Inspection on 20/11/07 for Yew Tree House Residential Care Home For The Elderly

This inspection was carried out on 20th November 2007.

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.

Other inspections for this house

Yew Tree House Residential Care... 19/07/06

Yew Tree House Residential Care... 04/01/06

Yew Tree House Residential Care... 29/07/05

Yew Tree House Residential Care... 06/07/04

Yew Tree House Residential Care... 19/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Yew Tree House Residential Care Home For The Elderly Yew Tree House 9 Station Road Headcorn Ashford Kent TN27 9SA Lead Inspector Jenny McGookin Key Unannounced Inspection 11:00 20th November 2007 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 House Residential Care Home For The Elderly DS0000024096.V352383.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 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 House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Tree House Residential Care Home For The Elderly Yew Tree House 9 Station Road Headcorn Ashford Kent TN27 9SA 01622 890112 Address 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 Michael Francis Discombe Vacant Mr Michael Francis Discombe Care Home 13 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (11) of places Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Provision of railings to the disabled access slope leading to the entrance of the new building. The conversion of existing private en-suite bedroom on first floor which is proposed for residents use, is to have an additional fire alarm sounder installed in the lobby outside the room as advised by the Fire Officer. 19th July 2006 Date of last inspection Brief Description of the Service: Yew Tree House comprises two detached properties - the original building and a new building. The original building offers a choice of ground and 1st floor accommodation but does not have a shaft or stair lift installed, so use of the first floor would be limited to the more physically able. The new building offers ground floor accommodation only – the 1st floor is reserved for use by the manager and staff. Both buildings have ramps up to their entrances, with handrails. One bedroom is registered for use as a double room but all the other bedrooms are for single occupancy, and once all the planned building work is completed, all bedrooms will be single occupancy. Each bedroom has a call point and a television point. There are communal toilet and bathroom facilities on each floor in the original building (one of which has a shower attachment), and each bedroom in the new building has its own en-suite shower, WC and wash hand basin. The original building has a lounge / dining room on the ground floor and a second lounge on the 1st floor, though this has always also served as an office / staff facility and (more recently still) was being used as a temporary bedroom for two residents while building work was being carried out to rectify subsidence in their bedroom area. The home’s kitchen is, unusually, located on the first floor. Meals are sent down in a dumb waiter to the dining room below. This arrangement was made to accommodate more bedrooms on the ground floor. Each bedroom in the new building has its own kitchenette facilities. The home is located in Headcorn village near to bus stops and the railway station. There is good access to local shops and other community amenities such as a church. Car parking is currently very limited (two spaces on site), though more are planned as part of the building work. There is some kerb-side parking available on side roads – though this is subject to restrictions. The home’s senior staffing team comprises the owner/ manager, and a trainee home manager. The home also employs 11 care staff working across a 24hour roster and two part time catering staff. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 5 The current fees range from £349.88 - £500 per week, and this includes transport costs (e.g. to hospital or family). Extra charges are payable for items of a personal or luxury nature such as newspapers, hairdressing, and chiropody. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose / Service User Guide. The e-mail address for this home is: Michael@yewtreehouse1943.wanadoo.co.uk Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to inform this year’s key inspection process; to review findings on the last inspection (July 2006) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion. The inspection process took nine hours, and involved meeting with the owner/manager, the assistant manager, and one of the part-time cooks. Consideration was also given to the Annual Quality Assurance Assessment submitted in advance of the site visit by the manager. This was judged a wellwritten and comprehensive account of the issues raised, which reflected provision fairly. The inspection also involved a tour of all the bedrooms and communal areas, and the examination of a range of records. Two residents’ files were selected for case tracking. Conversations were held with one group of four residents over lunch, and individually with three others. Interactions between staff and the residents were observed during the day. Feedback questionnaires were issued by the inspector for distribution to residents and a range of other stakeholders, and feedback was received from two residents, one relative and two healthcare professionals. Any responses received after the final publication of this report will be assimilated into the Commission’s own intelligence, for future reference. What the service does well: What has improved since the last inspection? When the home was first set up in 1987 it had a small extension, which has, more recently been showing signs of subsidence. On the day of this inspection visit, builders were on site putting this right, though this work is expected to take three months to complete. