Care Home: Tree Tops Residential Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well The AQAA was completed in excellent detail by the manager and gave information on how the service is meeting the needs of the residents who live at the home. Detailed information is available on the service provided for prospective residents, relatives and visitors to view. This information is contained in the statement of purpose and service users guide and the home also has a web site for people to access. This information assists them to make an informed choice prior to admission to the home. All prospective residents receive a detailed assessment of their needs prior to admission thus ensuring the home can meet their needs. All residents receive a contract of terms and conditions of residency which is signed by them or their representative. Care plans provide detailed information on the care needs of the residents to ensure their needs can be met by the staff. These are reviewed monthly to ensure any changing needs are addressed. Risk assessments are obtained on each resident and are reviewed monthly to ensure the residents are kept safe from harm. There was a pleasant, friendly atmosphere in the home and people who use the service were seen to be treated with dignity and respect at all times. Staff were seen to to be attentive when calls for assistance were made and they spoke to residents in a caring, polite manner. Residents have access to health care professionals when needed to ensure they are kept well. Staff who administer medication are trained to do so safely. Thus ensuring the residents are safe from harm. Residents spoken with commented that the food was very good and they were offered a choice of wholesome, nutritious meals. Meals were observed to be served by staff in an unhurried manner in a relaxed environment. The accommodation was found to be spotlessly clean, spacious and comfortably furnished with high quality furnishings. The grounds are well maintained and provide a pleasant area for the residents to use in the summer. An ongoing maintenance programme and quality assurance systems are in place to ensure the home provides a safe place for the residents to live. The laundry is very organised and effectively run in the interest of the residents. There is a complaints policy and procedure in place and residents and visitors feel their views will be listened to and acted upon. All staff receive training in the protection of vulnerable adults to ensure they are aware of how to keep the residents safe.The staff training programme provides staff with the skills to carry out their roles. In addition to the statutory training provided, such as food hygiene, staff are also provided with training to meet the needs of the client group they care for. These include training in dementia care and dealing with challenging behaviour. Over 73% of the care staff are trained in at least National Vocational Qualifications (NVQ) Level 2 or above. Thus ensuring staff have the skills to provide the care and support to meet the residents` needs. The manager is qualified in NVQ Level 4 and has the experience to enable her to provide the care and support needed for the residents. There is a low staff turnover thus providing continuity of care for the residents. There is a management team who all have clear roles and responsibilities to ensure the efficient and effective running of the home in the interest of the people who live there. Records viewed were found to be very organised, easy to read and accessible. All new staff are recruited following a robust procedure to ensure the residents are safe from harm. Good communication was observed between the staff, management, visitors and the residents. The staff and management were available to discuss any issues throughout the day. There is a planned activity programme, which enables the residents to access activities of their choice. There is an excellent quality monitoring system in place to ensure the home is run in the best interest of the people who live there. The residents and their representatives are able to `have their say` regarding the day to day running of the home to ensure it is managed in the best interest of the residents. Residents and relatives are kept informed of developments and activities by the home`s newsletter. What has improved since the last inspection? Since the last inspection the manager has completed NVQ Level 4 in Health and Social Care thus ensuring she has the skills and knowledge to carry out her role in the best interest of the residents and staff. The home has made many major improvements to the environment and continues to provide a homely, safe and comfortable place for the residents to live. Information is available in the entrance hall on deprivation of liberty and safeguarding for all visitors to access should they need to use these to help to protect the people they care for. Tree Tops has signed up as a `Dignity Champion`, which is an initiative by the Department of Health. Thus ensuring the residents are treated with dignity and respect at all times. What the care home could do better: Information on how to provide an environment more suited to people will dementia was advised to be obtained. Equipment should be purchased to enable staff to provide more stimulating activities for the people they care for in the Delphlands unit. These should improve the quality of life and outcomes for the people living in the dementia unit. It is recommended that the manager reviews the manual handling training for staff to ensure it is provided on a regular basis in line with the current legislation. This was agreed on the day of the visit and action taken to confirm future training dates for staff. Key inspection report Care homes for older people Name: Address: Tree Tops Residential Home 27-29 View Road Rainhill Prescot Merseyside L35 0LF     The quality rating for this care home is:   three star excellent 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: Elaine Stoddart     Date: 3 0 0 9 2 0 0 9 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 36 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 36 Information about the care home Name of care home: Address: Tree Tops Residential Home 27-29 View Road Rainhill Prescot Merseyside L35 0LF 01514264861 01514311080 treetopsreshomes@btconnect.com www.treetopsresidentialhomes.co.uk Tree Tops Residential Homes care home 43 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users 