Care Home: Plane Tree Court Care Village

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What the care home does well We found that the manager ensured that peoples needs were assessed before they moved into Plane Tree Court, so that effective plans could be made to meet their needs. We found that the manager has responded to the findings of the previous inspection and made changes that are described in the next section. This has improved the outcomes for people living in the home. People at Plane Tree Court are protected from abuse through staff who understand what to report and how to behave toward vulnerable people. We found that the complaints procedure was fair and open and that people were listened to. We found that people living at Plane Tree Court are treated with dignity and respect. They told us: `The staff really do listen to you.` And families found: `The staff are absolutely lovely, very nice, lovely. He likes it he is very happy.` And What has improved since the last inspection? Since the previous inspection, the manager has made sure that staff keep a clear and detailed record of everything they do concerning personal and health care, so that it can be confirmed that people are receiving the support and care they need. People using the service said: `If you have a cold or anything they look after you.` And `Very prompt if anyone takes ill.` Since the previous inspection, the manager has made sure that medications are kept at their recommended temperature so that they retain their therapeutic properties. Since the last inspection, people living at Plane Tree Court are able to live the lifestyle they would like and have frequent opportunities to participate in activities and events that they find interesting, stimulating and, therefore, enjoyable. Since the previous inspection, more care is taken to ensure that peoples specialist nutritional requirements are catered for. Since the previous inspection, signs have been put up around the home to make the corridors less confusing and help people to know where their rooms are and to identify toilets and bathrooms. Since the previous inspection, staff have received statutory training and updates in moving and handling, health and safety, infection control and medication handling. Since the previous inspection, clear evidence has been produced to show that peoples concerns are listened to and that they have been given opportunities to comment about the quality of the service provided at Plane Tree Court. We were told: `I definitely think this manager would listen to any concerns.` And: `The current manager is a lot better he seems to be doing more.` What the care home could do better: The registered person should ensure that the dates on the medication record sheets are sequential from one month to the next and that staff are mindful of the different number of days in each month. This will help to ensure that people receive medication as prescribed and prevent errors in the administration of medication that is to be given at intervals. The registered person should ensure that all the people who use the service have their interests recorded so that the variety of activities offered, can be improved even further. The registered provider should ensure that at least 50% of care staff achieve the National Vocational Qualification in care level 2 or an equivalent qualification. This is to ensure that staff have, the knowledge and understanding required to enable them to carry out their basic duties, and also, a good foundation than can be built on in relation to more specialist areas. The registered person needs to make sure that staff receive specialist training in pressure area care, nutritional screen and diabetes care so that they have up-to-date information about how to work with people at risk in relation to these areas. This was previously a requirement and has not been fully achieved. Although, at this inspection we found that peoples needs were been met in these areas the training would be an advantage to staff and people using the service. The registered person must ensure that a person is put forward to complete the CQC Registered Managers process. This is to demonstrate stability and promote continuity in the management of the home which will sustain and build on the improvements identified at this key inspection. And will confirm that the current manager has the competencies, abilities and integrity to run a Registered Care Home. The registered person should ensure that the records of monies managed on behalf of people living at Plane Tree Court is 100% accurate and audited so people are completely protected from financial abuse. Key inspection report Care homes for older people Name: Address: Plane Tree Court Care Village 11 St. Lesmo Road Edgeley Stockport Cheshire SK3 0TX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Haller     Date: 0 5 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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. 