Care Home: Tall Trees Nursing Home

What the care home does well The Regional Director and Support Manager from another Lanemile Ltd service have been managing Tall Trees, in the absence of the manager and deputy. They confirmed both, the Registered Manager and the deputy have resigned their positions. The Regional Director confirmed investigations found their conduct was related to management issues and did not relate to any safeguarding concerns. Both managers were able to resign without being placed on the Protection of Vulnerable Adults (POVA) list. Time was spent talking with a clinical nurse employed in another Lanemile Ltd service, who has been seconded to look at clinical issues and medication. They have been reviewing practice in the home with a view to setting up a local policy for reviewing peoples care and medication. They have been in consultation with the General Practitioners (GP) associated with the home, a co-ordinator from the Mental Health Team and a Dementia Consultant. They are planning to arrange monthly reviews to reassess all of the residents medical needs. The Regional Director confirmed they are in the process of arranging a meeting with residents and relatives to update them on the management situation in the home. They are also in the process of changing the staffing structure, implementing clinical head and senior staff on each unit, to provide more leadership and direction to the staff team and to relieve some of the pressures on the nurses. Discussion with staff, residents and relatives confirmed their had been an improvement in the morale and atmosphere recently in the home. Relatives commented, "my relative has recently moved into the home, it is an improvement to the previous home, I have no complaints, they are eating well and being looked after properly and their general well being has improved" and "I am generally happy with the care of my relative, I am now being involved in a review of their care plan, I feel my relative is well cared for and settled, the staff are really nice and the atmosphere is much improved, however it would be nice to have a permanent managers presence. What the care home could do better: The pharmacist inspector examined practices and procedures for the safe handling, administration and recording of medication. On arrival a number of residents were being given their medication in the lounge/dining area on Rowan Unit. The nurse was seen to adminster medication to residents with regard to their personal choice but the record made when medication is given was seen to be signed for one resident some time after the medication was given and after medication had also been given to other residents. The nurse explained that this was due to interruptions while she was doing the medication. The signing of medication records some time after medication is given is unacceptable practice. When people allow themselves to be interrupted during this process then this increases the risk of medication error. Medication record forms and medication in use were examined for a number of residents on both floors of the home. There were some worrying discrepancies in the medication records giving no clear indication of whether medication has been given or not. When it was not given, no clear records were made of the reasons for the omissions and when medication is given in variable doses, e.g. one or two tablets, the actual number given is not always recorded. This could result in people receiving too much or too little medication for their needs. The requirement made on the last inspection that medication is properly administered and clear records are kept has not been met. This has been repeated on a number of occasions since October 2006. These shortfalls identified continued breach in regulation, therefore the providers have been issued with a Statutory Requirement Notice (SRN) on 23rd December 2008 to make the necessary improvements by 12th January 2009. During our visit we looked at the staff roster, which reflects the established staffing ratio is four carers and one qualified member of staff allocated during the waking hours on each unit, with three carers and two qualified staff covering the home at night. Examination of rotas identified that staffing levels are not always consistent with the established ratio. Inspection of rotas for the weeks commencing 24th November 2008 and 1st December 2008 confirmed staffing levels fell below these numbers, especially at weekends. Staffing levels were noted to be of particular concern on the weekend of 6th and 7th December, where there the rota showed two care staff, instead of three worked the night shift. On the Sunday 7th December, six care staff were on duty in the morning and five in the afternoon between both units. This was confirmed in discussion with staff and relatives. Staff confirmed when they have a full compliment of staff, there are sufficient staff to meet the residents needs, however staffing levels had deteriorated over the past weeks. Annual leave and sickness have caused problems. Staff confirmed staffing at weekends is a particular problem and that they are able to call agency and bank staff, however currently they only have one bank staff and agency are not always able to cover shifts, at short notice. Staff also commented that the needs of the people living in the home have increased, with a high proportion requiring staff to double up to meet moving and handling needs and at least 90% people require assistance to eat their meals.Whilst touring the home, residents were observed sitting in lounges unoccupied, for most parts of the day. Staff commented that there used to be two activity coordinators, one has recently left and has not yet been replaced. They commented the activities co-ordinator does have one to one sessions with residents, but it is difficult to ensure all residents are occupied. Additionally, staff were observed still supporting people with their personal care and to get up at 12.20am. Staff confirmed this is usual even when they have a full staff compliment, it can be as late as 11.30 before all residents are up for the day. The Regional Director was left an immediate requirement to ensure that the set staffing levels of four carers and one qualified nurse on each unit are maintained at all times. This will ensure there is sufficient staff available to meet the assessed needs of the people using