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 (maximum number of places: 30) Dementia, over 65 years of age - Code DE(E) (maximum number of places: 13) The maximum number of service users to be accommodated is: 43 Date of last inspection Brief description of the care home Tree Tops Residential Homes is located in the Rainhill area of St Helens. The home is easily accessible to bus, road and rail links. The home is owned by a family partnership. The manager is Kate Joanne Williams. There are two homes within the complex, Tree Tops, which accommodates thirty service users in the older age category, and Delphlands, which accommodates thirteen service users who are elderly mentally infirm. Neither home provides nursing care. The homes both offer passenger Care Homes for Older People Page 4 of 36 Over 65 13 30 0 0 Brief description of the care home lifts and stair access and both homes share kitchen facilities. Communal facilities in Tree Tops include two lounges, one smoking and one non - smoking, a dining room, conservatory and large well maintained gardens. Delphlands has a communal lounge, dining room and a small-enclosed garden. The weekly charge for the service is from 372.00 pounds to 445.00 pounds on the residential unit. From 449.22 pounds to 508.00 pounds for Elderly Mentally Infirm (EMI). Care Homes for Older People Page 5 of 36 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: three star excellent 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: A site visit took place over one day as part of an unannounced inspection. The visit took place for the duration of approximately twelve hours. The visit was conducted over one day by Elaine Stoddart. Forty two residents were living at the home at this time. A tour of all the communal areas and a number of residents rooms took place. A selection of care, staff and health and safety records were viewed. Discussion took place with the managers, staff, residents, relatives and visitors. During the inspection five residents were case tracked (their files were looked at and their views of the service were obtained). This was not to the detriment of other residents who were involved in the inspection. Case tracking helps to look at the service from the point of view of the people accommodated. All the key standards and other standards were inspected during the visit. Care Homes for Older People Page 6 of 36 Satisfaction surveys were distributed to residents and staff prior to the inspection. A number of comments received have been incorporated in this report from interviews conducted and surveys received. The Care Quality Commissions details were available at the home for the residents and their families to access. This included copies of the most recent inspection reports for their information. The last key inspection took place on the 7th September 2006. An AQAA (annual quality assurance assessment) was completed by the manager for this inspection. The AQAA comprises of two self questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. This had been completed to an excellent standard by the manager and some information from it is recorded in this report. The people accommodated are referred to in this report as residents. Care Homes for Older People Page 7 of 36 What the care home does well: The AQAA was completed in excellent detail by the manager and gave information on how the service is meeting the needs of the residents who live at the home. Detailed information is available on the service provided for prospective residents, relatives and visitors to view. This information is contained in the statement of purpose and service users guide and the home also has a web site for people to access. This information assists them to make an informed choice prior to admission to the home. All prospective residents receive a detailed assessment of their needs prior to admission thus ensuring the home can meet their needs. All residents receive a contract of terms and conditions of residency which is signed by them or their representative. Care plans provide detailed information on the care needs of the residents to ensure their needs can be met by the staff. These are reviewed monthly to ensure any changing needs are addressed. Risk assessments are obtained on each resident and are reviewed monthly to ensure the residents are kept safe from harm. There was a pleasant, friendly atmosphere in the home and people who use the service were seen to be treated with dignity and respect at all times. Staff were seen to to be attentive when calls for assistance were made and they spoke to residents in a caring, polite manner. Residents have access to health care professionals when needed to ensure they are kept well. Staff who administer medication are trained to do so safely. Thus ensuring the residents are safe from harm. Residents spoken with commented that the food was very good and they were offered a choice of wholesome, nutritious meals. Meals were observed to be served by staff in an unhurried manner in a relaxed environment. The accommodation was found to be spotlessly clean, spacious and comfortably furnished with high quality furnishings. The grounds are well maintained and provide a pleasant area for the residents to use in the summer. An ongoing maintenance programme and quality assurance systems are in place to ensure the home provides a safe place for the residents to live. The laundry is very organised and effectively run in the interest of the residents. There is a complaints policy and procedure in place and residents and visitors feel their views will be listened to and acted upon. All staff receive training in the protection of vulnerable adults to ensure they are aware of how to keep the residents safe. Care Homes for Older People Page 8 of 36 The staff training programme provides staff with the skills to carry out their roles. In addition to the statutory training provided, such as food hygiene, staff are also provided with training to meet the needs of the client group they care for. These include training in dementia care and dealing with challenging behaviour. Over 73 of the care staff are trained in at least National Vocational Qualifications (NVQ) Level 2 or above. Thus ensuring staff have the skills to provide the care and support to meet the residents needs. The manager is qualified in NVQ Level 4 and has the experience to enable her to provide the care and support