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 Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Plane Tree Court Care Village 11 St. Lesmo Road Edgeley Stockport Cheshire SK3 0TX 01614806919 01612863175 richard.lake@opulenthomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Altruistic Care Limited care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP Physical disability - Code PD The maximum number of people who can be accommodated is: 66 Date of last inspection Brief description of the care home Plane Tree Court is a large, detached building set in its own grounds in Edgeley, a suburb of Stockport. There are local amenities situated close by. Altruistic Care Limited owns the care home. The directors of the company are Mr and Mrs Jivraj. The care home has a passenger lift to assist service users to mobilise to the upper Care Homes for Older People Page 4 of 33 Over 65 66 0 0 66 0 4 1 1 2 0 0 9 Brief description of the care home floors. Lounge and dining areas are situated on the ground floor with an additional lounge and dining rooms on the first floor. The home accommodate a maximum of 66 people. The fees for staying at the home vary from £350 to £900 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this key inspection without informing the manager before hand and we looked at all of the most important or key Care Homes for Older people National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service since the previous key inspection in November 2009. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We spent time at Plane Tree Court, talked to people living at the home and their relatives, and interviewed three members of staff and talked to the manager and the administration worker. We received one Care Quality Commission survey from a member of staff. Care Homes for Older People Page 6 of 33 We checked through written information, including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the service. During the inspection period Daren Wills the manager assisted. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Since the previous inspection, the manager has made sure that staff keep a clear and detailed record of everything they do concerning personal and health care, so that it can be confirmed that people are receiving the support and care they need. People using the service said: If you have a cold or anything they look after you. And Very prompt if anyone takes ill. Since the previous inspection, the manager has made sure that medications are kept at their recommended temperature so that they retain their therapeutic properties. Since the last inspection, people living at Plane Tree Court are able to live the lifestyle they would like and have frequent opportunities to participate in activities and events that they find interesting, stimulating and, therefore, enjoyable. Since the previous inspection, more care is taken to ensure that peoples specialist nutritional requirements are catered for. Since the previous inspection, signs have been put up around the home to make the corridors less confusing and help people to know where their rooms are and to identify toilets and bathrooms. Care Homes for Older People Page 8 of 33 Since the previous inspection, staff have received statutory training and updates in moving and handling, health and safety, infection control and medication handling. Since the previous inspection, clear evidence has been produced to show that peoples concerns are listened to and that they have been given opportunities to comment about the quality of the service provided at Plane Tree Court. We were told: I definitely think this manager would listen to any concerns. And: The current manager is a lot better he seems to be doing more. What they could do better: The registered person should ensure that the dates on the medication record sheets are sequential from one month to the next and that staff are mindful of the different number of days in each month. This will help to ensure that people receive medication as prescribed and prevent errors in the administration of medication that is to be given at intervals. The registered person should ensure that all the people who use the service have their interests recorded so that the variety of activities offered, can be improved even further. The registered provider should ensure that at least 50 of care staff achieve the National Vocational Qualification in care level 2 or an equivalent qualification. This is to ensure that staff have, the knowledge and understanding required to enable them to carry out their basic duties, and also, a good foundation than can be built on in relation to more specialist areas. The registered person needs to make sure that staff receive specialist training in pressure area care, nutritional screen and diabetes care so that they have up-to-date information about how to work with people at risk in relation to these areas. This was previously a requirement and has not been fully achieved. Although, at this inspection we found that peoples needs were been met in these areas the training would be an advantage to staff and people using the service. The registered person must ensure that a person is put forward to complete the CQC Registered Managers process. This is to demonstrate stability and promote continuity in the management of the home which will sustain and build on the improvements identified at this key inspection. And will confirm that the current manager has the competencies, abilities and integrity to run a Registered Care Home. The registered person should ensure that the records of monies managed on behalf of people living at Plane Tree Court is 100 accurate and audited so people are completely protected from financial abuse. Care Homes for Older People Page 9 of 33 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. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Plane Tree Court have their well-being promoted because they are admitted following a detailed assessment, and so the staff can be prepared to meet their needs. Evidence: We looked that the assessment information for the most recent admission to Plane Tree Court. We found that their needs had been fully assessed and planned for and that this information had been updated and extended since admission. We found that the assessment provided information about peoples needs in relation to their personal and physical wellbeing; diet and weight management; sensory needs such as hearing and sight; oral health; mobility; medication; mood and mental health; family involvement and social interests and hobbies. We found that risk assessments were conducted in relation to the development of Care Homes for Older People Page 12 of 33 Evidence: pressure sores; falls; malnutrition or other risk areas identified during the assessment process. We saw that detailed plans were put in place to mitigate or reduce these risks. For example staff were informed that a person required one persons support while they used a walking aid to mobilise. The member of staff who returned the survey stated that they were always provided with enough information to meet peoples needs. We discussed the admission process with the manager. He informed us that the home was currently admitting one person each week. He informed us that where possible peoples needs would be assessed by a member of qualified staff prior to their admission and opportunities given to them and their families to visit the home. Plane Tree Courts Statement of Purpose (a booklet that describes how the home completes it work) states: The Registered manager or one of our team will visit you in your home, or hospital if necessary and will document preadmission assessment with you. People living at the home told us that: The manager visited us and my daughter came to the home to see if we might like it. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Plane Tree Court have their health and personal care needs met to a standard that promotes continued good health and a sense of wellbeing. Evidence: We examined four care files and other records and correspondence about the care and support that people living at Plane Tree Court currently received. At the previous inspection we found that care plans did not address all the needs identified at assessment, and that they did not provide enough information for staff follow with respect of what they must do to meet any needs identified. At this inspection we saw that each person had a detailed care plan that instructed staff about how to meet the needs identified during the assessment or reassessment. We noted that these care plans were reviewed and updated on a monthly basis to reflect any changes in a persons needs. We found that there were specialist care plans that informed staff about the actions they must take in relation pressure area care, PEG (when a person receives all Care Homes for Older People Page 14 of 33 Evidence: nourishment through a tube directly into stomach) feeding; mouth care and diabetic care. We found through the records kept by staff and through what people told us that most health care needs were been met in keeping with best practise in these areas such as diabetic care, falls prevention, continence care and maintaining a healthy weight and good nutritional state. We saw that people were supported to maintain oral hygiene and that a specialist care plan was put in place for people who could not do this for themselves. We noted that this care plan was followed and effective in achieving a high level oral cleanliness and keeping people comfortable and free from oral infections. We noted that pressure area care was effective and that staff were able to recognise and deal with this issue promptly, therefore reducing the risk of developing pressure sores or ensuing that treatment is provided at the earliest sign of a problem. Body maps were used to show and describe areas of concern and what action needed to prevent the skin from breaking down. We found that people received routine check-ups with the dentist, opticians and general practitioners. We noted that people were supported to attend out outpatient appointments. We noted that two people commented that they had not received the chiropody care that they felt was needed. We discussed this with the manager who stated that a private chiropodist attended to people living at Plane Tree Court and he would ensure that everyone who wanted this service received it. We observed the interaction between, people living in the home, the staff and visitors. We saw that people looked relaxed and content. We noted that people were neat and well-groomed, peoples hair was neat and tidy and the gentleman shaved and neat, each person wearing a choice of their own belongings. We found that personal care matters were dealt with discreetly. We saw that staff talked to people in an caring manner and offered people choices. We looked at the daily records compiled by the care staff and these were written in respectful way. They provided detailed information about what had happened for a person at different intervals throughout the day. These confirmed that people were supported to attend to personal care needs and maintain their independence. Care Homes for Older People Page 15 of 33 Evidence: Staff enable people to do things for themselves and one person wrote: ..did most things herself this morning she just needed help with her bra. We found that staff had a good understanding about where to get information about peoples needs and how to show dignity and respect. A staff member told us: We must ask people what they want to wear, what they want to do, we must give choices in how they want to look- some like bright clothes we must try to keep things normal for people. On the day of inspection a pharmacy inspection was been undertaken by the pharmacist who supplies the home with medication. At the previous inspection we found that medication was not been kept at the correct temperature. At this inspection we found that the medication is now kept in larger room and daily temperature checks are kept to ensure