the service. One of the concerns raised by the anonymous caller related to staff working long hours. Three staff files were examined, these reflected all the documents required under regulation had been obtained prior to the individual commencing employment, which protects the people living in the home from people who are unsuitable to work with vulnerable adults. Information in the staffs terms and conditions of employment reflected their contractual hours ranged from 36 to 48 hours per week. These peoples hours matched against the rotas reflected staff are not working excessively long hours. Where staff had undertaken extra shifts they confirmed, this had been their choice. One member of staff contracted to work 48 hours had worked a t Inspecting for better lives Random inspection report Care homes for older people Name: Address: Tall Trees Nursing Home Oaks Place Mile End Road Colchester Essex CO4 5XR one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Deborah Kerr Date: 2 1 0 1 2 0 0 9 Information about the care home Name of care home: Address: Tall Trees Nursing Home Oaks Place Mile End Road Colchester Essex CO4 5XR 01206844425 01206855230 manager.talltrees@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lanemile Limited care home 48 Number of places (if applicable): Under 65 Over 65 24 3 24 3 dementia old age, not falling within any other category physical disability terminally ill Conditions of registration: 24 0 24 3 The total number of service users accommodated must not exceed 48 persons Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 4 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 24 persons) Care Homes for Older People Page 2 of 10 Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) Date of last inspection Brief description of the care home Lanemile Ltd is the proprietor of Tall Trees who are part of the Care UK group. Tall Trees is situated in the grounds of a private hospital, in Colchester. It is a modern, purpose built care home providing short and long term nursing care for up to 48 frail older people and dementia. It is set in attractive and secure gardens within walking distance of the town centre, railway station, pubs, shops and a church. The building has two floors, divided into two separate units. Rowan is on the ground floor and provides care for people with dementia. Aspen is on the first floor providing care to frail elderly people. The home is fully wheelchair accessible, with a passenger lift to the first floor. There are 40 single rooms and 4 double rooms. All double rooms have ensuite toilet facilities and all single rooms are fitted with their own hand washbasin. Fees charged by the home are between £600.00 to £713.00. This was the information provided at the time of the key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Care Homes for Older People Page 3 of 10 What we found: The last key inspection on 16th July 2008 identified over the past three years a history of non compliance to meet regulatory requirements for medication. Although it was noted that there had been some improvements made to the auditing of medication held and administered in the home and that staff had received further training, further medication errors were identified. An immediate requirement and a warning letter were issued to the providers. The reason for this random inspection, where Derek Brown, pharmacist inspector, accompanied me was to follow up on compliance with the action plan provided by the homes manager, following the issue of the immediate requirement and warning letter. Additionally, we (The Commission) were notified in October 2008 by the Regional Director for Tall Trees that the registered manager and deputy manager had been suspended, pending disciplinary investigations regarding their conduct. We also received an anonymous complaint in December 2008 raising concerns about lack of management in the home and staffing levels. We were told, the home is understaffed, staff are working long hours, appear overworked and residents were being left sitting alone, unoccupied and unstimulated. These issues were also looked at during this visit. What the care home does well: The Regional Director and Support Manager from another Lanemile Ltd service have been managing Tall Trees, in the absence of the manager and deputy. They confirmed both, the Registered Manager and the deputy have resigned their positions. The Regional Director confirmed investigations found their conduct was related to management issues and did not relate to any safeguarding concerns. Both managers were able to resign without being placed on the Protection of Vulnerable Adults (POVA) list. Time was spent talking with a clinical nurse employed in another Lanemile Ltd service, who has been seconded to look at clinical issues and medication. They have been reviewing practice in the home with a view to setting up a local policy for reviewing peoples care and medication. They have been in consultation with the General Practitioners (GP) associated with the home, a co-ordinator from the Mental Health Team and a Dementia Consultant. They are planning to arrange monthly reviews to reassess all of the residents medical needs. The Regional Director confirmed they are in the process of arranging a meeting with residents and relatives to update them on the management situation in the home. They are also in the process of changing the staffing structure, implementing clinical head and senior staff on each unit, to provide more leadership and direction to the staff team and to relieve some of the pressures on the nurses. Discussion with staff, residents and relatives confirmed their had been an improvement in the morale and atmosphere recently in the home. Relatives commented, my relative has recently moved into the home, it is an improvement to the previous home, I have no complaints, they are eating well and being looked after properly and their general well being has improved and I am generally happy with the care of my Care Homes for Older People Page 4 of 10 relative, I am now being involved in a review of their care plan, I feel my relative is well cared for and settled, the staff are really nice and the atmosphere is much improved, however it would be nice to have a permanent managers presence. What they could do better: The pharmacist inspector examined practices and procedures for the safe handling, administration and