needed for the residents. There is a low staff turnover thus providing continuity of care for the residents. There is a management team who all have clear roles and responsibilities to ensure the efficient and effective running of the home in the interest of the people who live there. Records viewed were found to be very organised, easy to read and accessible. All new staff are recruited following a robust procedure to ensure the residents are safe from harm. Good communication was observed between the staff, management, visitors and the residents. The staff and management were available to discuss any issues throughout the day. There is a planned activity programme, which enables the residents to access activities of their choice. There is an excellent quality monitoring system in place to ensure the home is run in the best interest of the people who live there. The residents and their representatives are able to have their say regarding the day to day running of the home to ensure it is managed in the best interest of the residents. Residents and relatives are kept informed of developments and activities by the homes newsletter. What has improved since the last inspection? Since the last inspection the manager has completed NVQ Level 4 in Health and Social Care thus ensuring she has the skills and knowledge to carry out her role in the best interest of the residents and staff. The home has made many major improvements to the environment and continues to provide a homely, safe and comfortable place for the residents to live. Information is available in the entrance hall on deprivation of liberty and safeguarding for all visitors to access should they need to use these to help to protect the people Care Homes for Older People Page 9 of 36 they care for. Tree Tops has signed up as a Dignity Champion, which is an initiative by the Department of Health. Thus ensuring the residents are treated with dignity and respect at all times. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 36 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 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear and detailed information is provided to prospective residents to enable them to make a choice if they wish to live at the home. Detailed assessments of needs are obtained to ensure the residents care needs can be met. Evidence: The AQAA was completed in excellent detail by the manager. The AQAA reported that Tree Tops has a very detailed service user guide, statement of purpose and a brochure detailing our service and facilities. The home also has an excellent website in which the service user guide can be viewed, with links to the Care Quality Commission website and the latest inspection reports, current news and events happening at the home. Copies of the statement of purpose and service user guide were seen. These were found to contain excellent, detailed information for prospective service users to enable them to make a choice if they wish to live there. The statement of purpose contained Care Homes for Older People Page 12 of 36 Evidence: detailed information on the purpose and objectives of the home, the organisation, staffing and the facilities provided. The service user guide contained detailed information for the residents and prospective residents on the homes philosophy of care, all about the home, how to make a complaint, contractual issues, fees and how care at the home is provided. The service user guide is presented in user friendly format with colour pictures thus providing an easy to read brochure for the people they care for. All residents have access to both booklets in their own rooms for their own use. Copies of these are also displayed in the entrance hall along with other information on the home for visitors to access. These include a copy of the most recent key inspection report and the annual service review. Other information available to visitors in the entrance include a copy of the monthly newsletter, which keeps residents and visitors up to date will the events and developments in the home. A new information section has been put in place since the last visit and contains a range of information for visitors and residents to access. All residents have a contract of their terms and conditions, which are signed by the residents or their representatives. The AQAA reported that all prospective residents and their families are invited to come for dinner, and an afternoon to experience home life before they decide to live there. All residents are admitted on a four week trial period, which is stated in their contract. Surveys received from relatives provided the following comments: Before we settled my Aunt in Tree Tops we visited other homes in the area. Tree Tops stood out in many ways above all the other homes and we were convinced she would be happy and well cared for. My Aunt has settled well and is now very happy. We are more than happy with Tree Tops. The staff have worked very hard to settle my Mum in. The home, residents and staff are always spotlessly clean when you visit. Visitors are always welcome whatever the time. Nothing is too much trouble. The AQAA reported the home maintains full occupancy levels and have waiting lists for both units. At the time of the visit there were thirty residents accommodated in Tree Tops and twelve residents in Delphlands with one vacancy. At the time of the visit the vacancy was being viewed by a prospective resident who was being shown around the Care Homes for Older People Page 13 of 36 Evidence: home by the manager. The prospective residents family was spoken with and provided the following positive comments: I looked on the website for all the information on the home and found that it suited my Dad due to the locality and the facilities provided. I have found it to be very homely and not clinical like some other homes I have looked at. As soon as I walked in, with no appointment, I liked it here. The staff have been very helpful. A newly admitted resident spoken with provided the following positive comments on the home: This is the best home I have been in. I feel so safe here and nothing is too much trouble. All enquiries regarding vacancies and admissions are recorded and followed up to obtain information should the enquiry not be pursued. This enables the management to address any issues raised regarding peoples first impressions of the service and allows them to take action to remedy this for future enquiries. All