Care Home: Cherry Tree Nursing Home

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• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
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• The Maypole Nursing Centre
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What the care home does well Pre-admission assessments are undertaken to ensure the home is able to meet the needs of potential people to use the service. People living in the home have a care plan to ensure that their health and personal care needs would be met.The home has a varied activity programme in place to ensure that people living in the home can be supported to follow their personal interests. The home has a complaints procedure to ensure that people living in the home and their relatives are able to raise any concerns The home has sufficient numbers of staff to ensure that the changing needs of people using the service can be met. The home`s quality assurance system ensures that it is run in the best interests of people using the service. What has improved since the last inspection? The requirement issued on the last inspection relating to faulty self-closing devises on doors has been remedied. The home has appointed an activity organiser, which means that the activity programme in the home has improved. As a result of listening to people who use the service the home has employed a gardener to look after the flower beds, which mean that the flower beds are well maintained. As a result of listening to people who use the service the home is in the process of replacing televisions in bedrooms to the flat screen type, which should improve on space and improve the viewing. The home has acquired two new dishwashers, which should improve efficiency in the kitchen. The home has purchased new beds, which should ensure that people using the service can be cared for in a dignified manner. What the care home could do better: The fire panel must be checked weekly to ensure that people using the service and staff safety is promoted and protected. Care plans must be signed by people using the service if they are able to or their relative, which should confirm their involvement in the plan of care.Handwritten entries recorded on medication administration record sheets must be checked by a second person, which should minimise the risk of error when transcribing. Locks must be fitted to the sluice room doors, which should ensure the ongoing safety and protection of people using the service. Gloves must be discarded after each activity for which they were worn, which should prevent the risk of transmission of microorganisms to other sites or to individuals. CARE HOMES FOR OLDER PEOPLE Cherry Tree Nursing Home Bledlow Road Saunderton Princes Risborough Bucks HP27 9NG Lead Inspector Joan Browne Unannounced Inspection 28th February 2008 09:45 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 Cherry Tree Nursing Home DS0000019193.V357875.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. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree Nursing Home Address Bledlow Road Saunderton Princes Risborough Bucks HP27 9NG 01844 346259 01844 342 698 cherrytreenh@googlemail.com 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 A.S. Dhot Maxine Bennell Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 50 Physically Frail Elderly Mentally Frail Date of last inspection 12th July 2006 Brief Description of the Service: Cherry Trees Nursing Home is an established care home registered to provide nursing care for up to 42 elderly persons. It is privately owned and managed. The home is situated in a rural location close to the market town of Princes Risborough. It is a two-storey building set in well-maintained gardens with a millstream and large millpond, which attracts wild life and birds. Accommodation is in single rooms with comfortable social areas. There are no rooms with en suite facilities. There is a passenger lift to the first floor. All service users are registered with the local general practitioner and have full access to local national health services through General Practitioner referral. The fees charged are presently £730.00 per week. Additional costs exist for such things as hairdressing, newspapers and personal toiletries. Information to support potential Service Users and their families to make a decision for admission to the home is provided in the homes Statement of Purpose and the Service Users Guide, which are provided to potential Service Users, with additional copies held in the home. Cherry Tree Nursing Home DS0000019193.V357875.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. This inspection of the service was an unannounced key inspection. We arrived at the service at 09.45 am and the inspection lasted for approximately seven hours. This inspection was a thorough look at how well the service is doing. It took into account information provided by the service’s manager in the annual quality assurance assessment (AQAA) and any information received about the home since the last inspection. We saw most areas of the home and looked at records and documents relating to the care of the people using the service and staff members. We asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that we sent out and their views are included in this report. We looked at how the service was meeting the standards set by the government and in this report made judgements about the outcomes for people living in the home. From the evidence seen and comments received we considered that the home was ensuring that people using the service diverse needs were being met. One requirement and six recommendations were made and this can be found at the end of the report in the requirements and recommendation section with fuller discussions in the text of the report under standards 7, 9, 19, 26, 29 and 38. We (the Commission) would like to thank all the people living in the home, visitors and staff who made the visit so productive and pleasant on the day. The final part of the visit was spent giving feedback to the manager and deputy manager about the findings of the visit. What the service does well: Pre-admission assessments are undertaken to ensure the home is able to meet the needs of potential people to use the service. People living in the home have a care plan to ensure that their health and personal care needs would be met. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 6 The home has a varied activity programme in place to ensure that people living in the home can be supported to follow their personal interests. The home has a complaints procedure to ensure that people living in the home and their relatives are able to raise any concerns The home has sufficient numbers of staff to ensure that the changing needs of people using the service can be met. The home’s quality assurance system ensures that it is run in the best interests of people using the service. What has improved since the last inspection? What they could do better: The fire panel must be checked weekly to ensure that people using the service and staff safety is promoted and protected. Care plans must be signed by people using the service if they are able to or their relative, which should confirm their involvement in the plan of care. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 7 Handwritten entries recorded on medication administration record sheets must be checked by a second person, which should minimise the risk of error when transcribing. Locks must be fitted to the sluice room doors, which should ensure the ongoing safety and protection of people using the service. Gloves must be discarded after each activity for which they were worn, which should prevent the risk of transmission of microorganisms to other sites or to individuals. 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. Cherry Tree Nursing Home DS0000019193.V357875.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 Cherry Tree Nursing Home DS0000019193.V357875.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): 3 People who use the service experience good quality out omes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective people to use the service have the information needed to choose a home and their needs are assessed prior to being admitted into the home to ensure that all identified needs would be met. EVIDENCE: The homes annual quality assurance assessment (AQAA) stated that every resident is asessed by a registered general nurse before admission. This is carried out either in hospital or in their own home. We were told that sometimes the prospective resident visits the home to be assessed and is invited for lunch or afternoon tea. This enables a realistic assesment of needs to be carried out such as, continence, mobility eating and drinking. Review of a random sample of residents files including one recently admitted resident demonstrated that pre-admission assessments were being carried out and relatives were involved in the assessment process. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 10 Residents are admitted on a trial period of one month and contracts seen validated this information. We were told that the current statement of terms and conditions of occupancy were being reviewed. The home would need to ensure that the Commissions details on the form are also updated. The home’s annual quality assurance assessment (AQAA) stated that it was in the process of developing an information booklet outlining the various activities and events that take place in the home. This should ensure that prospective residents have all the information they need about the services provided. The home does not provide intermediate care. Cherry Tree Nursing Home DS0000019193.V357875.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): 7, 8 9, 10 & 11 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has systems in place to ensure that people who use services health and personal care needs would be met. Staff respect individuals’ rights to privacy and dignity. EVIDENCE: Three care plans were examined and they contained information on how all aspects of individuals identified health, personal and social care needs should be met. However, information in the daily report writing did not inter-relate with the care plan to reflect what progress was being made on the identified needs. Daily report writing referred to personal care given and eating and drinking. Care plans seen were not signed by individuals or their representatives to indicate their involvement in what care they received. However, the member of staff undertaking the development and monthly review of the care plans had signed and dated them. Evidence was seen indicating that care plans were being reviewed monthly or as and when Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 12 required. Relatives who responded to the Commissions survey said that the home was meeting individuals needs. As a good practice a recommendation is being made to ensure that those residents who are able to or their relative should sign the care plan to demonstrate their involvement in the plan of care. A further recommendation is being made to ensure that daily report writing inter-relate with the care plan to reflect what progress was being made on needs identified. All residents were registered with a general practitioner (GP) of their choice. One particular GP visits the home weekly. Access to specialist healthcare professionals such as the dentist and optician is available and a chiropodist visits the home twice monthly. National health treatment can be accessed through the GP practice if required. Arrangements were in place to ensure that professional advice about the promotion of continence is sought and acted upon and aids and equipment needed are provided. Those residents at risk of pressure sores were provided with pressure relieving mattresses and cushions. Evidence was seen to indicate that pressure sore risk assessments for individuals were being reviewed monthly also nutritional risk assessments. Health care professionals who responded to the Commissions survey said that the home always seek advice and act upon it to manage and improve individuals health care. Hairdressing facilities are available at a cost to people living in the home and on the day of the inspection the hairdresser was visiting. In discussion with the registered nurses and care workers they were extremely proud of the high standard of care they provided to all residents in the home. We were told that they were no residents in the home on the day of the inspection assessed as capable to self-medicate. The medication administration record (MAR) sheets were examined. A recent photograph for individuals was in place to reduce the risk of error occurring during medication administration and there were no unexplained gaps. A random selection of controlled