Care Home: Cherry Tree Lodge

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What the care home does well People were provided with useful information about the services available at the home which would help them decide whether Cherry Tree Lodge was the right place for them. Before admission detailed information was obtained about the care and support people needed; this helped to determine whether they could be looked after properly. Residents had access to health care services and staff were trained in a range of healthcare matters; this would give them the skills and competencies to recognise and respond to any changes in people`s health. It was clear that, despite the lack of detail in the care plans, staff were responsive to any changes in residents` physical and emotional wellbeing. Training records showed that staff were provided with a range of appropriate training that gave them the skills and competencies to meet resident`s needs. Residents were happy with the care they received; one said `they know me and know what I want`; they said that staff treated them well and respected their choices and decisions. Each resident had a key worker who would be a `special` friend to them. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 A decision had been taken to allow the home to provide `hospice at home` care; staff worked closely with external professionals and specialists to ensure dying residents, their families and staff received the care and support they needed. Residents confirmed that choices were given in various aspects and that routines were flexible; one resident said `I can do what I want they don`t bother`. A range of activities, entertainments and excursions had been provided and staff had made every effort to ensure resident`s diverse social needs and dependencies were met. One resident said `I`m never bored there is always something going on`, another said she enjoyed the visits from the entertainers and another preferred to stay in her room or in the quiet lounge for `peace and quiet` and this was respected. Residents were given the opportunity to plan their activity programme and encouraged to make suggestions for improvement. The menus offered a choice of well balanced and nutritious meals. A recent survey indicated that residents were happy with the meals and residents made positive comments about the food including `there is always a choice and good food`, `good food but not always a choice` `food is always nicely prepared` `we get plenty to eat and drink` and `we always have a choice for breakfast but there is not always a choice at other times but if I didn`t like it they would give me something else`. Residents said they knew who to speak to if they were unhappy and said they were happy with the service they received; comments included `staff are very helpful and would try to sort things out`, `I cant grumble, I cant say enough about the staff` and `I`m well looked after and get all the love and care I need`. The policies and procedures for safeguarding adults gave clear guidance which would help staff to respond promptly and appropriately if abuse was suspected. During a tour it was clear that the home was well maintained, safe and comfortable and residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Staff were provided in sufficient numbers to meet resident`s needs. Residents said `you only need to press the buzzer if you need help`, `there are enough staff but they are always busy looking after everyone` and `staff always come when I use the buzzer`. Residents also said `staff are helpful and will do anything for you` and `I`m happy here`. One member of staff said there was a good team. It was clear that staff were happy working in the home and received the support they needed; one said `everything is done very well and a high standard of care is always kept`. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 7Residents and their relatives were regularly consulted about whether their needs and expectations were being met and changes had been introduced if any issues had been raised. Results from the annual surveys were very positive and indicated that people were satisfied with the care they received; comments included `the home is second to none`. A number of residents were involved in a committee that met regularly and were involved in making decisions about the day to running of the home; this showed that their opinions were valued. What has improved since the last inspection? The care plans included some useful information about residents` likes, dislikes, routines and preferences which would help to ensure they received the care they both needed or wanted. Staff had gathered information about residents` hobbies and interests which would help them to meet their diverse social needs. The medication recording systems had improved since the last key inspection visit; they showed that medicines were managed safely. The way the home recruited new staff had improved although in the absence of a recruitment procedure there was no clear guidance for senior staff to follow. There had been concerns that there was no registered manager in post; however the `business` manager was in the process of applying to register as manager. What the care home could do better: The care plans did not always clearly record what care was needed or reflect the care being given by staff to meet residents` needs; this could result in residents not receiving the care they needed. The manager advised that in view of the concerns raised, the care plan system would be reviewed. The plans had been reviewed each week by staff but it was not always clear that residents` or their relatives had been involved in the development or review process; residents should be involved in decisions about their care. Not all risks to residents` health and well-being were considered or kept under review; this could put residents at risk of not receiving the correct care. Staff need up to date training to help them to recognise and respond appropriately to any abuse or neglect.Cherry Tree LodgeDS0000009644.V376094.