prospective residents are admitted following a full assessment of their care needs prior to admission. Thus ensuring the home can meet their needs. Assessments of need were viewed for three residents in the residential unit and two on Delphlands. The assessments were found to contain detailed information on the individual care needs of the residents accommodated. These include personal care, mobility, finances, food and drink, sleep patterns, medication, identified risks and safe systems of working. A social profile of each resident is completed and this enables the staff to have information on the residents history, employment, family and their hobbies and interests. This enables the staff to have a clearer understanding of the lives and experiences of the people they care for. The assessments of need are then used to provide detailed plans of care, which enable the staff to provide the care and support the residents need in the way in which they prefer. Standard 6 was not assessed as the home does not provide this service. Care Homes for Older People Page 14 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date, detailed care plans ensure that the residents receive the care they need. The residents are treated with dignity and respect at all times. Medication is administered safely to the residents by staff who are trained. Evidence: The AQAA reported that all service users have a comprehensive individual care plan, which are reviewed and updated on a monthly basis. The Manager encourages the service user and/or their relatives to be fully involved when devising the care plan and this is then signed to show agreement by all parties involved. Service users and their relatives are kept informed of any amendments made to the care plan if there has been a change in the service users needs. Regular reviews and updates about the service user enables the care staff to continue to meet the changing needs of all service users. Five residents care files were viewed and were found to provide detailed and clear information on the individual care needs of each resident. The care plans had been drawn up with the involvement of the resident, where possible and their families or Care Homes for Older People Page 15 of 36 Evidence: representatives. Each care plan is signed to show the residents or representatives agreement. Each plan clearly outlined the tasks to be undertaken by the staff to enable them to meet the residents care needs in the way they prefer. The care plans viewed covered all areas of the residents care needs and included personal care needs, mobility, communication, medication, finances, sleep patterns, behaviour, safety and their wishes at the time of their death. All areas of their care are reviewed monthly by the manager in conjunction with their key worker (a carer who works closely with the resident to support them). Each care record is updated monthly, or before if needs change and any changes are recorded to ensure the residents receive the care they need. Discussion took place with the management to recommend that care plans outline the positive outcomes for the residents. This was agreed to be recorded in all residents care files at the time of the visit. The care plans viewed were found to be very well organised, gave clear instructions to staff and were very easy to understand. Records on care plans viewed clearly showed what had occurred since last review, such as seen by their GP due to hearing problems and recorded the action taken to support the resident. A clear social profile is available for each resident. This enables the staff to have the information on the residents personal history to enable them to have an greater understanding of their past employment and family networks. Thus ensuring realistic outcomes for the people they care for. Risk assessments are completed on all areas of their care and include environmental, psychological and safe systems of moving and handling. These are reviewed monthly to ensure residents are safe. Nutritional assessments are undertaken and reviewed monthly by the manager. Care files showed residents food preferences, nutritional needs and their likes and dislikes. This information is provided to the chef to ensure residents are provided with the food they like and is served in the way they prefer. Staff spoken with demonstrated their knowledge of the residents individual needs and said they found care plans easy to follow. Thus ensuring residents needs are met. Staff spoken with commented: The home cares for the residents very well Daily shift reports are completed day and night by care staff to ensure residents daily care needs are recorded and the action taken by staff to meet those needs. Records are made of all personal care provided including bathing, nail care and when residents Care Homes for Older People Page 16 of 36 Evidence: have their hair done. This ensures residents are cared for. All health care visits are recorded in plan of care thus ensuring residents have access to their GP and district nurses when required to keep them healthy. Records showed that residents wishes at the time of their death have been discussed with their families and the residents in a sensitive manner to ensure their wishes are met. The medication practices were found to be robust and ensures that medication is administered safely to the residents. Senior staff who administer medication are given regular training to enhance awareness of up to date information and new legislation regarding the handling, storage, administration and disposal of medication. Weekly stock checks and medication audits are carried out by the management team to ensure correct procedures are followed at all times and staff are competent in their roles. The manager also conducts random checks on the medication systems and records anything that needs further action and speaks to the staff directly regarding any issues identified. Regular medication audits are carried out by the supplying pharmacy to ensure medications are stored, administered and disposed of correctly. All medication for each resident is recorded and all medication given is signed for on administration. Residents who wish to self medicate are allowed to do this following a risk assessment to ensure it is safe to do so. Medication is securely stored in the treatment room. Residents have the choice to have their treatment in this room or in their own room. Staff were observed to