recording of medication. On arrival a number of residents were being given their medication in the lounge/dining area on Rowan Unit. The nurse was seen to adminster medication to residents with regard to their personal choice but the record made when medication is given was seen to be signed for one resident some time after the medication was given and after medication had also been given to other residents. The nurse explained that this was due to interruptions while she was doing the medication. The signing of medication records some time after medication is given is unacceptable practice. When people allow themselves to be interrupted during this process then this increases the risk of medication error. Medication record forms and medication in use were examined for a number of residents on both floors of the home. There were some worrying discrepancies in the medication records giving no clear indication of whether medication has been given or not. When it was not given, no clear records were made of the reasons for the omissions and when medication is given in variable doses, e.g. one or two tablets, the actual number given is not always recorded. This could result in people receiving too much or too little medication for their needs. The requirement made on the last inspection that medication is properly administered and clear records are kept has not been met. This has been repeated on a number of occasions since October 2006. These shortfalls identified continued breach in regulation, therefore the providers have been issued with a Statutory Requirement Notice (SRN) on 23rd December 2008 to make the necessary improvements by 12th January 2009. During our visit we looked at the staff roster, which reflects the established staffing ratio is four carers and one qualified member of staff allocated during the waking hours on each unit, with three carers and two qualified staff covering the home at night. Examination of rotas identified that staffing levels are not always consistent with the established ratio. Inspection of rotas for the weeks commencing 24th November 2008 and 1st December 2008 confirmed staffing levels fell below these numbers, especially at weekends. Staffing levels were noted to be of particular concern on the weekend of 6th and 7th December, where there the rota showed two care staff, instead of three worked the night shift. On the Sunday 7th December, six care staff were on duty in the morning and five in the afternoon between both units. This was confirmed in discussion with staff and relatives. Staff confirmed when they have a full compliment of staff, there are sufficient staff to meet the residents needs, however staffing levels had deteriorated over the past weeks. Annual leave and sickness have caused problems. Staff confirmed staffing at weekends is a particular problem and that they are able to call agency and bank staff, however currently they only have one bank staff and agency are not always able to cover shifts, at short notice. Staff also commented that the needs of the people living in the home have increased, with a high proportion requiring staff to double up to meet moving and handling needs and at least 90 people require assistance to eat their meals. Care Homes for Older People Page 5 of 10 Whilst touring the home, residents were observed sitting in lounges unoccupied, for most parts of the day. Staff commented that there used to be two activity coordinators, one has recently left and has not yet been replaced. They commented the activities co-ordinator does have one to one sessions with residents, but it is difficult to ensure all residents are occupied. Additionally, staff were observed still supporting people with their personal care and to get up at 12.20am. Staff confirmed this is usual even when they have a full staff compliment, it can be as late as 11.30 before all residents are up for the day. The Regional Director was left an immediate requirement to ensure that the set staffing levels of four carers and one qualified nurse on each unit are maintained at all times. This will ensure there is sufficient staff available to meet the assessed needs of the people using the service. One of the concerns raised by the anonymous caller related to staff working long hours. Three staff files were examined, these reflected all the documents required under regulation had been obtained prior to the individual commencing employment, which protects the people living in the home from people who are unsuitable to work with vulnerable adults. Information in the staffs terms and conditions of employment reflected their contractual hours ranged from 36 to 48 hours per week. These peoples hours matched against the rotas reflected staff are not working excessively long hours. Where staff had undertaken extra shifts they confirmed, this had been their choice. One member of staff contracted to work 48 hours had worked a total of 82.5 hours for the week beginning 1st December. They confirmed they had chosen to work these extra shifts, however management should monitor the hours staff work to ensure they are fit to perform their duties. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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 1 29 18 The regsitered provider must 26/01/2009 ensure that the set staffing levels of 4 carers and 1 qualified nurse on each unit are maintained at all times. This will ensure there is sufficient staff available to meet the assessed needs of the people using the service. 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 9 13 Promote and make proper 26/01/2009 provision for the health and welfare of service users by ensuring that prescribed medicines for service users in safe control and custody of the home are given in accordance with the doctors instruction as specified by the pharmacy issuing the medicine. Statutory Requirement Notice 2 9 13 Put in place suitable arrangements for the satisfactory completion of medicine administration records in respect of medicines administered to service users by workers at 26/01/2009 Care Homes for Older People Page 8 of 10 the home in accordance with individual prescription instructions. Statutory Requirement Notice 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 27 Management should monitor the hours staff work to ensure they are fit to perform their duties. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!