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Cherry Tree Lodge 226/228 Bury Road Rawtenstall Lancashire BB4 6DJ Lead Inspector Mrs Marie Matthews Key Unannounced Inspection 11th June 2009 09:30 DS0000009644.V376094.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree Lodge Address 226/228 Bury Road Rawtenstall Lancashire BB4 6DJ 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) 01706 224868 Cherry Tree Lodge Limited None registered Care Home 22 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (22) of places Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP Dementia - Code DE (maximum number 4) The maximum number of service users who can be accommodated is: 22 Date of last inspection 11th June 2007 Brief Description of the Service: Cherry Tree Lodge is a care home providing personal care and accommodation for 22 older people. The premises are detached and situated in their own grounds with car parking facilities to the side. There is also an enclosed and well-maintained garden area. The home is located on the main Bury Road close to local shops and is situated on a main bus route that offers transport to all towns in the Rossendale Valley area. Accommodation is provided in 14 single and 4 double rooms situated on two floors, the first floor being accessed by a passenger lift. Communal space is provided in two lounges, a conservatory and a dining area. Information about the services that the home offers is provided in the form of a service user guide and is available, with the summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees from April 2009 are set at £435.00. Additional charges are made for hairdressing and personal toiletries. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The key unannounced inspection, including a visit to the home, took place on 11th June 2009. The inspection process included looking at records, a tour of the home, and discussions with the proposed manager, staff manager, the cook, two care staff and four residents who lived in the home. Information was also included from survey forms filled in by one visiting professional (GP), seven visitors and ten residents. The inspection also looked at things that should have been done since the last visit and a number of areas that affect residents’ lives. There were twenty-one residents living in the home on the day of the inspection. What the service does well: People were provided with useful information about the services available at the home which would help them decide whether Cherry Tree Lodge was the right place for them. Before admission detailed information was obtained about the care and support people needed; this helped to determine whether they could be looked after properly. Residents had access to health care services and staff were trained in a range of healthcare matters; this would give them the skills and competencies to recognise and respond to any changes in people’s health. It was clear that, despite the lack of detail in the care plans, staff were responsive to any changes in residents’ physical and emotional wellbeing. Training records showed that staff were provided with a range of appropriate training that gave them the skills and competencies to meet resident’s needs. Residents were happy with the care they received; one said ‘they know me and know what I want’; they said that staff treated them well and respected their choices and decisions. Each resident had a key worker who would be a ‘special’ friend to them. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 6 A decision had been taken to allow the home to provide ‘hospice at home’ care; staff worked closely with external professionals and specialists to ensure dying residents, their families and staff received the care and support they needed. Residents confirmed that choices were given in various aspects and that routines were flexible; one resident said ‘I can do what I want they don’t bother’. A range of activities, entertainments and excursions had been provided and staff had made every effort to ensure resident’s diverse social needs and dependencies were met. One resident said ‘I’m never bored there is always something going on’, another said she enjoyed the visits from the entertainers and another preferred to stay in her room or in the quiet lounge for ‘peace and quiet’ and this was respected. Residents were given the opportunity to plan their activity programme and encouraged to make suggestions for improvement. The menus offered a choice of well balanced and nutritious meals. A recent survey indicated that residents were happy with the meals and residents made positive comments about the food including ‘there is always a choice and good food’, ‘good food but not always a choice’ ‘food is always nicely prepared’ ‘we get plenty to eat and drink’ and ‘we always have a choice for breakfast but there is not always a choice at other times but if I didn’t like it they would give me something else’. Residents said they knew who to speak to if they were unhappy and said they were happy with the service they received; comments included ‘staff are very helpful and would try to sort things out’, ‘I cant grumble, I cant say enough about the staff’ and ‘I’m well looked after and get all the love and care I need’. The policies and procedures for safeguarding adults gave clear guidance which would help staff to respond promptly and appropriately if abuse was suspected. During a tour it was clear that the home was well maintained, safe and comfortable and residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Staff were provided in sufficient numbers to meet resident’s needs. Residents said ‘you only need to press the buzzer if you need help’, ‘there are enough staff but they are always busy looking after everyone’ and ‘staff always come when I use the buzzer’. Residents also said ‘staff are helpful and will do anything for you’ and ‘I’m happy here’. One member of staff said there was a good team. It was clear that staff were happy working in the home and received the support they needed; one said ‘everything is done very well and a high standard of care is always kept’. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 7 Residents and their relatives were regularly consulted about whether their needs and expectations were being met and changes had been introduced if any issues had been raised. Results from the annual surveys were very positive and indicated that people were satisfied with the care they received; comments included ‘the home is second to none’. A number of residents were involved in a committee that met regularly and were involved in making decisions about the day to running of the home; this showed that their opinions were valued. What has improved since the last inspection? What they could do better: The care plans did not always clearly record what care was needed or reflect the care being given by staff to meet residents’ needs; this could result in residents not receiving the care they needed. The manager advised that in view of the concerns raised, the care plan system would be reviewed. The plans had been reviewed each week by staff but it was not always clear that residents’ or their relatives had been involved in the development or review process; residents should be involved in decisions about their care. Not all risks to residents’ health and well-being were considered or kept under review; this could put residents at risk of not receiving the correct care. Staff need up to date training to help them to recognise and respond appropriately to any abuse or neglect. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 9 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 Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People using this service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People had the information they needed to decide whether their needs would be met at Cherry Tree Lodge. EVIDENCE: The information about the home had been reviewed and was made available in a range of formats to existing and prospective residents and their families. The ‘welcome pack’ included a new brochure with accompanying photographs and a DVD to help people to decide whether Cherry Tree Lodge was the right place for them; one resident said she had been involved in the development of the Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 11 brochure and had enjoyed the experience. One resident said her family had visited the home before she decided on admission and they had been given enough information to help her to decide; she said she had been aware of the good reputation of the home. Each resident was issued with a contract to which they have agreed; this ensured they were aware of their rights and responsibilities whilst living at Cherry Tree Lodge. The contracts need to detail the number of the room to be occupied; this would reassure residents that they could stay in the room of their choice. Three residents’ care records were looked at in detail. Prior to admission detailed assessments of resident’s needs had been carried out by experienced senior staff. Information had been gathered from a range of sources including the resident and their relatives and significant others; this would ensure all aspects of people’s needs were considered. Nursing care was provided by the district nursing service and separate records were maintained. Letters confirming that resident’s needs could be met were not on the care records; the manager said they would be sent out with the welcome pack. The manager advised that residents and their families would be invited to visit and spend time in the home where they could meet with other residents and staff and view the facilities. Each new resident was allocated a personal member of staff or ‘key worker’ to help them to settle in. Training records showed that staff were provided with a range of appropriate training that gave them the skills and competencies to meet resident’s changing needs. A number of staff had attended dementia training to help them meet the specialised needs of some of the residents living in the home. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The care plans need to reflect the care and attention that was being given to ensure resident’s needs were met. Medication policies and procedures provided staff with clear guidance resulting in safe management of residents’ medicines. EVIDENCE: Three care plans were looked at in detail. There were some concerns about the lack of detail in the care plans as this did not always reflect the care that was being given; concerns were discussed with the manager who advised that the system would be reviewed. It was clear that, despite the lack of detail in the care plans, staff were responsive to any changes in residents’ physical and Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 13 emotional wellbeing. Each resident had a care plan that had been developed from the initial and ongoing assessment information which been reviewed each week by staff but it was not always clear that residents’ or their relatives had been involved in the development or review process; communication sheets had been introduced to help to improve relatives’ involvement in care planning. Two residents said they didn’t know about care plans and one said they were happy to leave this to staff. It was recommended that the daily report included more detail regarding how residents spent their day as it was not clear about the level of care and support given by staff and whether there had been any changes to the resident’s condition. The care plans included some useful information about residents’ likes, dislikes, routines and preferences which would help