Care Home: Cherrytrees

What the care home does well The aim of the home is to provide respite care to people who live in the community. The service supports and encourages people to maintain and develop independent living skills. The home is situated in a residential area in the town of Frome. People living at the home are enabled to lead independent lives where possible, accessing the community and work placements locally. Care plans were overall well maintained and detailed. The home is furbished to a good standard with appropriate aids and facilities. Cherrytrees is a comfortable home with a family feel shared amongst the people living there and staff. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Staff were familiar with the likes, dislikes and individual needs of the individuals living at the home. Interactions between staff and individuals were kind and respectful. People were seen to be relaxed and comfortable in the presence of staff. One person spoken to commented `I`m very happy living here`. People are consulted with regarding the daily running of the home, and are encouraged to exercise choice. People benefit from a wide range of activities and opportunities. People are supported to continue with their "normal" routines including social, recreational and educational opportunities. The home is maintained to a good standard of cleanliness. What has improved since the last inspection? No requirements were made at the last inspection. What the care home could do better: The care and support afforded to people at the home is good however some minor issues have been identified as a result of this inspection. It could not be confirmed that all staff have received all necessary mandatory training. It is a requirement of this inspection that the training staff have undertaken be reviewed and that any arrangements are made for staff to undertake training or update training previously completed. Staff need to review the care and support plans to ensure that they give clear guidance on the care needs of all individuals. This should include increased consideration to Mental Capacity Act and Deprivation of Liberty safeguards (DOLS). The temperature of hot food should be taken at all meals thus reducing the chances of food poisoning.CherrytreesDS0000054215.V375776.R01.S.docVersion 5.2Some of the paint work in some areas of the home is in need of attention and redecoration. A recent fire risk assessment has been completed. The recommendations in this report needs to be actioned. Key inspection report CARE HOME ADULTS 18-65 Cherrytrees Cherrygrove Road Frome Somerset BA11 4AW Lead Inspector Justine Button Unannounced Inspection 20th May 2009 09:00 Cherrytrees DS0000054215.V375776.R01.S.doc 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 home adults 18-65 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. Cherrytrees DS0000054215.V375776.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 Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherrytrees Address Cherrygrove Road Frome Somerset BA11 4AW 01373 452965 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) glawson@somerset.gov.uk Somerset County Council (LD Services) Mrs Melitta Gay Izzard Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Indivduals may be admitted who have concurrent physical disabilities and/or sensory impairment Indivduals will be admitted for a maximum of 3 months between each admission and discharge 16th May 2007 Date of last inspection Brief Description of the Service: Cherrytrees has been registered as a care home for up to 6 younger adults (aged 18 - 65) with learning disabilities for respite care since September 2003. Also run from the same site is a community care outreach service for adults with learning disabilities. A number of local people also access the home for day care services. The home is run by Somerset County Council. A registered manager is in charge of the day-to-day running of the home. Cherrytrees is a single storey purpose built home in the town of Frome. This has the local facilities of shops, banks, pubs and leisure amenities. Cherrytrees is adapted to be able to support highly dependent Indivduals whilst maintaining a homely atmosphere. All accommodation is in single rooms. Outdoor space includes well-maintained gardens as well as shared use of an all-weather outdoor sports court. The home benefit from being sited adjacent to a day service facility for adults with learning disabilities, also run by the Council. The current charges are £51.00 (18-24 years), £63.00 (25-59 years) and £98.00 (60 years) per week. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection ( Now known as the Care Quality Commission) in April 2006.The inspection methodology used by the Commission for Social Care Inspection enables the us to make a judgment on the quality of the service delivery based on the outcomes for people living at the home. The inspection took place over the course of one day. We looked at selected staff and residents files, policies and procedures and other documentation related to the running of the home. We looked around the home and also viewed several private rooms and the garden. As part of the inspection we spoke to people living at the home, staff relatives/representatives and people living at the home. The responses and comments are incorporated into this report. In addition the home sent us information in the form of an Annual Quality Assurance Assessment (AQAA). This document helps us form a judgment on the improvements made at the home. The quality rating for this care home is: Two star “Good” service What the service does well: The aim of the home is to provide respite care to people who live in the community. The service supports and encourages people to maintain and develop independent living skills. The home is situated in a residential area in the town of Frome. People living at the home are enabled to lead independent lives where possible, accessing the community and work placements locally. Care plans were overall well maintained and detailed. The home is furbished to a good standard with appropriate aids and facilities. Cherrytrees is a comfortable home with a family feel shared amongst the people living there and staff. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 6 Staff were familiar with the likes, dislikes and individual needs of the individuals living at the home. Interactions between staff and individuals were kind and respectful. People were seen to be relaxed and comfortable in the presence of staff. One person spoken to commented Im very happy living here. People are consulted with regarding the daily running of the home, and are encouraged to exercise choice. People benefit from a wide range of activities and opportunities. People are supported to continue with their “normal” routines including social, recreational and educational opportunities. The home is maintained to a good standard of cleanliness. What has improved since the last inspection? What they could do better: The care and support afforded to people at the home is good however some minor issues have been identified as a result of this inspection. It could not be confirmed that all staff have received all necessary mandatory training. It is a requirement of this inspection that the training staff have undertaken be reviewed and that any arrangements are made for staff to undertake training or update training previously completed. Staff need to review the care and support plans to ensure that they give clear guidance on the care needs of all individuals. This should include increased consideration to Mental Capacity Act and Deprivation of Liberty safeguards (DOLS). The temperature of hot food should be taken at all meals thus reducing the chances of food poisoning. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 7 Some of the paint work in some areas of the home is in need of attention and redecoration. A recent fire risk assessment has been completed. The recommendations in this report needs to be actioned. 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. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard 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, 5. People using 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. Individuals and their families are provided with the information they need to enable them to make an informed choice about moving to the respite unit. Appropriate assessments are completed to ensure that the home will be able to meet Individuals’ needs. EVIDENCE: The home has a Statement of Purpose that provides details of the services and facilities offered at Cherrytrees. The information has been developed in total communication. This makes sure the information is accessible to as many people as possible. The home has an Admissions policy. People told us that were able to visit the home prior to considering respite at the home. Comments included “I came to Cherrytrees with my family to have a look before I had respite at the home I stayed for a night before my respite visit Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 10 A copy of the service user contract was provided. This clearly states which services are included within the weekly fee, and provides details of any notice periods required. Fee levels vary dependant on the care and support provided. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6, 7,8, 9, 10 People using 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 developed a care plan for each individual who receives respite at the home. Individuals are encouraged to exercise choice and are consulted appropriately. People are able to participate in all aspects of life within the home. Records relating to individual are appropriately maintained. EVIDENCE: Two care plans for people currently using the service were viewed during the inspection. The care plans showed that a range of assessments and care plans had been developed by staff. Care plans provide details of individual’s needs, Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 12 daily routines and preferences. The majority of risk assessments had been completed as required. It was noted however that for one person, who was living at the home on a full time basis, frequently refused the meals on offer. The manager stated that staff offered alternative foods at different times other than the “normal” mealtimes. The weight of the individual remained stable demonstrating that meals must be being consumed. This issue however was not clearly identified in the plan of care. This is required to ensure that all staff are aware of the action to be taken when meals are refused and that this is applied consistently. For the second individual it had been assessed that the individual would be at risk if they accessed the kitchen without staff supervision. A risk assessment and restrictive practise documentation had been completed. This however had not been reviewed since April 2007. Staff should review these assessments to ensure that they remain valid and that the guidance contained in the documentation remains up to date. This will ensure the continued safety of the individual concerned. In one of the care and support plans viewed a folder had been developed containing pic’s and photographs. These would be used to aid communication with the individual. The use of these tools was not detailed in the plan of care. This was discussed with the manager who stated that staff were in the process of developing a “communication passport”. This development is welcomed however once developed staff update the care plans to give clear guidance to all staff