Care Home: Cherrytrees

What the care home does well The service users are provided with a homely and well maintained environment that meets their needs. The meals at the home looked well presented and balanced and the service users said met with their satisfaction. What the care home could do better: The care plans and risk assessments should be further developed to ensure that all care needs are identified and action plan put in place to meet them. The medication management is inadequate and must be improved to ensure that this is managed safely at all times. Staff must ensure that footrests are used on wheelchairs to reduce the risks of entrapment and the safety of people using the service. The registered person must ensure that all staff complete update and training in safe moving and handling and health and safety for the protection of the service users. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Cherrytrees 149 Park Road Cowes Isle Of Wight PO31 7NQ two star good service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Tengnah Date: 2 7 0 2 2 0 0 9 Information about the care home Name of care home: Address: Cherrytrees 149 Park Road Cowes Isle Of Wight PO31 7NQ 01983299731 F/P01983299731 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) : Mrs Dorothy Mary Gustar,Mr Laurence Woodford Gustar care home 25 Number of places (if applicable): Under 65 Over 65 0 6 25 0 9 mental disorder, excluding learning disability or dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability physical disability Conditions of registration: 25 0 0 25 0 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Old age, not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD) The maximum number of service users to be accommodated is 25 Care Homes for Older People Page 2 of 11 Date of last inspection Brief description of the care home Cherrytrees is registered to provide personal care for up to 25 older people, the home may also provide care for up to 6 older people with a mental disorder. The home is a converted period property set within its own gardens and is within easy reach of the town and all of its amenities and facilities. For those individuals unable to walk into town or without other means of transport the local bus company operates a scheduled bus service, which runs directly past the home. Transport is provided by the home for appointments. If service users, visitors or representatives have their own transport then car parking is available to the rear of the home or along the roadside. The building is accessible with a passenger lift or stairs providing access to the upper floor. However, due to the layout of the building, which has been extended, part of the first floor is only accessible via a short flight of steps from the passenger lift. Care Homes for Older People Page 3 of 11 What we found: We undertook a random unannounced visit to the home on the 27th February 2009 as part of our monitoring process of the service. We looked at the care records of one of the service users who had been recently admitted to the service to look at the assessment process that the home had in place. This person had been admitted for short term care with the view of moving to another home. We found that there was a detailed pre admission assessment that had been completed. A care managers assessment was also available as part of the information that the home had gathered. This is to ensure that the home is able to meet the needs of the person prior to admission. Assessments included mobility, personal care , oral health, hearing and health needs such as on inhalers for asthma. The manager reported that this information is used in the formulation of care plans. Records of care plans for two of the service users that we looked at showed that details of the persons abilities and assistance that they require for their activities of daily living. The assessments in the care records seen included moving and handling and falls. Care plans needed further developments to include assessment of skin integrity and continence. Two of the records we looked at showed that the service users were incontinent and used pads. The manager stated that a continence assessments had been completed , however the records were not available. The registered manager was contacting the continence nurses to ensure that these assessments are available and form part of the continence management at the service. The provider has confirmed that more details were kept in another file. There was evidence of some reviews of care plans and assessments, however these were not consistent. Further development would ensure that these are completed and reviewed at regular intervals ensuring that the information in care plans are current to inform practice. Areas lacking included weight monitoring and reviews. Details of continence management should include the types of pads that had been allocated and the frequency of changes to inform practice and ensure that the service users needs are fully met. We found that records of care given were inadequate and did not give adequate details of how the persons assessed needs were being met. The manager confirmed that there were no records of care that people received at nights in their individual care plans except in handover sheets. The manager is aware of the service users entitlement to NHS care and supports the service users in accessing the care as required. This included attending dental and eye care in the community. A chiropodist visited the home regularly. The home has the support of the local primary care trust nurses. One of the service Care Homes for Older People Page 4 of 11 users was receiving treatment for pressure ulcers. There were detailed records of the care and treatment available inn the district nurses notes. The district nurses attended a service user twice daily to administer their Insulin. The manager reported that four of the senior carers had received instruction in monitoring one of the service users blood sugar and this was done twice a day.The registered person must ensure that record to demonstrate staffs competency following assessment must be maintained as these were not available at the time of the visit. We looked at the process that the home has in place for the management of medication on behalf of the service users. The manager confirmed that only the carers who had completed a medication management training were responsible for medication. A sample of the Medication Administration Record (MAR) sheets seen indicated that satisfactory records of oral medication