medication was checked and the medication in the cupboard corresponded with the controlled drug register record. It was noted that two staff members witnessed and signed for the disposal of all medication and this is deemed as good practice. Some inconsistencies in staffs recording practice were noted. For example, handwritten entries recorded on some MAR sheets were not checked by a second person to minimise the risk of error when transcribing. Scribbled over entries were noted on some individuals MAR sheets, which made it look like medication was signed for before being offered then refused. Not all staff were using the appropriate codes as indicated on the MAR sheet when medication was not given or had been refused. To comply with best practice guidelines recommendations are being made for handwritten entries to be checked by a second person to minimise the risk of error when transcribing and for staff to Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 13 use the appropriate code as indicated on the MAR sheet when medication has been refused or not administered. The annual quality assurance assessment (AQAA) stated that some improvements had been made to the medication system. Medication was being ordered monthly and the pharmacist supplying the medication had been changed. The daily routine of the administration of medication by staff was also altered to ensure that there was sufficient time to administer all the medication. Residents and relatives who responded to the Commissions survey said that staff upheld their privacy and dignity. Residents spoken to on the day of the inspection said that they were treated with dignity and respect. Staff were observed treating residents in a respectful manner. A staff member was observed discussing a particular residents condition with a relative in a sensitive and dignified manner. One resident said I am very happy here, I have my own room, which is nice and clean and my privacy everything is so nice. I do what I want. The home provides expert end of life care and have developed a good relationship with the Iain Rennie Hospice team. Evidence was seen indicating that the appropriate analgesics and aperients were being provided to individuals to improve and maintain the quality of their lives. Cherry Tree Nursing Home DS0000019193.V357875.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): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has an activity programme in place, which should ensure that people using the service are supported to follow their personal interests and activities. People are able to keep in touch with family and friends and nutritious meals and snacks are provided to meet individuals preferences. EVIDENCE: The homes annual quality assurance assessment (AQAA) stated that a new activtiy organiser had been employed. Those residents and relatives who responded to the Commissions survey indicated that since the appointment of the new activity person the activity programme had improved. Residents spoken to on the day of the inspection said that they were pleased with the daily activities provided. We were told that those residents who were unable to join in with group activities were provided with one to one attention. A discussion was held with the activity person who seemed passionate about her role. She explained what activities were being provided and the process. Once a fortnight a facilitator provides gentle exercise and arts and crafts Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 15 classes take place weekly during term time. Board games, quizzes, bingo and reminicence were on offer. Residents birthdays are celebrated and they are presented with a card and a birthday cake. Two major functions are held yearly these were the annual strawberry tea party, which is held in the summer and the pre christmas tea party. Both events are well attended by relatives and staff. During the summer a local brass band provides entertaintment. Staff were observed taking some residents in wheelchairs in the garden to enjoy the newly planted daffodils that were blooming and the ducks in the pond. Once a month a church service takes place in the home for those residents who wish to promote their religious needs. The home does not have any restrictions on visiting. Those relatives who responded to the Commissions surveys said that they were free to visit at anytime and made to feel welcome. The homes annual quality assurance assessment (AQAA) stated that visitors are always welcome to have tea and coffee. The home was planning to purchase a tea machine to enable visitors to make their own drinks. On the day of the inspection there were no residents using the services of an advocate. However, the manager confirmed that if a resident requested the services of an advocate the homes staff would endeavour to comply with the request. It was evident that residents were made aware that they are entitled to bring personal possessions with them, if they wished to. A sample of bedrooms seen looked homely with individuals personal belongings. The home’s annual quality assurance assessment (AQAA) stated that equality and diversity is promoted by ensuring that individuals’ race, gender, disability, sexual orientation, age and religion are respected. Information recorded in the AQAA demonstrated how in the past it had supported a particular individual with promoting their religious needs by setting up a phone sytem to enable the individual to take part in weekly prayer meetings. Residents are provided with three meals daily and hot and cold drinks are available at all times and offered regularly. Special diets to meet individuals preferences and dietary needs were being provided. Liquidised meals seen were presented to look as appetising as possible. Residents who responed to the Commissions survey and those spoken to on the day of the inspection said that overall they were happy with the meals provided. Staff were observed assisting those residents who required assistance in a sensitive and dignified manner. The cook was spoken to and she confirmed that an alternative choice would be provided if an individual did not like the choice on offer. The homes annual quality assurance assessment (AQAA) stated that changes had been made recently to the system of how suppers were being ordered and as a result residents have a choice of sandwiches or a hot meal. Residents, relatives and staff spoken to during the inspection confirmed that the new sytem was working well and the meals provided were of a high standard. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 16 Cherry Tree Nursing Home DS0000019193.V357875.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): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a complaints procedure to ensure if people living in the home or their relatives have any concerns about their care it would be looked into and action taken to put things right. EVIDENCE: A record of all complaints is held in the home, which was open to inspection. The home had received one formal complaint which was dealt with appropriately. The Commission was made aware of the complaint. Residents and relatives who responded to the Commissions survey said that they were aware of how to make a complaint and that the home responds appropriately to any concerns raised. The following comments were noted from a relative: If ever I have a query or concern it is always dealt with and a satifactory conclusion is reached. The homes safeguarding of vulnerable adult policy has been updated to ensure that it is in line with the Buckinghamshire Inter Agency safeguarding of vulnerable adults policy . There have been no protection issues raised at the home since the last inspection and the Commission has not been made aware of any issues. Staff spoken to were aware of the action, which should be taken Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 18 if they suspected or witnessed any incidents of abuse. Staff have had training in the safeguarding of vulnerable adults, which is ongoing. The home stated in its annual quality assurance assessment (AQAA) that plans for improvement within the next twelve months was to ensure that all staff undertake training in the mental capcity act, which should heighten staffs awareness. Cherry Tree Nursing Home DS0000019193.V357875.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): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There is an ongoing maintenance programme ,which should ensure that people live in a safe and well-maintained home that is homely clean, pleasant and hygienic. EVIDENCE: On the day of the inspection the home was clean and tidy and free from odours. We were told that the home employs a full time maintenance person to carry out regular checks and maintain the home in good repair and that there was an ongoing maintenance programme in place. There is also a dedicated domestic team to ensure that the cleaning in the home is of a high standard. Spot checks were carried out in some bathrooms and toilets and they were found to be in a satisfactorily condition. Bedrooms seen looked homely and were personalised with individuals personal belongings, pictures Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 20 and mementoes. Residents spoken to said that they liked their rooms and that the home was fresh and clean. At the last inspection a requirement was made for faulty self-closing devises fitted to doors throughout the home to be repaired to ensure doors are closing efficiently. It is pleasing to report that the requirement had been complied with. A recommendation was made for locks to bathrooms and toilets to be changed to the type that can be opened from the outside in case of an emergency. The majority of the locks had been changed however, some were missed out and the manager has agreed to ensure that all locks are of the type that can be opened from the outside in an emergency. A further recommendation was made for suitable locking mechanisms to the sluice room doors should be fitted. This recommendation had not been complied with and would be repeated to ensure the ongoing safety and protection of residents. The homes annual quality assurance assessment (AQAA) stated that there had been some improvements made to the environment . For example, two new dish washers to aid the smooth running of the kitchen had been purchased. Some new beds and chairs had also been purchased. Plans to build some raised flower pots beds in the garden to enable residents to participate in planting and weeding were being considered. A comment relating to the efficiency of the passenger lift was noted and referred to the management for action. The laundry room was clean and tidy and is situated away from areas where food is stored prepared cooked or eaten and does not intrude on residents. The floor and walls were impermeable, which makes it easy to clean. We observed a staff member not disposing of used gloves after providing personal care to a resident. To prevent the transmission of microorganisms to other sites or to other residents gloves should be discarded after each activity for which they were worn. Cherry Tree Nursing Home DS0000019193.V357875.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home ensures that people who use services are cared for by staff who receive up to date mandatory training but more staff need to gain the National vocational qualificatiion in care. EVIDENCE: We were told that the home rarely uses agency staff. The staff rota was examined and it reflected that two trained nurses were on duty in the morning along with eight carers. In the afternoon the number of carers is reduced to six with two trained nurses. The night shift is covered by one trained nurse and three carers. Comments noted from some relatives who responded to the Commissions survey indicated that the staff were very busy and there is always the need for additional staff to support residents. From our observations, the number of staff on duty on the day of the inspection was apppropriate to meet the needs of people in the home. Overall those residents and relatives who responded to the Commissions survey were complimentary about the staff team. The following comments were noted: The staff are very friendly to us when we visit. As far as I know all staff seem competent. The staff work very hard and are patient and helpful to all the residents. Staffing difficult at times puts pressure on the excellent regular staff. A particular comment was noted relating to some new staff having difficulties through language problems, which was causing disagreements. The comment Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 22 was referred to the management. We were reassurred that staff whose first language is not English are encouraged to undertake English classes and other training such as national vocational qualification (NVQ) training in direct care at level 2. The home’s annual quality assurance assessment (AQAA) also stated ‘that it was planning to make further changes to promote quality and diversity by providing training for staff from other countries to ensure that they are aware of the expectations and differences in care that the british elderly citizens would expect to receive.’ At present the number of staff members with national vocational qualifications at level 2 in direct care does not reach the expected level of 50 . The manager said that she was working to ensure that the 50 percentange is achieved. The recruitment records for three newly appointed staff members were examined. All staff had enhanced criminal record bureaus clearances and had completed an application form. Evidence of interview notes were seen. In one particular file we found two references were of a To whom it May Concern type and were not in response to a request from the organisation. There was no evidence available to verify that they were authentic. It is recommended that references are addressed to the person who requested them and not To whom it may concern. We were told that the home was currently involved in setting up a cluster group for training purposes, which should enable new members of staff to access training promptly. The homes induction programme is to the expected standard. The homes annual quality assurance assessment (AQAA) stated that Skills for Care had visited the home and a training needs analysis was carried out. It was noted that each member of staff had a personal development plan. Three staff members files were spot check and all mandatory training was up to date. On the day of the inspection some staff had undertaken training in customer care. Staff members who responded to the Commissions survey said that the home always provides training that was relevant to their role and helps them to understand and meet the diverse needs of individuals. Cherry Tree Nursing Home DS0000019193.V357875.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the 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 have confidence in the care home because it is being managed appropriately. Electrical, gas and other equipment in the home is regularly maintained but weekly checks of the fire panel would need to be carried out to ensure that the environment is safe for people and staff. EVIDENCE: The home is managed by a qualified and experienced manager who has the registered managers award (RMA) qualification. Comments from residents, relatives and staff during the inspection is that she will listen to concerns and suggestion for improvement and that she works with her staff team. The manager is supported by a competent and experienced deputy manager and a Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 24 team of trained nurses and health care assistants. The manager said that she is supported by the proprietors and the homes administrator to achieve the goals for the home and explore new initiatives that will further improve the quality of service provision. Staff spoken to on the day of the inspection confirmed that group supervision was taking place and regular staff beings were being held. There was evidence seen to indicate that regular monthly audits were taking place in relation to care plans and the medication administration record sheets, maintenance and health and safety checks. Satisfaction surveys are sent to residents and relatives to gain their views and build on the sytems in place. The home’s annual quality assurance assessment (AQAA) stated that as a result of listening to people it was planning to replace the old televisions in individuals’ bedrooms, with flat screens, which should save on space. Evidence was seen to indicate that regulation 26 visits were being carried out by the proprietor. The home does not act as an appontee for residents personal allowance. However, small amounts of money is left in the home by family members for some residents. We were told that one of the homes administrators was respondible for the safe keeping of this account and recipts were kept for all transactions made. There is also an invoicing system for such things as hairdressing, newspapers and personal purchases made on behalf of residents. The homes annual quality assurance assessment (AQAA) stated that the maintenance of electrical, gas and moving and handling equipment had been undertaken and was up to date. A spot check was carried out on the fire panel and although regular fire drills were being carried out it was noted that the fire panel had not been checked since the 08/02/08. A requirement has been made to ensure that the fire panel is checked weekly. We were told that the environmental health officer recently carried out a food safety inspection and no requirements had been made. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 (4)(c) Requirement The fire panel must be checked weekly to ensure people using the service and staff safety is promoted and protected. Timescale for action 30/04/08 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 OP7 Good Practice Recommendations To comply with best practice guidelines people using the service if they are able to or their representative should sign the care plan to demonstrate their involvement in the plan of care. The daily log should inter-relate with people using the service care plan to reflect what progress was being made on identified needs. To comply with best practice guidelines handwritten entries recorded on the medication administration record sheets should be checked by a second person to minimise the risk of error when transcribing. To comply with best practice guidelines staff should use the appropriate code as indicated on the medication DS0000019193.V357875.R01.S.doc Version 5.2 Page 27 2. 3. OP7 OP9 4 OP9 Cherry Tree Nursing Home 5 6 OP19 OP26 administration record sheet when medication has been refused or not administered. Locks should be fitted to the sluice room doors to ensure the ongoing safety and protection of people using the service. To comply with infection control guidelines gloves should be discarded after each activity for which they were worn. Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherry Tree Nursing Home DS0000019193.V357875.R01.S.doc Version 5.2 Page 29 - 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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