on its use. Recent guidance has been issued with regard to the Mental Capacity Act and Deprivation of Liberty safeguards (DOLS). These two documents are intended to protect the interests of an extremely vulnerable group of individuals and to: - ensure people can be given the care they need in the least restrictive regimes - prevent arbitrary decisions that deprive vulnerable people of their liberty - provide safeguards for vulnerable people - provide them with rights of challenge against unlawful detention - avoid unnecessary bureaucracy The care and support plans need to be developed to ensure that this guidance is fully considered for all people who use the service. The home assists people in managing their monies. Records are maintained of all transactions involving personal finances. These are supported by receipts and staff signatures and are audited on a daily basis. The home has installed a fixed lockable safe in each individual’s wardrobe to enable individuals to store medication and personal monies. All records relating to individuals are stored securely, and may be accessed by individuals at their request. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16, 16, 17. People using 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 are able to participate in a wide range of activities, and have regular opportunities to access the local community. Independence is promoted. People are encouraged to develop and maintain daily living skills. Meals provided are of a high standard and offer a well balanced diet. EVIDENCE: People who access the service on a respite basis are supported by staff to maintain their “normal” day time routines and activities. On the day of the inspection one person was making bread and butter pudding with staff Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 14 support. This individual was then supported to go for a walk. One person was at work placement during the day and a trip to the cinema has been arranged for the evening. Another individual was out at the local shops and one person had chosen to remain in bed having a lie in. One person was doing activities within the house and was receiving 1:1 staff support. The home have a range of activity equipment in house and it was reported that this was well used. The home have recently purchased an Nintendo WII and a karaoke machine. We were told that these have been well enjoyed by all people visiting the home for respite. The service has a relatively well maintained garden and some new garden furniture has recently been donated to the home. The home does not have its own transport. Transport can be arranged via the SCC transport department, This transport can be borrowed evenings and weekends but is not available through the day during the weekdays. Social and recreational opportunities outside of the service may be limited at this time. Occasionally, a person had stayed for longer than the maximum stipulated for a respite facility, risking the development of strong relationships with staff and the feeling that may be associated with not having a permanent home. There were three such person in the home on the day of the inspection. The manager should keep CQC informed with regard’s to progress with finding a long-term placement for these people. People accessing Cherrytree’s have strong links and contact with their families. One parent confirmed in the feedback form that the home promotes regular contact and reviews are held regularly. The comments were positive: ‘oh very good, no problem at all and staff are very good here’. The parent also confirmed that they are aware of who to contact should they have any concerns. Care plans also provide details of individual’s personal and family relationships. All bedrooms are lockable and Individuals are issued with their key if they wish to use it. Staff were respectful of individuals private space and demonstrated each persons preferred ways. Individuals accessed all areas of the home freely. On the day of the inspection lunchtime was relaxed and unhurried. Individuals were supported with their choices and timing. The home has a file which lists two meal choices offered that day and throughout the week. The home has implemented a running record to evidence what the individuals have eaten for their meals. One person spoken with confirmed that she enjoys the food and is able to access the kitchen anytime to make snacks if she wishes. The nutritional needs of individuals had been assessed as evidenced in their care and support plans. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 15 The fridge and freezer were in good working order and daily temperature recorded. Food opened were clearly labelled and dated. It could not be confirmed that the temperature of hot meals were taken and recorded on a regular basis. This is required to reduce the risk of food poisoning. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18, 19, 20, 21. People using 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 are provided with appropriate assistance to meet their personal care needs. The home supports service users in accessing healthcare services. The home has an appropriate medications policy. All medications are stored securely. EVIDENCE: The home has appropriate aids and equipment to support service users mobility. The health and safety checks for these equipments are maintained regularly. Through discussion with staff and manager, it was evident that care was taken to check equipment for wear and tear and action where appropriate. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 17 It was evident from the care plans through regular monitoring that any changes in the service users wellbeing or behaviour would be identified. The manager and staff team would then take pro-active steps to address and meet changing needs. The care plans sampled contained health and medical information. Records are kept of all visits and consultations. The home’s procedures for the management and administration of medication were examined at this inspection. Medication was seen to be handled and stored appropriately. The Medication Administration Record clearly demonstrated that two staff signatures confirm all administration. The home has a detailed medication policy in place including homely remedy guidance. Photographs of service users are pre-printed onto their medication administration record to ensure correct medication is given. The home maintains records of medication entering and leaving the home. Two members of staff also sign these. The home has a policy in place in respect of standard 21. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22, 23. People using 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 provides people with regular opportunities to provide feedback on the service provided. The home has developed an appropriate complaints procedure. The home has policies relating to the Protection of Vulnerable Adults and whistleblowing. EVIDENCE: The home gives each individual a document “have your say” on a regular basis. This ensures that people have the opportunity to ensure that their views were listened to. This form is currently being redeveloped to include photographs. This will enable more people to access this document. The home has a complaints procedure, which includes details of external agencies that may be contacted, including CQC. The complaints procedure is available in alternative formats to ensure that it is accessible to all. This is displayed on the noticeboard in the hallway. All people living at the home stated that they knew how to complain and all stated that they would be happy to do so if they had any complaints or concerns. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 19 The home has policies relating to the Protection of Vulnerable Adults and Whistleblowing. Staff recruitment procedures ensure that all new staff have a criminal record bureau check prior to commencing work at the home. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24, 25, 26, 27, 28, 29, 30. People using 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 been furnished to a good standard. Some redecoration will be required in the near future. Appropriate adaptations have been provided. The home has sufficient communal areas and bathrooms to meet peoples needs. The home was found to have a high standard of cleanliness. EVIDENCE: Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 21 The home is a purpose built unit that opened in 2003. The home is adapted to a high standard to meet the range of disabilities that people may have. A tour of the building was conducted during the inspection. All areas are homely and comfortable. All the bedrooms are for single occupancy with en-suite facilities. One bedroom was viewed with permission. The bedrooms viewed were found to be personalised and comfortable. Some of the bedrooms seen were equipped with television Some bedrooms were equipped with overhead hoist track including the ensuite to aid personal care if required. All rooms that were inspected had window restrictor in place and secured wardrobe. There are 9 toilets in this home with adequate space for wheelchair users. There is one very large shared bathroom with a bath suitable for service users with severe mobility impairment to access via an overhead hoist. The water temperature of the bath is displayed on a digital readout. There is also a shower trolley available, where adequate space is provided for its use in the bathroom. All washing and bathing facilities inspected were clean and tidy. Also, paper towels and liquid soap were available. Water temperatures were checked monthly. Communal space at the home includes a large lounge and a separate dining area. The lounge is comfortable and homely. The kitchen is spacious and provides good storage and cooking facilities. Staff wear catering aprons for improved food hygiene practice. In some of the areas the paint work was chipped, peeling or scuffed and in need of redecoration. This was raised with the manager at the end of the inspection. There are two patio areas to the rear of the building that are wheelchair accessible and equipped with tables and benches. The surrounding gardens are pleasant and well maintained. The home has shared access of an outdoor sports court. The home also has access to the neighbouring day unit during evenings and weekend if required. The laundry provides good equipment for washing of clothes and machines enable programmes to heat to a degree to manage infection control measures. All chemicals are stored in a locked cupboard. The manager confirmed that yellow waste disposals are stored in secured refuse bin area outside. A quiet room is available for service users and visitors to meet in private. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 22 Pictorial signs were evident throughout the home to signpost fire exit or toilets. The home was maintained in a clean and tidy condition. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 32, 33, 34, 35, 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are appropriate to meet people’s needs. Staff are competent and provide a high standard of care and support. Although it could not be confirmed that all staff have completed all necessary mandatory training. The home ensures that appropriate information is obtained prior to a staff member commencing employment at the home. EVIDENCE: Staffing levels at the home were seen to be at a good level during the inspection. Staffing levels are determined by the numbers of people accessing the home and their individual needs. On the day of the inspection the staffing Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 24 levels were such that all people were able to access social and recreational opportunities with a number of people receiving one to one support from staff. Staff spoken with stated that it was a good place to work and that they received appropriate support. Staff receive an Individual Performance Review, and receive supervision on a regular basis. Staff stated that they received enough training to fulfil their roles. The training matrix viewed however did not confirm that all staff had undertaken or updated all necessary training. This included training in moving and handling, medication administration, recognition and prevention of abuse and food hygiene. It is a requirement of this inspection that the training of staff be reviewed and that for any identified shortfalls training is arranged. The home has a relatively stable staff group. It was evident from discussion with staff that they were committed to the work that they did and took pride in delivering a high standard of care and support. No new staff have been employed by the home. Any new staff now working at the home have transferred from recently closed services in the area. As such there were no new recruitment files to view. One file of a staff member recently transferred from a local home was viewed and this contained all necessary checks including CRB and POVA checks. These checks ensure that as much as possible people accessing the service are protected. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37, 38, 39, 40, 41, 42, 43. People using 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 is well run. There are appropriate systems in place for consultation with people living at the home and their families. There is a relaxed and open atmosphere within the home. Appropriate actions have been taken to promote the health and safety of staff and service users. (With the exception of food safety as previously discussed) EVIDENCE: Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 26 Melitta Izzard is the registered manager and has worked at the home for some time . Ms Izzard has NVQ 3 in care and is working toward the NVQ 4 in care and the Registered Managers Award with Somerset Council. In addition to this she has completed the management development programme with Somerset Council and a number of other training courses that are related to the management and care of people who use the service. She has a good knowledge of the needs of the individuals living at the home. People living at the home and the staff were very complimentary about the managerial support that Ms Izzard provides and all stated that she was approachable. People living at the home and their families are encouraged to provide feedback on the service provided. People accessing the home and /or their relative stated that they felt that their views were listened to and respected. A member of the senior management team visits the home regularly to provide Melitta with support, to conduct a tour of the building and review the quality of care and support provided on a monthly basis. This is in line with Regulation 26 of the care home regulations. The home has appropriate policies and procedures in place to safeguard vulnerable people. All records relating to service users are stored securely in accordance with the Data Protection Act 1998. The home displays appropriate Employers Liability Insurance. Fire records were examined, and had been appropriately maintained. A fire risk assessment had recently been completed. This report made some recommendations as to improved fire safety at the home. These recommendations have yet to be implemented. The manager stated that she was awaiting funding in order that the works could be completed. Staff are provided with regular fire safety training. Health and safety records have been appropriately maintained. All accidents have been recorded and reported as required. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 1 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 2 3 Version 5.2 Page 28 Cherrytrees DS0000054215.V375776.R01.S.doc N/A Are there any outstanding requirements from the last inspection? 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 YA32 Regulation 18 (1) ( C) Requirement It is required that a review of staffing training is completed. Following this staff should be supported to complete all necessary training (including updating training). This should include moving and handling, food hygiene, medication training, prevention and recognition of abuse and health & safety training Review to be completed by 12/07/09 Timescale for action 12/07/09 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. Refer to Standard YA6 YA6 Good Practice Recommendations It is recommended that all care and support plans give clear guidance to staff with regard to all the care needs of people who access the home. It is recommended that the manager and staff consider up dating the care and support plans to clear demonstrate DS0000054215.V375776.R01.S.doc Version 5.2 Page 29 Cherrytrees 3. 4. 5. 6. YA8 YA42 YA24 YA42 consideration to Mental Capacity Act and Deprivation of Liberty safeguards (DOLS). It is recommended that communication passports continued to be developed. It is recommended that the temperature of hot food is regularly completed to avoid the risk of food poisoning. It is recommended that consideration is give to the redecoration of some of paint work throughout the home. It is recommended that the points raised in the fire risk assessment are actioned. Cherrytrees DS0000054215.V375776.R01.S.doc Version 5.2 Page 30 Care Quality Commission South West PO Box 1251 Newcastle Upon Tyne NE99 5AN 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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