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 7 The residents have benefited by the extra floor space created by the removal of a hearth and the redecoration and re-carpeting of this room. The residents are reported to have chosen the décor for themselves, and new curtains are planned. New carpets have also been laid in the 1st floor lounge, hallway and landing, with more in prospect due to grant funding becoming available. One bedroom carpet has been replaced by impervious floor covering to help maintain hygiene standards and the occupant now has the use of a hoist. The home has acquired a new washing machine with a sluice cycle. The new building had already been completed to a high standard by the time of the last key inspection visit (July 2006) and access to both buildings has benefited by the installation of ramps and handrails. The external paintwork on the original building has been refreshed. Investments in staff training have been better regularised and NVQ training is being phased in. The competency of home’s staff has traditionally benefited by assessments carried out by a retired District Nurse 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. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.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 House Residential Care Home For The Elderly DS0000024096.V352383.R01.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 3, 4, 5, 6 Prospective residents and their representatives have the information they need to properly decide whether this home will meet their needs Residents can feel confident that they will have their needs assessed. This home does not provide intermediate care. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which have previously been judged compliant with the elements of the National Minimum Standards. They will only require reassessment when amendment is warranted. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 10 No other languages are currently warranted, but an admission checklist is recommended to evidence the issue of these documents and whether other languages or formats (e.g. large print, tape or explanation etc) were warranted. Feedback on this site visit confirmed that the decision to apply to this home was influenced largely by its locality (i.e. close to where the resident or their friends or relatives lived), and by previous contact or its recommendation by others. Each resident said they were very satisfied with the choice of home made. Each file assessed included preadmission assessment forms, which comprise very summary statements about a range of health, social and personal care issues. These are developed through further discussions, assessments and care planning within the first 2-4 weeks of admission. The residents confirmed having visited the home before moving in, and each new resident is routinely offered a trial stay before their admission is confirmed by contract. The extent to which residents are supported to settle in and feel at home was identified as a key strength of this home, and this is evident in the way bedrooms have been personalised, for example. However, this aspect of the home’s operation should be documented, as the quality rating for this section is overly reliant on anecdotal information. See section on “Environment” for a description of equipment and adaptations, and section on “Health and Personal Care” for a description of services provided. Intermediate Care This home does not provide intermediate care. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 The health and personal care, which each resident receives, is based on an assessment of their individual needs. The care of relatives is enhanced because the principles of respect, dignity and privacy are put into practice. EVIDENCE: “The staff are very conscious about the individuals’ health care needs, seeking advice and discussing various ways that healthcare needs can be improved” – Community Staff Nurse. “Personal care at high level. Carers all well known to the residents. Happy to go that extra mile” - GP Two residents’ files were selected for case tracking on this occasion. The format of each care plan is clearly designed to identify the resident’s needs or Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 12 strengths, objectives and the action required in each case. This format is applied to a range of issues: mobility, personal care, physical (including sensory) and mental health, social needs (including social networks and cultural issues). These care plans are usefully underpinned by a range of risk assessments designed to identify any physical, psychological or other risks or hazards (such as manual handling, self medication or physiotherapy) and controls that need to be in place. Daily reports are being made, and records indicated care plans and risk assessments were being reviewed monthly. The manager talked about the support given to residents when they attend hospital, for example, but the home needs to better document its holistic approach, as the quality rating for this section is overly reliant on anecdotal information. One resident’s expressed interest in supporting people in the community with the ageing process could, for example, usefully be pursued through care planning. When asked, only one of the residents showed any recognition of the formal care planning process, though they each confirmed that there is a generally sound level of satisfaction with the care provided by the staff at this home. Observed interactions were judged appropriately familiar and respectful. Care plans need to better evidence the active participation of interested parties, most notably the residents. The home has made satisfactory arrangements for the secure storage of medication and for its administration. Five staff have been trained and assessed as competent to administer medication, and they have ready access to a directory and a pharmacist, for advice, to underpin their knowledge and practice. The manager was advised to also obtain a copy of the Royal Pharmaceutical Society Guidance on the administration and storage of medication for reference. A spot check of some medication administration records indicated compliance with required standards for record keeping. The home has access to a range of healthcare professionals (GP, CPN, chiropodist and nurses) and documents their contact and any tests or checks carried out (blood, intake, behaviour changes). Feedback from visiting