to ensure they received the care they both needed or wanted. Not all risks to residents’ health and well-being were either recorded or kept under review. Two residents had been identified at risk of developing pressure sores but there was no information to support that appropriate care had been given by staff to reduce the risk and the assessments had not been kept under review; this could place residents at risk of not receiving the care and support they needed. There were no assessments in place to determine whether residents were nutritionally at risk although weights had been monitored. Concerns were raised as, according to the care plan, alternative methods of feeding a resident were being used although this had not been agreed or discussed with a dietician, had not been risk assessed and there were no records to support that staff had received training and understood the risks of using this method. The risk of falls had not been assessed despite one resident having fallen twice in the past month; action to be taken by staff to reduce the risks had not been recorded in a plan of care. The use of bed rails had not been risk assessed, discussed with the resident or their relatives and kept under review; this meant it was unclear whether this form of restraint was safe and suitable for the resident. The procedures for the use of restraint and use of bed rails need to be reviewed to reflect current safe practice and the managers were directed to the Department of Health web site for current safe guidance. Records showed that resident’s health was monitored and that staff had sought appropriate advice when needed. Residents had access to health care services and one resident said she had seen her GP recently and staff made sure she received the prescribed medication. A number of the residents had complicated care needs and some required input from the district nursing services. Staff were trained in a range of healthcare matters; this would give them the skills and competencies to recognise and respond to any changes in people’s health. Residents were happy with the care they received; one said ‘they know me and know what I want’. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 14 Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Each resident had a key worker who would be a ‘special’ friend to them. There were clear procedures to support senior staff with the safe management of residents’ medicines; minor additions were still needed to ensure staff had access to all aspects of safe practice. One member of staff confirmed that in house training was given and staff were only allowed to administer medicines when they were deemed competent to do so; it was recommended that clear records of the training content and assessments of competencies were recorded on the staff file. There should also be clear evidence to support that staff were competent to monitor resident’ blood glucose levels and understand when further advice should be sought; this would ensure residents’ needs would be met. The medication records were accurate and had improved since the last key inspection visit; they showed that medicines were managed safely. Medication storage areas were secure and medicines were stored at the appropriate temperatures. Staff were observed responding to residents and visitors in a friendly, welcoming and respectful manner. Residents’ privacy was respected and staff had received training to help them with this. Residents said that staff treated them well and respected their choices and decisions. There were clear policies and procedures to help staff to support residents who were dying; resident’s and relatives final choices and decisions had been recorded and staff would follow their wishes. A decision had been taken to allow the home to provide ‘hospice at home’ care; staff worked closely with external professionals and specialists to ensure dying residents, their families and staff received the care and support they needed. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using this service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Social activities met residents’ social needs and expectations. Residents received a healthy and varied diet that met their dietary needs and expectations. EVIDENCE: Residents confirmed that choices were given in various aspects and that routines were flexible; one resident said ‘I can do what I want they don’t bother’. A range of activities, entertainments and excursions had been provided and staff had made every effort to ensure resident’s diverse social needs and dependencies were met. It was recommended that a record was maintained of Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 16 residents who had participated in the activities to ensure every resident’s needs were being met. One resident said ‘I’m never bored there is always something going on’, another said she enjoyed the visits from the entertainers and another preferred to stay in her room or in the quiet lounge for ‘peace and quiet’ and this was respected. Excursions had taken place and relatives and friends were regularly invited to the home to enjoy a buffet lunch and entertainment. Resident’s spiritual needs were met by regular visits from local clergy and the local church choir. One resident said ‘I’ve met some nice people since coming here’. Residents were given the opportunity to plan their activity programme and encouraged to make suggestions for improvement or changes about the issues that affected them at the residents ‘committee’ meetings. Staff had gathered information about residents’ routines, preferences, hobbies and interests to help them to meet their diverse social needs. Residents said their visitors were made to feel welcome and they were able to see them at any time either in the privacy of their bedrooms or in other communal or quiet areas of the home. The menus were displayed in the dining room and showed a choice of