed residents’ and staff health and safety is being promoted. Yew Tree Care Home DS0000060593.V343954.R02.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 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 X 3 Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 23 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 OP19 Regulation 23 (2) (b) Requirement The registered person must ensure the fabric of the building is maintained in a good state of repair, externally and internally. This requirement has been met in part, however, external areas of the building need attention. Timescale of 01/05/07 not met. Staffing must be provided at a level that meets the assessed needs of residents All staff must have a criminal record certificate to ensure they are suitable to work in the care home. Timescale for action 31/10/07 2. 3. OP27 OP29 18[1][a] 19[10][a] 30/09/07 30/09/07 Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations It is recommended that the provider reviews the role of the manager to ensure she has sufficient time to fulfil her role. It is recommended that all staff receive formal supervision at least six times a year. 2. OP36 Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincolnshire Area Office Unity House, The Point Weaver Road Lincoln LN6 3QN 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. Extracts may not be used or reproduced without the express permission of CSCI Yew Tree Care Home DS0000060593.V343954.R02.S.doc Version 5.2 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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