healthcare professionals confirms that individuals are supported to administer their own medication, where appropriate. Although one room is currently registered for use as a double room, the longer-term aim is to have all single occupancy rooms i.e. once all the planned building works are completed. All the other bedrooms in this home are single occupancy, which means personal care and treatments can be given in privacy. Feedback from visiting healthcare professionals confirms that this is the practice. Two residents are currently having to use the 1st floor lounge as their bedroom while work is being done to put some subsidence in the building right. This is not ideal as this room is also used by staff as an office facility, but the Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 13 inspector was assured that it is only a temporary arrangement, which has been agreed with residents and relatives as the preferred option, and access by staff is controlled. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents benefit from a life style of their choosing and are provided with a range of social activities. Residents are supported to keep in contact with family and friends. Residents benefit from a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: The care plans seen did not document any attempts to actively pursue the residents’ emotional needs or interests; or to establish any unmet needs. The residents who met with the inspector on this occasion were not able to give many examples of any particular interests and hobbies being promoted by the home. The residents all said they were very content with their lifestyles there, and there was ample evidence of materials for activities stacked up on one shelf in the dining room. The residents were observed playing cards during the day. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 15 The Assistant Manager, moreover, was readily able to list a range of activities: crafts (e.g. making cards) – though this is said to be only of interest to a few, quizzes, Bingo, shopping, scrabble, and puzzles. One resident has some interactive games for the TV – treasure hunt, and “brain teasers”. They also enjoy reminiscence sessions. One resident told the inspector how she used to like to do some light gardening, but once she realised this was no longer manageable, turned to pot plants and had successfully cultivated strawberries in a trough. The home had clearly supported her with this, with the provision of shelf space in her bedroom. There is currently no dedicated activities co-ordinator to ensure information on the range of community resources and events is kept up to date; to actively motivate individuals; or to ensure records are maintained on individuals’ activities. Staff shares this responsibility. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. One told the inspector how she likes to spend long periods of the day in bed. They were observed being supported to make choices and decisions during the day of this inspection. The home has good links with the local community, including the Baptist Church next door on Station Road. There are in fact four churches in Headcorn. A vicar visits the home every month for Holy Communion and one resident has been supported to attend healing services. One resident goes out every day to buy a paper and spoke enthusiastically about the local library, which runs a book club. The home has open visiting arrangements. This was confirmed by residents during this site visit. One is driven to visit a relative. All the bedrooms have telephone points but the installation of private lines and bills would be at the resident’s own expense. There is a pay phone in the hallway, which has been provided with a chair, but it is not in practice being used. There is no charge for any calls made from the office phone. See description at front of this report in respect of access to local shopping outlets and transport links. Records confirmed that dietary needs and preferences are properly identified as part of the preadmission assessment and care planning process, and observed or amended thereon. The inspector discussed the catering arrangements with the manager and one of the home’s part-time cooks and followed this up by meeting with residents over lunch. The meals tend to be traditional English fare. Menu planning is done on a 2-3 weekly basis, but is applied flexibly on a dayto-day basis. Food is bought fresh or frozen from a local supermarket and butcher, and meals are prepared on site. There was anecdotal information Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 16 about the special diets and preferences being catered for (e.g. diabetic, intolerance to citrus or onion products), and meals (including home-made cakes and fancies) were identified by the residents as one of this home’s key strengths. Notwithstanding the skills the cooks have brought into the home with them, there was no evidence of any periodic top up training e.g. in catering for the elderly, dementia care or in respect of care planning. This is strongly recommended, so that the home can demonstrate compliance with best practice standards. The inspector joined the residents for lunch on this site visit and judged the selected lunchtime meal options tasty, well prepared and well presented. The pace of the meal was unhurried. Staff were observed attending residents in a respectful way. The home has some adapted cutlery, but this is reported to be not currently warranted. The home does not have its own policy on Food Safety Hygiene, but maintains the “Safer Food, Better Business” manual supplied by Environmental Health to the satisfaction of its own inspecting officer. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 16, 17, 18 There is a process for resolving complaints but it requires amendment, to ensure it is effective. There are systems in place to ensure residents’ legal rights are protected There is a range of policies governing the protection of the residents, but the home needs to better evidence staff training. Residents and staff feel there are safeguards. EVIDENCE: This home has a complaints procedure on display on the inside of every bedroom door, but this is judged institutionalising. The procedure needs to give timeframes and remove its reference to CSCI as it is no longer the lead agency. Information supplied before the inspection visit indicated that no complaints had been registered over the past twelve months. This is not usually judged a realistic reflection of communal living, but for the high level of satisfaction expressed by residents on the day of this visit. The manager reports having used a range of independent services to support the residents e.g. advocacy (Citizens Rights for Older People for one resident’s Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 18 financial affairs), Age Concern, Kent Association for the Blind and MacMillan Nurses. And the manager also reports that residents are supported to vote at the local polling station or by postal vote. This is judged good practice. The manager has confirmed that home has all the policies prescribed by the CSCI governing the protection of the residents, including the management of aggression, bullying, gifts, anti-racism, restraint and whistle-blowing. This list is not exhaustive. In discussions with the inspector, staff confirmed their commitment to challenge and report any instances of adult abuse, though they each went on to say that this had not been warranted in this home. However, there was scant evidence of training for staff – a training matrix only listed four staff. Records need to be updated. And the manager will need to check that he has a copy of the local multi-agency protocol to ensure a timely and co-ordinated approach, should an incident ever occur. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 18, 20, 21, 22, 23, 24, 25, 26 The physical design and layout of the home require attention to enable service users to live in safety. Service users benefit by this reasonably well-maintained and comfortable environment. EVIDENCE: All areas of the home inspected were found to be comfortable and reasonably clean. One relative described it as “home from home”. Since the last inspection the exterior paintwork has been repainted, and some areas had been re-carpeted and redecorated, with more in prospect. On the day of this site visit, the home was judged adequately lit and maintained at comfortable temperatures. The furniture tends to be domestic Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 20 in style and there were homely touches throughout. All bedrooms, bathroom, WC and communal areas have accessible call bells. The gardens at the front and back are not large but they will provide pleasant enough areas to walk or sit in once the hazards and unsightly trappings of ongoing building works have been removed. There is some garden furniture, and the inspector was told residents enjoy the sun and chatting to passing members of the local community at the front. There is a short drive at the front (off a side street), providing parking for two vehicles and there is some kerb side parking on the side roads, though this is subject to restrictions. There is a ramp and handrails up to the entrance of each building, but there is no shaft passenger lift up to the first floor of the original building (0ne relative has suggested this), so this floor is only usable by the more physically able. The two bedrooms in the new building are both on the ground floor. There is a limited range of equipment and adaptation available in this home. Residents have access to wheelchairs, zimmer frames and other mobility equipment. There are hand / grab rails throughout the property, and another handrail has been installed since the last inspection in a corridor leading to a bathroom. However, overall periodic audits by specialists such as Occupational Therapists, are strongly recommended, to ensure the home maintains its capacity to meet the needs of its residents. An outside shed is being considered to provide a wheelchair store, as communal areas and thoroughfares in the home are cluttered. Residents currently have a very limited choice of communal areas. There are two lounge areas, one of which also serves as a dining area. One lounge on the first floor is currently being used as a bedroom for two residents and as office facilities for staff, as well as housing a fridge and freezer. The arrangement is far from ideal. Furnishings tend to be domestic in character throughout. Neither lounge has a Loop system for use with hearing aids. This is recommended, given four residents are reported to be hearing impaired, subject to specialist advice on this matter. One curiosity in this home is the kitchen which is sited on the first floor. Meals are delivered to the dining area via a “dumb waiter”. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. The two bedrooms in the new building are very spacious and their standard of finish is high. The other bedrooms are, however, much smaller – only one is Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 21 over 12 square metres; three others are between 10-11 square metres and the rest are below 10 square metres – and would not be suitable for use as bedrooms if this were a new registration. One bedroom is registered for use as a double room, though the longer-term plan is for all bedrooms to be single occupancy once all the planned building work is completed. All the other residents have access to the privacy of single bedrooms. Work on subsidence meant that some bedroom facilities were blocked off and two residents were using the 1st Floor lounge. But all the other bedrooms were assessed, and found to be not fully compliant with the National Minimum Standards. The manager will need to ensure that non-provision is justified in each case by properly documented consultation or risk assessment. The inspector was pleased to see the commodes in use in this home were discreet models, to accord the residents with dignity. All the rooms were personalised and homely. The propping open of bedroom doors (which are also fire doors) and the use of a baby alarm in one bedroom in the new building must be justified by properly documented consultation (e.g. with the local fire officers in respect of the fire doors, and relatives) and risk assessment. This home has WC and bathroom