that medication the temperature is correct. At the previous inspection we found that at times medication ran out and so people did not receive their medication as prescribed. At this inspection we found that the manager has a means of auditing medication and that additional medication training has been given. We looked at the medication record sheets and found that in the main medication was given as prescribed and there were no gaps in medication caused by lack of medication availability. We noted that a medication error was made that have resulted in medication running out before the expected date. This error did not put the person at risk, however it highlighted an area for improvement in relation to dating and carrying forward instructions about medication from one months medication record sheet to the next months. This matter was brought to the attention of the manager. Apart from two comments concerning the need for a chiropodist, people living at Plane Tree Court were satisfied with the personal and health care they received at the home. They told us: I cant wish for better care, the opticians came to check my eyes. And pretty well always and a nurse on duty as well- they are very prompt if anyone takes ill. Care Homes for Older People Page 16 of 33 Evidence: And relatives commented: His hair looks done, he has had his eyes treated here. Theyve looked after him wonderfully. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Plane Tree Court benefit from having access to a varied lifestyle, including activities, social contact, community presence and diet and meals that meet their individual needs and preference. Evidence: We found through talking to people, looking at the activities calender and reports made by staff that people living at Plane Tree Court have the opportunity to participate in a variety of meaningful activities that keep them stimulated, interested in the world around them and which meets their cultural and social needs. The calender indicated and the residents confirmed that activities took place at different venues including in the local community. The activities calender indicated that these included: games including indoor bowls and tabletop games, discussion regarding current affairs, photographs and reminiscing, reading groups, drawing and sketching and theme days. The activities organiser also widens peoples experiences by arranging opportunities for people to try alternative therapies such as Reiki and relaxation sessions. The activities organiser also arranges opportunities for Christian worship within the home. People living at Plane Tree Court also have opportunities to enjoy activities in the local community. This includes attending a weekly tea dance, Care Homes for Older People Page 18 of 33 Evidence: going shopping at the local supermarket, pub and restaurant lunches and other excursions. We found that there was some information about peoples hobbies, work experiences and family history and this was detailed in the case of a recent admission. We saw that this information was added to as the activities coordinator got to know the person. Currently the care plans and service user profiles are been updated. We were informed by the manager that it is planned for peoples relatives to contribute personal profiles. We talked to care-staff about their role in supporting people to arrange and participate in activities. We were informed that the activities co-ordinator works alternate weekends and that people develop friendships and networks that sustain them over the weekend. We were also informed that weekends was a busy time for people because that was when most received visitors. We found that people were able to receive visitors when they wished and in privacy. Families are able to go out with their relatives and spend as much time in the home as they liked. We saw that people were able to make choices about how they lived at Plane Tree Court. We found that people were able to choose what they wanted fro breakfast and were offered choices for their meals at lunch time and teatime. We saw that the menu was varied and provided traditional meals that met the needs of the people living at the home. We discussed the menus with the chef who was on duty. He told us that he had National Vocational Qualification Level 2 in Catering. We were informed that the routine of the home was to ask people to make their meal choice each morning, however, extra portions of each meal was made in case people changed their mind. The meal choice on the day of the inspection was fish in batter or steak pudding, chips and peas. Dessert was rice pudding. The tea time choice was cheese and tomato quiche or sandwiches and soup. We observed the meal time and the food looked appetising and people seemed to complete and enjoy their meals. We saw that staff keep a detailed and accurate record of the food and drink consumed by people living at the home. This is good because it means that peoples nutritional state can be monitored and steps taken and referrals made to resolve any problems. People on special diets such as diabetic diets or soft diets are provided with a choice of Care Homes for Older People Page 19 of 33 Evidence: the correct meals. People who commented about the lifestyle experienced at Plane Tree Court told us: The food is alright- food tastes good and theres a lot of it-If I was on my own I wouldnt be feeding like this. My family come 2 or 3 times a week. We have an entertainments manager we have a laugh. The activities are good- we join in all the activities and we go out - usually go for a tea dance at the town hall, we go the Salvation Army and the town centre shopping. Relatives come when they like. The food is good but Ive not got a good appetite at the ,moment. The nurse makes sure that I always have water or drinks so that I wont get dehydrated. And Hes quite happy, hes had a couple of trips out and all his food is pureed- hes put weight on. He likes the activities coordinator who takes him out. He goes to the salvation army, they go to Castle Street shopping and they go to Mickelbrook pub and sit outside if the weather is right. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Plane Tree Court have access to a clear complaints procedure and there are systems in place that promote their continued safety. Evidence: We found that since the previous inspection the service has rewritten its complaints procedure. We read through this document and assess that it is simple ands clear and states the timescales by which certain stages will be reached. The information indicates that people will have a response within 24 hours of the complaint been lodged and a final reply and outcome within 28 days if possible. The complaints policy also states that if a complaint is upheld the complainant will be informed of any changes that may take place as result of the findings. The complaints policy also provides the contact details of the local social services, primary care trust and Care Quality Commission. We discussed the management of complaints and was informed by the manager that these were now looked at on monthly basis and an update was also published monthly. We looked at the latest new letter and it stated that there had not been any complaints for February 2010, however there was comprehensive list of suggestions made by people living in the service and their friends and relatives. We saw that a response to each suggestion had been made by the management team of Plane Tree Court. Care Homes for Older People Page 21 of 33 Evidence: The newsletter also highlighted compliments that were made. The home operates a safeguarding adult policy that is in keeping with that required by the local authority, health service and other statutory bodies. We found that a resume of this policy is presented in the homes service user guide which is provided to people using the service. We looked at staff training records and found that all staff had received protection of vulnerable training within the previous year. We talked to staff about this training and whether it had changed their attitude. The care staff felt that this strengthened her views about dignity and respect. We discussed incidents between residents and she said that she had never witnessed any untoward incidents but if she did she would intercede, make a recorded and reported it to the senior on duty. We saw from the daily records that if people were upset staff would check out what was worrying them and try and resolve any problems. We talked to the cook on duty about his understanding of protecting vulnerable adults- he said that it was important to provide people with the correct diet especially specialist diets such as soft diet or diabetic diet. At the time of this inspection there were no new safeguarding adult investigations been undertaken at Plane Tree Court. The manager informed us that senior staff have completed Mental Capacity and Deprivation of Liberty Training. He stated that none of the current people living at the service had aspects of their care managed under these guidelines. People who use the service were confident that it they has concern they would be listed to and taken seriously. They told us: If I was unhappy I would talk to Daren and he would listen- never known him to ignore me yet- but never had a complaint. And I definitely feel this manager would listen to any concerns. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We found that people living at Plane Tree Court have access to accommodation that is clean, comfortable and well-maintained. Evidence: The approach and gardens at Plane Tree Court is very pleasant and there are ample parking areas. There is a large inner court yard that some bedrooms open onto. We conducted a tour of the communal areas and some of the private areas of the home. We found that all areas appeared clean. We noted that useful temporary signage has been put in place to assist with orientating people around the home. The manager stated that there were plans to install permanent signage around the home and also to personalise peoples front doors using memory boxes and or colour. He also said that he was considering how to use colour around the home to reduce confusion in references to the different corridors that all look the same. We noted that people were able to move around the home independently using the equipment and adaptations provided. At the previous inspection in November we found that the laundry operated in keeping Care Homes for Older People Page 23 of 33 Evidence: with the regulations. At that inspection we also found that there had been recommendations made in relation to kitchen hygiene. At this inspection we were informed that these issues had been addressed. The manager has initiated a new cleaning roster that imposed an increase in the frequency of deep cleaning of the kitchen. We found, through information in the minutes from the staff meeting, that the kitchen staff were also now responsible for maintaining the cleanliness of the satellite kitchen on the unit. We were informed that all kitchen and domestic staff had received food hygiene and infection control training. We noted that different coloured aprons were now in use to differentiate between when staff were dealing with personal hygiene and food. There was liquid soap and paper towels in each toilet. We found that the manager treated rules and guidance around infection control and maintaining hygiene around the home seriously. We noted that he reminded staff of their responsibilities at the team meetings. With respect to cleanliness people living at Plane Tree Court told us: Yes the home is clean youd go a long way to find cleaner. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at Plane Tree Court are supported by staff who are employed using an effective recruitment and selection process, however care staff have not been supported to achieve the required National Vocational Qualification. Evidence: We looked at the staff recruitment and supervision records for three members of staff and we also interviewed three staff members about their experience of working at Plane Tree Court. Each file we looked at held a copy of the original application form, confirmation of two references, Criminal Record Bureau disclosure requests and protection of vulnerable adults references. We also noted confirmation of address through bank statements. We found that the application form does not allow the applicant to provide all the information necessary for the manager to make an initial judgement about the persons suitability for the post. We found that the forms need to request information about the start and end date for periods of employment and training so that gaps in the dates can be easily identified. We also found that the forms need to request information about the persons experience, philosophy and plans in relation to the post they have applied for. There were no interview notes and so it was not possible to gauge whether people were interviewed and employed in accordance with equality and Care Homes for Older People Page 25 of 33 Evidence: diversity guidelines. Currently the newly appointed manager is updating the recruitment and selection process. He has introduced a more detailed application form and has plans to use a different system of induction for new recruits. This new system will continue to meet the competencies recommended by the Skills for Care organisation and includes the completion of a workbook. We were informed that the current staff compliment is 2 carers supporting 16 service users on the residential care level with the manager distributing medication. And 2 nurses, with 1 carer to five people on the nursing level. We were informed that at night the staff compliment was 1 nurse and 5 carers for both units. In addition to this, domestic staff, an activities co-ordinator and 4 kitchen staff are also employed. People we talked to felt that there was always enough staff on duty and commented: They come as soon as I call them, as soon as I press the button. At the previous inspection we found that staff had not received all the training necessary for them to do their jobs. We found at this inspection that training had increased and more training opportunities were on offer. We found, through examining the training calender, that since the previous inspection in November 2009 the majority of staff have received the following training: Protection of Vulnerable adults; Infection Control; moving and handling; care planning; Control of substances hazardous to health (COSHH) and using a key worker system of care. All staff were also up-to-date in relation to Food Handling; fire-safety training; First Aid; Health and safety; the Mental Capacity Act and medication training. According to the training matrix staff need additional skin care training as only two members of staff have completed this course, and this was in 2008. We also found that no staff had completed diabetic awareness training, this would be of benefit to staff who are working with people at Plane Tree Court who have this condition. The training matrix also highlighted that five care staff out of approximately 30 had achieved National Vocational Qualification (NVQ) in level 2 in Care. The expected staff ratio for this qualification is 50 . The manager informed us that he was in discussion with a training company to source NVQ training for himself and staff. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Plane Tree Court currently benefit from the effective day to management of the home, and the required financial auditing and health and safety systems are in place. Evidence: Since the previous key inspection in November a new manager has been employed at Plane Tree Court. We found that he has completed the Registered Manager Award Training and is attempting to commence NVQ level 5 in management. The manager has more than 2 years experience of managing social care establishments. We have found that manager has made a number of positive changes since taking up post. These includes introducing a new Care Plan format and daily record sheets. He has initiated staff meetings, residents meeting and ensured the production of newsletters and other publications to inform the residents and their relatives about what is happening at Plane Tree Court. Care Homes for Older People Page 27 of 33 Evidence: The manager has initiated a program of training and supervising for staff that has helped to skill them up and help them to understand the importance of completing each task to high standard. This is the fourth manager to be employed in the home during 2009 and so the management at Plane Tree Court has been ineffective and resulted in the home receiving a poor rating at the last Key Inspection. The new manager took up post on 4th December 2009 and has not yet began the process of becoming registered with Care Quality Commission. We remain concerned about the sustainability of the improvements that have been brought about by this manager should they leave and fail to become the registered manager. The