well balanced and nutritious meals. A recent survey indicated that residents were happy with the meals and residents made positive comments about the food including ‘there is always a choice and good food’, ‘good food but not always a choice’ ‘food is always nicely prepared’ ‘we get plenty to eat and drink’ and ‘we always have a choice for breakfast but there is not always a choice at other times but if I didn’t like it they would give me something else’; it was recommended that the record of meals served recorded that a choice of meal was always offered. The cook was aware of resident’s dietary likes and dislikes and they were consulted about any changes to the menus to ensure they received the meals they enjoyed. Dining areas were pleasant and bright and tables set with appropriate condiments, cutlery and crockery. Staff gave support to residents who needed extra assistance and residents were able to take their time and eat their meals in an unhurried way; one resident said she was unsure what it was for lunch but staff would help to cut food her up. Cherry Tree Lodge DS0000009644.V376094.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The complaints procedures were clear and accessible and residents knew who to speak to if they were unhappy. The safeguarding procedures provided staff with clear guidance although lack of up to date training in this area could result in staff failing to recognize and respond to incidents of abuse and neglect. EVIDENCE: There had been one complaint made in the last twelve months; records showed the procedure had been followed and that it had been dealt with properly. The procedure was clear and easy to understand; the manager was aware that the Care Quality Commission contact information needed to be updated. Residents said they knew who to speak to if they were unhappy and said they were happy with the service they received; comments included ‘staff are very helpful and would try to sort things out’, ‘I cant grumble, I cant say enough about the staff’ and ‘I’m well looked after and get all the love and care I need’. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 18 Staff surveys indicated they knew how to respond to any concerns; this would ensure people’s concerns would be taken seriously. There were a number of letters complimenting the service; this supported that people living at Cherry Tree Lodge were happy. The policies and procedures for safeguarding adults gave clear guidance which would help staff to respond promptly and appropriately if abuse was suspected. There were no records to support staff had received recent safeguarding adults training; staff needed up to date training to help them to recognise and respond appropriately to any abuse or neglect. Procedures provided safe guidance for staff regarding management of residents’ finances and management of verbal and physical aggression; it was recommended that staff have challenging behaviour training to help them to meet the needs of the current residents living in the home and to keep themselves and others safe from harm. Staff should be provided with training to support them with the mental capacity act and deprivation of liberty safeguards; this would help them to support residents who were unable to make their own decisions. Bed rails were being used for one resident without evidence of an assessment of risk, discussion with the resident (or relative) or regular review (see standard 8); it was unclear whether this form of restraint was appropriate or whether other equipment could be used. Cherry Tree Lodge DS0000009644.V376094.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. People using this service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Residents lived in a safe, comfortable and well maintained environment with plans in place to support ongoing improvement. EVIDENCE: During a tour of the home it was clear that the home was well maintained, safe and comfortable and was equipped with a range of specialist equipment and adaptations to meet resident’s individual needs. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 20 Residents were happy with their rooms, they were clean and bright and had been personalised with treasured possessions to enhance the homely atmosphere. There were privacy screens in shared rooms and all rooms had accessible alarm facilities for residents to call for assistance. Communal areas were bright and comfortable and residents were able to sit and chat or watch television with their friends and visitors. The driveway remained in need of attention and there were a small number of double glazed units that were still in need of repair or replacement; however these were included in a development plan that supported ongoing improvement. A handyman visited regularly and attended to any needed repairs and maintenance. It was recommended that the maintenance book was dated on completion of the work; this would help to identify whether repairs were being attended to promptly. There were safe and accessible patio and garden areas that were provided with suitable garden furniture. Residents said the home was always clean and fresh and there were no odours on day of visit; comments from a recent survey included ‘the home is clean and tidy and smells fresh’. One resident said her clothes always came back clean and ironed. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The recruitment process had improved but needed to be supported by clear and safe recruitment procedures to ensure the protection of people living in the home. Staff were competent and provided in sufficient numbers to meet resident’s needs. EVIDENCE: The duty rotas showed that staff were provided in sufficient numbers to meet resident’s needs; staff surveys indicated there were enough staff. Residents said there were enough staff and comments included ‘you only need to press the buzzer if you need help’, ‘there are enough staff but they are always busy looking after everyone’ and ‘staff always come when I use the buzzer’. Residents also said ‘staff are helpful and will do anything for you’ and ‘I’m happy here’. One member of staff said there was a good team Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 22 Records showed that staff turnover was very low which meant that residents received care from staff that were familiar with their needs. Staff were given the opportunity to attend regular staff meetings where their views and opinions were listened to. Staff said they met regularly with and received support from their manager; a record of supervisions was maintained however there were no records of the content of the discussion or an action plan to record any issues raised. Three staff files were looked at in detail. It was noted that the recruitment process had improved since the last inspection visit although in the absence of a recruitment procedure there was no clear guidance for senior staff to follow. Recruitment checks were in place prior to employment although one file included ‘testimonials’ rather than references and references had not always been verified with a telephone call. It was recommended that the start of employment date was recorded clearly on the file and staff should provide a recent photograph as a means of identification in accordance with Schedule 2 of the Care Homes Regulations. A record of the interview, linked to the job description, was needed to demonstrate an equal opportunities process had been followed. Most of the staff had a recognised qualification in care which would help them to meet resident’s needs properly. Training had taken place and was recorded in a book although in the absence of a training matrix and individual training records it was not very clear what had taken place, was due or was planned. Three staff commented that they were given induction and up to date training that was relevant to their role. The manager said new staff would be given time to settle into the routines of the home and to get to know the needs of the residents. A record of their initial introduction to the home should be made to support they were able to work as part of the team and able to keep themselves and others safe. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The home was safe and people were consulted about the running of the home. EVIDENCE: Currently the day to day running of the home was managed by a ‘staff’ manager, ‘care’ manager and ‘business’ manager although no-one was registered with the Care Quality Commission (CQC). At previous inspections Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 24 there had been concerns that there was no registered manager in post; however following further discussions with the home and to meet their responsibilities under the care Standards act 2000 the ‘business’ manager was in the process of applying to register as manager. The business manager was enrolled on appropriate care and management training which would support her with the role. From survey information it was clear that staff were happy working in the home and received the support they needed; one said ‘everything is done very well and a high standard of care is always kept’. Most of the recommendations and requirements made at the last inspection visit had been responded to; this showed the home was prepared to work with the CQC and improve outcomes for people. Residents and their relatives were regularly consulted about whether their needs and expectations were being met and changes had been introduced if any issues had been raised. Results from the annual surveys were very positive and indicated that people were satisfied with the care they received; comments included ‘the home is second to none’. A number of residents were involved in a committee that met regularly and were involved in making decisions about the day to running of the home; this showed that their opinions were valued. The home had achieved the Investors In People award; this was a recognised quality assurance system that monitored standards of the management of the home and staff training and development. Staff had access to clear procedures which would provide them with safe practice guidance. It was noted that some procedures were missing or did not reflect current safe practice and these had been referred to under the relevant standard. The staff manager said policies and procedures were currently being reviewed by the care manager. There were no formal systems in place to monitor whether staff were following safe policies and procedures although the staff manager and care manager monitored staff on a day to day basis and worked closely with staff, residents and their relatives. The manager was advised that the Care Quality Commission (CQC) must be notified of any incident that affects service users well being in accordance with regulation 37; this enables the CQC to monitor practices in the home. Records were stored safely and the manager said residents could access their records at any time. Any concerns regarding records were referred to under the appropriate standard. Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 25 The home sent us their Annual Quality Assurance Assessment (AQAA) before the inspection visit; this was fully completed and gave us a good picture of what had improved over the last twelve months and where further improvements were needed. The business manager advised that the home did not deal with resident’s finances although clear records were maintained of fees and invoices. Records showed that equipment and systems were well maintained and safe although it was noted that the testing of portable appliances certificate was overdue; the manager advised this would be arranged. Staff had attended safety training although some of this was now overdue; the manager said further sessions were planned. Cherry Tree Lodge DS0000009644.V376094.