administered was available. The home maintained a record of medicines that are received into the service, there was a procedure in place for the administration of as required medication. We found that when we walked around the service there were inadequate system in place to ensure that the service users medications are managed safely at all times. One of the service users told us that they had been given some white cream in an unmarked pot to apply when they had complained of their neck itching. We also observed that there were a number of creams, ointments that were not label led and pose a high infection control risk. One cream was found in a bedroom that belonged to a service user that the staff said had passed away last year. Other medication found in a bedroom included diabetic medication that had expired in 2007. There were no procedures and risk assessments in place for the service users who were administering their own medication. We noted that these medications included inhalers and a potent spray for angina. These practices put the service users at risk of not receiving their medication appropriately and their needs not being met. Anyone wishing to self medicate must be supported to ensure that this is carried out within a risk assessment framework and storage facility must be available so that they can store their medicines safely. Records should be developed and maintained for the application of creams and ointments that carers undertake on behalf of the service users as this was not available. A random sample of the medication received into the service was looked at. We found that although some records were maintained of medication received these did not correlate with the existing stock as maintained at the home. We found that there was large variation with the records that the home kept. There was a large stock of medication and a system should be developed so that this is managed effectively. The AQAA tells us that the home has not received any complaints. We have received two safeguarding referrals about the service that has been investigated by Social Services. As part of the investigations, the local primary health care team undertook a review of the service users accommodated at the service. The provider has confirmed Care Homes for Older People Page 5 of 11 an Occupational Therapist assessment was completed and no further action was needed. During our visit there was no complaint recorded in the complaint log, incidences that were recorded separately had been dealt with by the manager. We sent out surveys to the service as part of the visit. We received seven comment cards and they were positive comments received in relation to the acre that they were receiving at the home. Some of the comments included my mother has always received the greatest level of care. All the staff are friendly and helpful and this also includes the handyman. The staff and the care at Cherrytrees are better than we ever hoped for was another comment. Other comments were that staff were usually available when they required help and one comment said sometimes they are busy. We observed that the carers had developed good relationship with the service users and treated them with respect when providing assistance. One service user said that the girls are lovely and always respectful. We received six comments cards that were returned from staff and they tell us that they are supported in their work. They say that they have a handover after each shift so that information is shared. One staff said that she had an induction and also shadowed another carer and helped them to get use to the routine at the home. All the staff commented that they knew what to do if any concerns are raised by the service users. We observed the lunch time meal on the day of the visit. Comments from the eight service users we spoke to showed that they were fully satisfied with the meals that they are provided. Comments were the food is very good and nothing to complain about. The meals looked well presented, varied and appetising and choices were available. Staff were available to offer support with meals in a sensitive manner. We looked at the recruitment record for one of the newly appointed staff at the service. We found that the home has a satisfactory process in place and checks were completed as part of the recruitment process. The checks included two references, Criminal Record Bureau (CRB) and POVA. We looked at the training matrix that was available at the home and we found that the staff had not all completed mandatory training and updates as required. This included moving and handling that can put the service users at risk of harm through poor staff practices. In order to ensure that people are safe when being transferred in wheelchairs, the registered person must ensure that footrests are in use at all times. We noted that this was not in place at the time of the visit on two occasions that People were wheeled around. Care Homes for Older People Page 6 of 11 What the care home does well: 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 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 9 Regulation13. The manager must ensure that all of the home?s medication storage facilities comply with the regulations and are safe and secure. 02/07/2008 Care Homes for Older People Page 8 of 11 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 1 7 15 The registered person must 15/05/2009 ensure that risk assessments and care plans are developed to ensure that all assessed needs are appropriately met So that you can ensure that the peoples care needs are met safely. 2 9 13 The registered person must ensure that arrangements are in place for the safe management of medication at all times. So that people are not put at risk of harm and all medications are managed and stored safely. 15/05/2009 3 38 13 The registered person must 15/05/2009 ensure that all satff receive training and update in moving and handling, health and safety as part of their work. So that you can ensure that people are not put at risk when receiving care through poor practices. Care Homes for Older People Page 9 of 11 4 38 12 The registered person must 15/05/2009 ensure that unnecessary risks to the health and safety of the service users are identified and as far as possible eliminated, when using wheelchairs. So that you can ensure that the service users safety is not compromised. 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 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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