home has employed an administrator to deal with the organisation of some aspects of the running of the home such as producing and updating the staff training matrix, dealing with finances, monitoring complaints and developing the news letters. This person is, for the most part, competent and efficient in completing these tasks. People we talked to had a high regard for the manager and comments included: The current manager is a lot better- he seems to be doing more. The manager has introduced a number of quality assurance systems. He has devised a questionnaire for relatives, people living at the home and other stakeholders such as social workers and nurses. He has initiated the development of a residents group and he has introduced a comments book that is kept at the entrance to the home by the signing in book. People told us that they found the relatives group useful, saying: Yes I have been to a couple of relative meetings- they are informative, they let you know whats going on and what theyre going to do- I feel I am able to make suggestions- I havent, though others have. We looked at the minutes of these meetings and found the information was reflected in the News Letter distributed for everyone. We noted that this information prompted action and changes in the home. For example, a discussion would be had with night staff about how they could answer the phones promptly at night, and the television reception in a number of rooms was very poor and the manager arranged for this to be addressed. The complaints, concerns and compliment report also acted as a quality assurance tool because peoples opinions both positive and negative were brought to the attention of Care Homes for Older People Page 28 of 33 Evidence: everyone dealing with home. And people could see how problems were solved and strengths built upon. We found that peoples finances were monitored by the home. We found that there were very minor discrepancies in some of the audit information, however people have free and ready access to their finance and receipts and a full audit trail is kept toe protect people form financial exploitation. We checked the maintenance records for the lift, moving and handling equipment, fire safety equipment and Landlords Gas Safety certificate. We found that all checks had been completed in accordance with the manufactures or regulating bodies instructions. We found that fire safety training fro staff was up to date and that a fire safety risk assessment had been completed, and this included an individual assessment for each service user who was ambulant. We found that all checks had been recorded as undertaken weekly. And a fire drill had been conducted on 19th February 2010. We noted that the Gas Safety certificate issued in October 2009 identified a problem with a flue. We discussed this with the registered owner. She informed us that the company who fitted the flue had also identified the problem and that this had been corrected at the time of the inspection. We advised the owner to get a new certificate issued as quickly as possible and this was achieved within a week of the site visit for this inspection. We noted that health and safety signs such as hand-washing guidance were strategically placed throughout the home. We looked at the accident record and found that these were recorded in detail. We found that these were carefully analysed to identify and deal with any patterns. We found that were three falls recorded in February 2010. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 31 8 The registered person must ensure that a person is put forward to complete the CQC Registered Managers process. This is to demonstrate stability and promote continuity in the management of the home which will sustain and build on the improvements identified at this key inspection. And will confirm that the current manager has the competencies, abilities and integrity to run a Registered Care Home. 11/06/2010 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 1 10 The registered person should ensure that the dates on the medication record sheets are sequential from one month to the next and that staff are mindful of the different number Page 31 of 33 Care Homes for Older People 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 of days in each month. This will help to ensure that people receive medication as prescribed and prevent errors in the administration of medication that is to be given at intervals. 2 12 The registered person should ensure that all the people who use the service have their interest recorded so that the variety of activities offered, can be improved even further. The registered person needs to make sure that staff receive specialist training in pressure area care, nutritional screen and diabetes care so that they have up-to-date information about how to work with people at risk in relation to these areas. This was previously a requirement and has not been fully achieved. The registered provider should ensure that at least 50 of care staff achieve the National Vocational Qualification in care level 2 or an equivalent qualification. This is to ensure that staff have, the knowledge and understanding required to enable them to carry out their basic duties, and also, a good foundation than can be built on in relation to more specialist areas. The registered person should ensure that the records of monies managed on behalf of people living at Plane Tree Court is 100 accurate and audited so people are completely protected from financial abuse. 3 27 4 28 5 34 Care Homes for Older People Page 32 of 33 Helpline: 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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