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 4 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 2 2 2 Cherry Tree Lodge DS0000009644.V376094.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 OP7 Regulation 15 Requirement The resident’s care plan must clearly detail the action to be taken by staff to meet all aspects of their needs; this would ensure residents’ received the care they needed. Any risks to residents (including falls, moving and handling, pressure and nutrition) must be clearly assessed, recorded in the care plan, detail action to be taken to reduce or eliminate the risk and kept under review; this would ensure residents’ needs would be met. Timescale of 06/08/07 not met. 3. OP8 13 03/08/09 The use of restraint measures such as bed rails must be risk assessed, discussed and agreed with the resident or their relatives and kept under review; this would ensure that this form of restraint was safe and suitable for the resident. The procedures for the use of restraint and use of bed rails Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 28 Timescale for action 03/08/09 2. OP8 13 03/08/09 must be reviewed to reflect current safe practice in line with the Department of Health guidance. 4. OP18 13 Staff must be provided with up to date safeguarding adults training; this would help them to recognise and respond to any abuse or neglect. There must be a recruitment procedure to support staff with a safe recruitment process; this would ensure residents were protected from unsuitable people. The Care Quality Commission (CQC) must be notified of any incident that affects service user’s well-being in accordance with regulation 37; this enables the CQC to monitor practices in the home. 03/08/09 5. OP29 18 03/08/09 6. OP37 37 03/08/09 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. 4. Refer to Standard OP2 OP4 OP7 OP7 Good Practice Recommendations The contracts or terms and conditions should include the number of the room to be occupied; this would re assure residents that they could stay in the room of their choice. Letters confirming resident’s needs could be met should be sent prior to admission and a copy maintained on file. Each care plan should include a falls risk assessment with appropriate interventions recorded. The assessment should be kept under review. The care plans should be drawn up with the involvement of the resident or their relative and agreed and signed by DS0000009644.V376094.R01.S.doc Version 5.2 Page 29 Cherry Tree Lodge 5. OP7 6. OP8 7. 8. 9. 10. OP8 OP8 OP9 OP9 11. 12. 13. OP12 OP15 OP18 14. OP18 15. OP29 the resident or their relative; this would ensure residents received the care they both needed and wanted. The daily report should include more detail regarding how residents spent their day indicating the level of care and support given by staff and whether there had been any changes to the resident’s condition. Any alternative methods of feeding residents should be used only following discussion and agreement with the multidisciplinary team; there should also be evidence of risk assessment and records to support staff have had training and understood the risks of this method of feeding. Residents should be regularly assessed to identify whether they are at risk of developing pressure sores and appropriate interventions recorded in the care plan. Nutritional screening should be undertaken on admission and kept under review. Medication procedures should support staff with transcribing (handwritten entries), verbal changes, covert admin and use of non prescribed medicines. There should be clear records maintained on staff files to support staff had received appropriate training in the management of medicines and blood glucose monitoring and had been assessed as competent; this would ensure residents’ needs would be met by competent staff. There should be a record of residents who had participated in the activities; this would help to identify whether every residents social needs were being met. The records of meals served should support that choices were offered at each meal time. Staff should be provided with training to help them to respond to challenging behaviour; this would help them to meet the needs of the current residents living in the home and to keep themselves and others safe from harm. Staff should be provided with training to support them with the mental capacity act and deprivation of liberty safeguards; this would help them to support residents who were unable to make their own decisions. Two written references (not testimonials) should be obtained as part of the recruitment checks. References should be verified with a telephone call. The employment start date should be clearly recorded on the staff file. A recent photograph as a means of identification should be Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 30 included as part of the application process. There should be a record of the interview, linked to the job description, to demonstrate that an equal opportunities process had been followed. There should be a training matrix to clearly identify the current skills and competencies of staff and to identify when training was due to take place. There should be a signed record to support that new staff had received a basic induction to the home; this would support they were able to work as part of the team and able to keep themselves and others safe. 17. 18. 19. OP31 OP36 OP38 The manager should complete the NVQ 4 in both management and care. Supervision records should be maintained including the content of the discussion and an action plan to record any issues raised. The safety of and testing of the portable electrical appliances should be supported by a current certificate. 16. OP30 Cherry Tree Lodge DS0000009644.V376094.R01.S.doc Version 5.2 Page 31 Care Quality Commission National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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