Care Home: High Trees Nursing Home

What the care home does well The home`s pre admission procedure is good and prospective residents and their representatives are provided with sufficient information about High Trees to enable them to make a decision about living there. Relatives and key people are actively encouraged to be involved in the life of the home and in the planning and meeting of residents` needs. Residents are treated with respect, their history and life style informing care practice. A balanced diet is provided and residents are supported to make choices and enjoy their meals. High Trees provides a comfortable clean environment that has been improved to support residents with dementia and mental health needs, where a smaller calm environment makes High Trees feel like home. Recruitment practices are good and ensure that all documentation required is in place, before staff members commence employment, ensuring that residents are in safe hands at all times. Health and safety management is good, ensuring that any risks to people are minimised. What has improved since the last inspection? All care plans and health records are now kept up to date and can be easily accessed to ensure that the health and social care needs of residents are always fully met. Specific information on the management of all types of diabetes is now available for staff. An appropriate clinical nutritional risk assessment tool is now used to assess the dietary and nutritional needs of residents at the home. Medicines are now safely administered, recorded, stored and disposed of, protecting the health and well being of residents. There is an audit system in place so that medicines are regularly checked from receipt to disposal / administration, ensuring that amounts of medication held correspond with Medication Administration Records. The home has refurbished some bathing and cloakroom facilities to a high standard. What the care home could do better: Staff should receive continual ongoing training updates to ensure that residents are in safe hands. CARE HOMES FOR OLDER PEOPLE High Trees Nursing Home 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB Lead Inspector Jo Pasker Unannounced Inspection 19th February 2009 10:00 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 High Trees Nursing Home DS0000059925.V374266.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. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Trees Nursing Home Address 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB 01202 761380 01202 761189 office@3glenfernavenue.bt.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) 3 Glenferness Avenue Ltd Mrs Celine Marie Stompedissel Care Home 13 Category(ies) of Dementia (13), Dementia - over 65 years of age registration, with number (13), Mental disorder, excluding learning of places disability or dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13), Physical disability (13), Physical disability over 65 years of age (13) High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Conditions concerning minimum staffing levels remain in force. Schedule of requirements, set out in a separate letter to the provider, to be complied with by 31.12.06. 5th February 2008 Date of last inspection Brief Description of the Service: High Trees is registered with the Commission for Social Care Inspection to provide nursing care for a total of thirteen people with dementia, mental disorder and/or physical disability. The home is situated in Talbot Woods, a residential area of Bournemouth and is close to the shopping area of Westbourne. A public transport bus stop, for buses to the nearby town centre, is opposite the home. There is parking space for visitors available at the front of the home. The building is on two floors, with a passenger lift, which enables easy access. Five of the rooms are single rooms and the other four are shared. There is a small comfortable lounge on the ground floor, which is also used as a dining area. Meals are prepared on the premises. There is also an attractive garden and conservatory for residents and visitors use. A nurse is available on the premises at all times and a nurse call system is installed in all rooms. A hairdresser visits the home each week; there is an additional charge for this service. During each Thursday a reflexologist visits to provide individual private therapy to particular residents; there is an additional charge for this service. The home is owned by Three Glenferness Avenue Ltd; the Registered Manager is Mrs Celine Stompedissel. The fee prices in February 2009 range from £450 to £1025 per week. See the following website for further guidance on fees and contracts: www.oft.gov.uk (Value for Money and Fair Terms in Contracts). High Trees Nursing Home DS0000059925.V374266.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 was a statutory unannounced inspection, required in accordance with the Care Standards Act 2000 and assessed the home’s compliance with all key standards of the National Minimum Standards. The inspection involved a tour of the premises, discussions with people living at the home, staff, management and the observation of routine tasks and daily interactions. Other information was gathered from documents including care files, staff files and home records. In advance of the visit, the home submitted a completed Annual Quality Assurance Assessment (AQAA) and surveys were received from 4 staff members, 3 healthcare professionals and 3 people living at the home. What the service does well: The home’s pre admission procedure is good and prospective residents and their representatives are provided with sufficient information about High Trees to enable them to make a decision about living there. Relatives and key people are actively encouraged to be involved in the life of the home and in the planning and meeting of residents’ needs. Residents are treated with respect, their history and life style informing care practice. A balanced diet is provided and residents are supported to make choices and enjoy their meals. High Trees provides a comfortable clean environment that has been improved to support residents with dementia and mental health needs, where a smaller calm environment makes High Trees feel like home. Recruitment practices are good and ensure that all documentation required is in place, before staff members commence employment, ensuring that residents are in safe hands at all times. Health and safety management is good, ensuring that any risks to people are minimised. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 7 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 High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 8 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 (Standard 6 is not assessed as this home does not provide intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are completed before people move into the home so that residents can be assured that their needs will be met by the service. EVIDENCE: The records of two people who had been admitted to the home since the last inspection were viewed. Both included full pre admission assessments with plenty of relevant information that was then used in planning their care. Letters are also sent out to all residents and their representatives prior to them moving into High Trees, to confirm that the home can meet their assessed needs. Three residents returned Commission surveys prior to the inspection. All stated that enough information had been received by themselves or their family, prior High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 9 to moving in, enabling them to make an informed decision about the suitability of High Trees as a home for them. A survey answered by a care professional also stated that they felt the home had assessed a particular person’s needs “well” and “drawn up an individual care plan accordingly” whilst remaining “flexible”. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive systems are in place to provide staff with the information they need to meet the health and personal care needs of individuals and good management of medication ensures people are kept safe. Individuals continue to be treated with respect and dignity. EVIDENCE: The care records of 3 people who live at the home were reviewed and found to contain assessments which then formed the basis for care plans, risk assessments and daily records describing the care of each person. There was evidence that care plans had been discussed with individuals or their families and signed by them. All care records seen were clear and detailed and showed evidence of other appropriate healthcare professionals visiting and being involved in peoples’ care. All comments received from healthcare professionals’ surveys returned prior to inspection, indicated that they felt that the home sought advice and acted upon it appropriately in managing and improving peoples’ healthcare needs. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 11 Medicine handling, administration and recording are well managed, with all staff appropriately trained and regular medicine audits carried out. People wishing to self-administer their medicines can do so following a risk assessment process, although all medicines were administered by the home at the time of the visit. Staff were observed to be compassionate and caring in their interactions with people living at the home and clearly well aware of individuals’ needs. Challenging behaviour was well managed, with patience and humour from staff appropriately used to care for a person’s needs. Comments received in staff surveys stated that they tried “to provide high standards of care whilst keeping a homely atmosphere” and had a “flexible and individual approach” to each person living there. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a range of activities and social events planned by the home, which meet the residents’ social, recreational and religious needs. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. A good choice of food is available, which provides a balanced diet and the individual needs of the residents are well catered for. EVIDENCE: High Trees offers a weekly programme of social and recreational activities and ensures that time is also spent with individuals who are unable or reluctant to join in with group activities. Staff were observed engaging with people during the morning of the visit, whilst a reflexologist was also giving treatments to those who had chosen to have one. One staff survey received commented that they felt the home now offered an “improved level of activities and outings”. All 3 healthcare professionals who replied to surveys felt that the home supported individual’s to live the life they choose to and that they responded well to the different needs of people living at High Trees. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 13 Visitors are warmly received and able to visit when they choose, with some arriving and taking people who live there out during the inspection. The menu varies with most meals homemade in the kitchen. Lunch on the day of the visit was chilli con carne and fruit pudding with custard, although alternatives were available. People appeared to enjoy lunch and most stayed in the main lounge area, where staff assisted them as needed, or otherwise ate in their room. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are procedures in place to ensure that complaints are fully investigated and residents and relatives can be sure that their concerns will be listened to and acted upon. Adult protection policies are in place, in order to safeguard residents from potential abuse and harm and staff receive appropriate training. EVIDENCE: The Commission or the home has received no complaints since the last inspection and an appropriate complaints policy and procedure is in place to deal with any. The home keeps the complaints/suggestions book in the foyer where it is accessible to everyone, however it was discussed that whilst being a very transparent practice, any details within the book must not breach individuals’ confidentiality. Three safeguarding referrals have been raised since the last inspection and both investigations closed following appropriate actions taken and recommendations made. Staff receive training in safeguarding and were clear in their understanding of it when discussed with them. Of the 3 healthcare professionals that answered the surveys, 2 felt that the home had responded appropriately if concerns had been raised about the care of a person. One felt that they could not comment, as they had not been involved in any referrals at this home. All 3 people living at High Trees, who responded to the surveys, stated that they ‘never’ knew who to speak to if High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 15 they were unhappy or wanted to make a complaint and 2 said they were ‘unsure’ how to make a complaint. However, comments indicated that they would speak to staff about any concerns they had and the complaints procedure is well displayed in the home, on the wall and in the service users guide. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 16 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): 19,21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. High Trees provides residents with a comfortable, safe and well-maintained place to live, which is clean and free from any offensive odours. EVIDENCE: A tour of the premises found the home clean, tidy and well maintained with maintenance work on going. Carpentry work was taking place during the visit, as all fire doors were being replaced; however this was not causing people any disruption. Several areas have been refurbished since the last inspection including the provision of a new cloakroom and a shower/wet room installed to replace the assisted bath, both on the ground floor and the upgrading of 2 bedrooms. The upstairs bathroom was under refurbishment at the time of the visit and all bedrooms displayed nameplates for the occupants. The AQAA submitted prior to the inspection detailed quite substantial improvements that had been made to High Trees environment and any further plans for this. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 17 Throughout the visit, there was a calm, peaceful atmosphere in the home with pleasant music being played in the lounge. The laundry continues to be well managed and there was evidence of good infection control procedures around the home, with staff observed appropriately using gloves and aprons and washing their hands. All staff have also received appropriate infection control training. Surveys received from 3 people living at the home indicated that 2 thought the home was ‘always’ fresh and clean, whilst 1 said ‘sometimes’. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that there are sufficient staff members on duty at all times. Significant improvements have been made in the appropriate recruitment and training of staff, ensuring that residents will be competently cared for and protected, however this must be an on going process. EVIDENCE: Sufficient staffing levels are provided to ensure that all peoples’ assessed needs can be met whilst living at High Trees. Of the 4 staff surveys returned 3 stated that they felt there were ‘always’ enough staff to meet the needs of people living at the home. 1 said that this was the case ‘usually’ but indicated that occasional staff sickness was the reason for this. Resident surveys indicated that 1 out of 3 respondents felt that staff were ‘always’ available when they needed them, with 2 stating ‘sometimes’, commenting that “mornings a problem”. The recruitment files of 3 staff were looked at and found to contain all the required documentation, including 2 references and evidence of identity. Criminal Record Bureau (CRB) disclosures were also present in the files and had been obtained prior to starting work. It was discussed that although interview records were very well kept, improvements could be made regarding obtaining fuller employment histories, as required by regulation. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 19 The home has a good induction process in place and all staff have either achieved or are working towards a minimum of NVQ level 2 in care. Significant improvements have been made in relation to provision of staff training and developing an on going programme of updates as needed. Although not all staff had received all mandatory training at the time of the visit, the Registered Manager was working hard to address this and all required training had been booked in. 4 staff surveys received showed that all staff felt they received training which was relevant to their role, up to date and addressed the individual needs of residents. They all also felt that their induction had ‘mostly’ covered everything they needed to know to do the job when they started. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a registered manager in place to ensure that the home is safely managed, well organised and run in the best interests of residents and a developing quality assurance system, which is based on the views of residents. Practices in the home ensure that the health, safety and welfare of all are promoted and protected. EVIDENCE: The home has recruited a suitable manager, Celine Stompedissel, since the last inspection, who has subsequently been registered with the Commission in November 2008. She demonstrated efficiency and competency throughout the inspection and has worked hard to address any shortfalls that were identified in the last report. It is clear that huge improvements and benefits to the running of High Trees and in the interests of both residents and staff have High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 21 been achieved by having a dedicated Registered Manager in post. Comments received from staff indicated that they felt the home had improved since the manager had joined the team and felt that she was approachable and “hands on”. The home has good systems in place for internal audit quality assurance monitoring, including medicines audits, residents and staff meetings and residents surveys. A completed Annual Quality Assurance Assessment (AQAA) was also submitted to the Commission as required, prior to the visit. This identified what they do well, what they have improved during the past 12 months and their plans for improvement over the next 12 months. The registered providers are also looking at using ‘Investors in People’ and have had an initial report completed from them. The home does not manage the finances of any residents and all aspects of health and safety looked at were well managed. Equipment is routinely tested and maintenance certificates seen were up to date. Some recommendations made by Dorset Fire and Rescue service, regarding the provision of accommodation in the upper flat for a resident, were being implemented. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 22 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 3 10 3 11 X 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 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP30 OP29 Good Practice Recommendations Staff members need to be trained sufficiently to ensure that residents are in safe hands. Employment histories of prospective staff need to be documented in greater detail so the home can assure themselves that only suitable people are employed. High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN 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 High Trees Nursing Home DS0000059925.V374266.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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