Care Home: Cherry Tree Manor

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What the care home does well When asked what does the home do well,one person living in the home told us in a survey "In my opinion, everything". There was overwhelmingly positive feedback from all parties consulted, either on the day or through surveys received. The standard of care seen throughout was good and there was a very pleasant atmosphere in the home, with good interaction between the people who live in the home and the staff who care for them. The standard of documentation was good and there are no requirements made following this inspection. Another quite typical comment received from a relative was; "I am extremely happy that I can visit my mother regularly and she is very happy with Cherry Tree Manor. Also I can go away and know that she is being very well cared for". What has improved since the last inspection? The recommendations made following the previous report have been addressed or work is under way to do so. The home identified staff training, care plans and enhancement to the home`s gardens as some areas of improvement and these were confirmed during the inspection. What the care home could do better: The home themselves recognise in their AQAA that care plans can be improved still further with additional personal life histories to inform the way care is given. To some extent the home depends on people living in the home or responsible for them, to help assemble this material. The home have recognised that efforts to involve relatives in a more formal way than is the case at present would be beneficial and are said to be looking at ways this could be achieved, for example through a home forum. The only area of concern that arose consistently was with perceived problems in communicating with some care staff where English was not their first language. There was and is no suggestion that this has directly affected the standard of care received by people living in the home, it does however have the potential to do so. The home are aware of this and are understood to be prepared to provide additional training support to those care staff concerned. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cherry Tree Manor 8 Great Road Adeyfield Hemel Hempstead Hertfordshire HP2 5LB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Orange     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Cherry Tree Manor 8 Great Road Adeyfield Hemel Hempstead Hertfordshire HP2 5LB 01442217621 01442262955 oak.care@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Oak Care Limited care home 47 Number of places (if applicable): Under 65 Over 65 47 47 47 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Cherry Tree Manor is a care home, which provides personal care and accommodation for 47 older people. The home is in Adeyfield, a residential area of Hemel Hempstead, close to shopping and local community facilities. There is a good-sized car park and access to local bus routes. This purpose built home opened in 1996. Resident accommodation is on floors reached by stairs or lifts. There is a choice of lounges and a dining room on each floor with additional kitchenettes for providing snacks and drinks. All of the bedrooms are single rooms with an en suite toilet and wash hand basin. There are additional assisted toilets and bathrooms on each floor. Residents have access to an enclosed garden area and conservatory. The home aims to meet the needs of older people who may also have physical disabilities or dementia. It does not provide a service to people who are Care Homes for Older People Page 4 of 25 Brief description of the care home assessed as requiring nursing care; it will however continue to provide a service for people with changing needs as long as they can be met in the home with input from the primary health care team. Information about the service is provided in the Statement of Purpose and Service User Guide, these and a copy of the latest Care Quality Commission (CQC) inspection report are available in the home. Fees for the services are £520:00 to £545:00 per week. ( At June 2009) Additional charges are made for newspapers, personal toiletries, hairdressing and chiropody services. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for this service was on the 6th June 2007 and we undertook an annual service review on the 3rd June 2008 where we reviewed all the information about the home that we had received since the last key inspection. The current inspection was unannounced and was carried out by one inspector, starting early in the morning and going through into the afternoon. Where this report refers to we it recognises that it was carried out on behalf of the Care Quality Commission (CQC). During this inspection we were able to look at the early morning routine of the home as people who live there were being helped to get up and ready for the day ahead. We also observed the mealtime experience at lunchtime and those activity sessions that took place during the day and early afternoon. We were able to speak to people who live in Cherry Tree Manor and to several visitors to the home, including Care Homes for Older People Page 6 of 25 health and social care professionals as well as relatives and friends of people living in the home. We spoke to members of the staff team and to the manager. During the inspection we looked at some key records, including those for staff recruitment, care planning and the administration of medication. This report also draws on information contained in a number of surveys returned to us from people living in the home, staff, relatives and health care professionals. We have also made use of the information provided to us by the home in their annual quality assurance assessment or AQAA. The AQAA is a self assessment document that sets out how well care outcomes have been achieved for people living in Cherry Tree Manor. It also includes some useful statistical information, for example about complaints and staff training. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Cherry Tree Manor as a home for themselves or someone they are responsible for can be assured that they will only be admitted if their needs have been thoroughly assessed and can be met. They can be confident that they will be able to visit the home before they make a decision about moving in. Evidence: When we asked people who live in Cherry Tree Manor in surveys if they had had enough information about the home before they moved in to enable them to decide if it was the right place for them 100 of those that responded said that they had. 100 of people surveyed also said that they always receive the care and support they need. When we looked at the homes welcome information and service user guide we found that they contained sufficient detail to enable people to make a well-informed judgement about the home and the services it provides together with any additional costs involved for services provided outside of the basic contract. All of those who Care Homes for Older People Page 10 of 25 Evidence: replied to our surveys indicated that they had received a contract from the home, and when we spoke to relatives about the process of choosing this home they indicated to us that they had been able to visit the home before a decision was made if they wanted to. When we looked at some recent pre-admission documents for people now living in Cherry Tree Manor we found that they contained sufficient detail to enable care staff to identify their needs and how they were to be met. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Cherry Tree Manor can be confident that they will receive effective health and personal care support, that they will be treated with respect and as an individual and that systems and records for the administration of their medication are accurate and efficient. Evidence: When people living in Cherry Tree Manor responded to our surveys, 95 told us they always receive the medical support they need, with 5 saying that they sometimes did. We received positive comments from a range of health and social care professionals both by survey and in a number of face to face conversations during the inspection. I would not hesitate to place my own mother in Cherry Tree Manor was one comment. During this visit we saw and spoke to an optician, community nurses and social workers. This indicates that people living in Cherry Tree Manor have ready access to health and social care services they require. Doctor always called when I need him was one persons comment. When we looked at care plans we found that these had been improved since the last inspection and although some of the routine Care Homes for Older People Page 12 of 25 Evidence: notes were less informative and tended to repeat stock phrases, care plans as a whole were sufficiently detailed to provide sufficient information for care staff about the care needs of people living in the home, how these were being kept under review and what changes in care needs there may have been. When we checked the medication records for the home we found that these were satisfactory and should give confidence to those people who require help with their medication that this is being done safely and in a way that promotes their well-being. Throughout this inspection visit we saw evidence of a good standard of care being given, with care staff treating those they were caring for in a way that protected their dignity and was respectful. I find the home helpful, caring and friendly and The home meets all aspects of my mothers care needs very well were some quite typical comments received during this inspection process. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Cherry Tree Manor can be confident that they will be encouraged and assisted to exercise choice in and control over their lives including their daily activities and routines. They can be assured that they will be able to maintain and build contacts with family and friends in the community. Evidence: When we asked people who live in the home if there are activities arranged by the home that they can take part in, all those who responded said that there were, if they chose to do so. Always an activity that you can join in, my particular favourite is a quiz and Always choice of activities offered. When we spoke to the homes activities organiser she told us that the home belongs to a national organisation that promotes and supports best practice in activities for care homes and she gave us details of the specific courses she has attended in order to build her own skill and expertise. We saw details of the information she has compiled in peoples life history folders to help provide person centred activities that reflect peoples tastes, preferences and interests. We saw examples of the homes regular programme of activities, including arts and craft sessions, quizzes and also special activities on particular themes, the homes AQAA gave as examples St.Georges day, the Queens coronation and the Care Homes for Older People Page 14 of 25 Evidence: introduction of decimalisation as themes and starting point for reminiscence based activities. We observed meals in various parts of the home, noting that recently named places have been identified at tables in the dining rooms. We were told that this did not mean that people could no longer choose where they sat and that they would be able to make a decision each mealtime if they wanted to. When we asked people living in the home if they enjoyed the food, the majority said that they either always or usually did and all of those spoken to indicated that they were always offered alternatives if they did not like the particular main dish on the menu. Throughout this inspection we saw and were able to speak to people visiting the home and in surveys returned to us from relatives carers and advocates very positive comments were received about access to and communication with the management of the home, although some expressed difficulties in communication with some individuals within the care staff team for whom English was not their first language. These comments were accompanied in every case with tributes to the high standard of care these carers provided. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Cherry Tree Manor can be confident that they are able to make a complaint and that they will be listened to and appropriate action taken. They can also be assured that staff have received training to help them protect people living in the home from abuse. Evidence: When we asked people who live in the home and their relatives, carers and advocates whether they knew how to make a complaint, all but one indicated that they did. When we looked at documentation provided by the home to people living in Cherry Tree manor or considering doing so, we found that full details of the complaints policy and procedure is clearly given. In their AQAA the home told us that there have been two complaints in the last twelve months, neither of which was upheld and both of which were dealt with within 28 days. When we looked at staff training records and spoke to staff, we were able to confirm that training provided to them should mean that they understand what constitutes abuse and what to do if it is seen or suspected. All of this should give confidence to people living in the home, or responsible for them, that they are being protected from abuse wherever possible, and that were it to be seen or suspected, rigorous and appropriate action would be taken to address it. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living and working in Cherry Tree Manor can be assured that the environment is safe, comfortable, clean and well-maintained. Evidence: When we asked people who live in the home in surveys if it was fresh and clean, 100 answered that it always was. When we asked relatives about the home, several made positive comments about the high standard and consistency of hygiene and cleaning.One person noted that there was a high standard of; cleanliness of residents rooms and all communal areas. When we spoke on the day to people who often visit the home, they indicated that their experience was that the home was very clean, tidy and usually free from any unpleasant smells. We saw the homes maintenance person during our visit and we were told by staff that minor repairs and maintenance are rapidly noted and dealt with. When we saw, with their permission, some bedrooms of people living in the home we found that they were personalised to reflect their personalities, interests and preferences. The home inform us that they have already improved the shower facilities available to people living in the home and further improvements and refurbishment, for example to some bathroom flooring, is planned. The home has a pleasant and well-equipped garden which provides additional communal space for people who live in the home to enjoy, weather permitting. Care Homes for Older People Page 17 of 25 Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Cherry Tree manor can be assured that they are protected by the recruitment policies and procedures followed by the home and that there are sufficient numbers of care and ancillary staff with the training, support, skills and experience to meet their needs. However at times there may be difficulty experienced with communication between staff and between staff and people living in the home. Evidence: When we looked at the recruitment files for some recently recruited staff, we found that the required checks had been completed and the information needed obtained to ensure that people receiving care and services from them are safe and that their care needs are met appropriately. When we spoke to people living in the home about the staff, staffing numbers and the standard of care that they receive they were overwhelmingly positive. Call bells always answered promptly was one judgement made. When we asked staff about the numbers of staff available they indicated that there were usually enough staff and on the day of this inspection there was no evident problem with staffing numbers nor was this raised as a major concern by any visitors or health and social care professionals spoken to. When we spoke to staff they confirmed that We have plenty of training and this was borne out by the training records seen. There was one consistent area of concern, arising from both staff and people either living in the home or responsible for them and this was the difficulty Care Homes for Older People Page 19 of 25 Evidence: sometimes said to be experienced in communicating with staff whose first language may not be English. It is not possible, certainly from the positive comments about the standard of care received from all staff, to state that this has affected the care experience of people living in the home, however it clearly has the capacity to do so, and should be appropriately monitored and addressed. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cherry Tree Manor is a well managed and run home and people who live or work there can be confident that their best interests are central in decision making about the routines and management of the home. Evidence: When we spoke to care staff, people living in the home, relatives and visitors they were all very positive about the way that the home is managed and run and about the manager and her team. I would give them 12 out of 10 was the assessment of one visitor to the home. We saw evidence of reports drawn up by the homes proprietor following regular routine visits, these give rise to action plans to address any issues raised. We saw evidence that the home send out their own quality questionnaire and a summary of the findings of this survey are shortly to be provided to people living in the home and their relatives. When we spoke to staff and looked at the supervision matrix a system of regular and frequent staff supervision is in place. The manager is very approachable and always on hand to help and support us in any way she can. Care Homes for Older People Page 21 of 25 Evidence: We were told that the home does not hold any monies on behalf of people living there and that individuals deal with these themselves or through family, legal or financial advisers. When we looked at care plans, we saw that these included risk assessments to promote the health, safety and well-being of people living in the home. The home has canvassed opinion from relatives of people living in the home about a formal forum or other form of regular meeting. This is understood to still be under consideration to ensure that all parties are able to have an input into the way the routines and activities of the home are determined. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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