facilities on both floors in the original building, and each bedroom in the new building has its own en-suite shower, WC and wash hand basin i.e. reasonably accessible to all the bedrooms and communal areas. One bath in the original building has a swing-out bath seat/hoist and a shower attachment. The second does not, and is only in practice being used for its WC facility. This effectively means that residents do not have much choice. The furniture on one bathroom door will require replacement. External bathroom windows all have obscure glass, but blinds or curtains would ensure their privacy (although it is accepted that an outside fence does afford some privacy) and provide a homely touch. Since the last inspection this home has acquired a washing machine with a sluice cycle. Continence appears to be managed adequately at this home. There were no unpleasant odours. The last inspection by an Environmental Health Officer was in November 2006 and did not raise any matters for attention. See schedule of recommended action for matters requiring attention. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents benefit by the training staff have received but training opportunities need to be systematically invested in and maintained. Residents benefit by the numbers and deployment of staff, to meet their changing needs. EVIDENCE: The inspector understands there are three care staff and a cook on duty every morning, and two care staff on duty every afternoon. Extra staff are made available to meet needs. At night there are two staff – one on waking duty and a second sleeping but on call. Staffing numbers and deployment complied with this on the day of this site visit, and are judged generally appropriate to the assessed needs of the service users, the size, layout and purpose of the home. However, staffing rotas were not requested for inspection for compliance with this statement on this occasion. The inspector relied in this instance, on feedback from staff and residents, which confirmed it was representative. The home does not use agency staff or volunteers. All staff are reported to be over 18 years of age. An audit of ten available personnel files confirmed a generally systematic recruitment process, which was subject in each case to satisfactory references, Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 23 identification checks and CRB checks. However, there were no interview notes, letters of appointment, Job descriptions or Job Specifications. This is recommended. The full extent of staff training could not be properly assessed on this occasion, for want of available documentation. Induction checklists were missing from four out of the ten files inspected. And a training matrix indicated that while some training had been well attended (1st Aid, food hygiene and health and safety) not all the staff had received all the mandatory training required. This will require attention as a priority. There was no record of any staff having had training in care planning at all; only three appear to have had dementia care training (matter raised for attention at the last inspection); only two appear to have had training in challenging behaviour and only four in safeguarding adults. At the last inspection (July 2006) the inspector found that five staff had obtained NVQ Level 2 accreditation, one had obtained NVQ Level 3 accreditation and one other had completed her NVQ Level 4 and gained the Registered Manager Award (RMA). The position was found to be unchanged at this inspection. Feedback confirms that the management style at this home is open, accessible and supportive to staff. However, see section on “Management and Administration” in respect of staff supervision records. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents benefit by the management and administration of the home, which is based on openness and respect. The manager needs to demonstrate that there are effective quality assurance systems in place, which can influence the way services are delivered. EVIDENCE: Mr Discombe is shown as the registered owner and manager of this home and has twenty years’ experience in the cared sector. His Assistant Manager has NVQ4 accreditation and the Registered Manager Award. Mr Discombe has responded positively to most matters raised at inspections. This is judged a generally good use of the inspection and regulatory processes. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 25 Some matters remain outstanding, however, and must be attended to as a priority. See schedule of required action for details. There are clear lines of accountability within the home. Team working and flexibility appear to be key strengths in this staff group. Feedback during the site visit indicates a sound level of satisfaction with the care given by staff. There was good evidence of residents exercising choices and control over their own daily routines and their financial affairs are properly safeguarded by the home’s policies and accounting methods. Feedback questionnaires were issued by the inspector for distribution to residents and a range of other stakeholders, and some feedback was obtained in time for the publication of this report. Examples are quoted throughout this report. Any responses received after the final publication of this report will be assimilated into the Commission’s own intelligence, for future reference. Records indicate, however, that the last quality assurance initiative carried out by this home for itself was in 2005. There are un-audited financial statements for each year, drawn up by Chartered Accountants, who look at general issues, trading profits and losses, balance sheets, and schedules of capital areas and tangible fixed assets. The most recent one available was, however, dated 30/11/05. The manager has produced a Business Plan for the current year, with summary statements about planned building works. The manager was advised that the annual development plan for the home needs to more conspicuously refers to the home’s quality assurance system and financial position. The views of all stakeholders should be central to this process, to properly measure the home’s success in meeting its aims, objectives and statement of purpose. Notwithstanding findings in respect of the management ethos in this home (see section on “Staffing” above), there was no evidence of formal documented staff supervision meetings, to comply with the elements of this standard. This will require attention as a priority and is judged a major shortfall. All the property maintenance records seen were up to date and adequately maintained. There were risk assessments in place in respect of each individual, their activities and their environments), and there was evidence of their regular review, to ensure the health and safety of residents and residents are being properly safeguarded. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 26 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 3 3 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 2 17 3 18 2 2 2 2 3 2 2 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 1 X 3 Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 27 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 OP18 Regulation 13(6) Requirement All staff to undertake training in Adult Protection and for refresher/updating training to be made available. Matter raised for attention on 19/07/06 for attention by 30/09/06 The propping open of bedroom doors (which are also fire doors) must be justified by properly documented consultation (e.g. with the local fire officers) and risk assessment. The grounds/garden to be made safe. Matter raised for attention on 19/07/06 for attention by 31/08/06 and ongoing The registered person shall ensure that there is a staff training and development programme, which meets National Training organisation (NTO) workforce training targets. Action plan to be submitted. As in accordance with the home’s registration, there is a need to ensure all staff receive sufficient training in the area of DS0000024096.V352383.R01.S.doc Timescale for action 31/01/08 2 OP19 13(4) 31/12/07 3 OP19 13(4)(a) 31/12/07 4 OP30 12(1)(a)( b) 18 (1)(a)(c) 31/12/07 5 OP30 18(1)(a) (c) (i) 31/12/07 Yew Tree House Residential Care Home For The Elderly Version 5.2 Page 28 6 OP33 24 (1)(a)(b), (2)(3) 7 8 OP33 OP36 24 (1)(a)(b), (2)(3) 18(2) Dementia. Action plan to be submitted. Matter raised for attention on 19/07/06 for attention by 30/09/06 There needs to be effective quality assurance systems in place, based on views of residents, to measure the home’s success in meetings its aims, objectives and statement s of purpose. Action plan to be submitted. The annual development plan needs to reflect aims and outcomes for residents There needs to be evidence of formal documented staff supervision meetings, to comply with the elements of this standard 31/01/08 31/01/08 31/12/07 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 OP1 Good Practice Recommendations An admission checklist is recommended to evidence (among other things) the issue of these documents and whether other languages or formats (e.g. large print, tape or explanation etc) were warranted. The admission process (e.g. preadmission visits, introductory events) should be documented, as the quality rating for this section is overly reliant on anecdotal information Care plans should document action taken to pursue each resident’s emotional needs or interests; or to establish any unmet needs. And care plans need to better evidence the active participation of interested parties, most notably the residents. Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 29 2 OP5 3 OP7 4 OP15 5 OP16 Periodic top up training e.g. in catering for the elderly, dementia care or in respect of care planning is strongly recommended for catering staff, so that the home can demonstrate compliance with best practice standards. Complaints procedure. The following matter are raised for attention. • The display of this procedure on the inside of every bedroom door is judged institutionalising and should be reviewed. • The procedure needs to give timeframes and remove its reference to CSCI as it is no longer the lead agency. The manager should check that he has a copy of the local multi-agency protocol to ensure a timely and co-ordinated approach, should an incident ever occur. Building. The following matters are raised for attention. • • • Some communal space cluttered. Alternative storage provision should be found All chemicals used in kitchen to be kept in locked cupboard Recommend a sample 1st Aid kit in kitchen for ease of access in event of emergency. Also recommend contents of existing 1st aid stock are maintained via checklist. G/F WC. Bare light bulb – needs diffuser / shade. Toilet roll requires dispenser within reach of user. G/F bathroom. Door furniture (handles and lock) requires re-installing. Bare light bulb requires diffuser or shade. 1st Floor bathroom. Non-use requires consideration. If brought back into use, there should be a chair for assisted dressing and provision for clothing and personal effects. The obscure glass window should have blind or curtain to guarantee privacy. A shower attachment is recommended so that residents have choice. The use of a baby alarm in annexe B needs to be justified by documented consultation and risk assessment in the resident’s care plan. Room 7 – The resident said she found the edges of her bed. All bedroom furniture and fittings should be checked against NMS and non provision should be justified by documented risk assessment or consultation Portable cash tins should be secured against firm surfaces as a precaution against risk of loss or theft One bedroom electrical socket was concealed behind DS0000024096.V352383.R01.S.doc Version 5.2 Page 30 6 7 OP18 OP19 • • • • • • • • Yew Tree House Residential Care Home For The Elderly wardrobe and should be made accessible by relocation or extension lead 8 OP23 It is recommended that the future use of the shared bedroom should be reconsidered with a service user offered sole use of the room. Matter raised for attention 19/07/06 Yew Tree House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 House Residential Care Home For The Elderly DS0000024096.V352383.R01.S.doc Version 5.2 Page 32 - 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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