treat residents with dignity and respect at all times throughout the inspection. Staff always knocked on doors prior to entering and spoke with residents using their preferred name. The home has policies and procedures in place on how to ensure the dignity and respect of the people they care for. Training is given in this area within their induction and the homes training plan. The home has recently signed up to the Dignity in Care campaign set up by the Department of Health. Leaflets are in place within the home to promote the campaign and to provide information for staff, residents and visitors. The aims of the campaign is to raise awareness of dignity in care by involving people to maximise their choice, have a zero tolerance of all forms of abuse and ensure they have a right to complain without fear or retribution. Comments from residents and relatives surveys received included: Very well cared for Care Homes for Older People Page 17 of 36 Evidence: Always clean clothes on and available to change into Hairdresser attends regularly, which is important to their care and well being Dads appearance is immaculate They are looked after well They care for us very well Staff are always cheerful, patient and and encourage the residents to do things When discussions are necessary regarding residents well being and treatment. The staff are always friendly and helpful. Discussions are open and confidential and staff are courteous Residents spoken with during the visit commented: If you need a GP they get you one straight away A relative spoken with during the visit commented: The staff always let me know when my Dad isnt well. They are always available to talk too. Care Homes for Older People Page 18 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are able to chose from the well balanced, wholesome and nutritious menu. A planned, varied activity programme is available to the residents and visitors are able to take part if they wish. Evidence: The AQAA reported The routines of daily living at Tree Tops are flexible and varied. Service users are encouraged to maintain independence and express their preferences freely regarding daily life and social activities. There is an activity planner on each unit, which sets out the leisure and recreational activities planned for the month. Service users have a residents meeting every month, with the manager/ deputy manager, in which they can express their views and make suggestions of their preferences in relation to the provision of social activities. The activity planner incorporates a wide variety of daily activities, external entertainment, religious meetings, library visits and any other external service visits. The visit took place during the early morning, lunch and evening periods. We observed the breakfast being served in dining area, which is available all morning depending on when the residents wish to get up. Some residents were seen to be having their breakfast at 10:00am as this was their wish. Care Homes for Older People Page 19 of 36 Evidence: There was very pleasant atmosphere in place throughout the day in both units visited. Visitors were made welcome at all times of day and evening and chatted freely with the staff on duty. Care files viewed recorded in detail residents social profiles. These had been completed in conjunction with the resident and their families. This provides information to the staff to enable them to be aware of the residents past history and employment. The residents food likes, dislikes and nutritional assessments completed in detail to ensure they get what they like in the way in which they prefer. Any special dietary needs, such as diabetes are recorded and this information is available to the chef to enable him to provide the food to meet their needs. The activity plan was viewed in both units and included includes trips out, dominoes, entertainers, and birthday celebrations. The activities are published in the newsletter to let the residents and relatives know what is planned for the coming months. The newsletter for September - November 2009 showed an entertainer, trips to chester zoo, singer and a Halloween party are to take place. Residents from both units were observed going on trip to Chester Zoo on day of the visit. Residents spoken with on their return expressed they had enjoyed their day. The staff spoken with said they had enjoyed it too. Communion is held at the home regularly for both Church of England and Roman Catholic worshipers. The activities take place in both units, however residents from Delphlands join the residents in the residential unit for special occasions, such as entertainers and trips out. Activities on the Delphlands unit is more personalised to meet the client group they care for. Discussion took place with the manager regarding the provision of activity equipment for the use of the staff and residents on the Delphlands unit. This equipment could be used to provide more stimulating activities, such as reminiscence sessions, to enable the staff to engage more with the residents and provide positive outcomes for them. The management team agreed with this recommendation at the time of the visit. Residents were observed having their lunch in a relaxed, friendly atmosphere. Tables were laid out neatly and staff were in attendance at all times to assist residents where needed. The chef, Andy, calls in daily to see the residents and discuss the food provided. On the day of the visit the residents were having a light lunch as many were on the trip and the main meal was provided on their return. Thus providing a flexible routine to meet the residents needs. Those residents on the trip were provided with a packed lunch by the chef. The menu of the day is displayed at the entrance to the Care Homes for Older People Page 20 of 36 Evidence: dining room for the residents to view. Alternatives are available at all times and snacks and drinks were seen to be provided throughout the day to residents and their visitors. Discussion took place with the chef and a tour of the kitchen facilities made. The chef commented that all the residents mainly eat in the dining area, however they have the option of having meals in their own rooms if this is their wish. The chef works five days a week and the kitchen assistant three days a week. Andy stated that he has full control for ordering all the food supplies and is never questioned by the management regarding the cost. All food is purchased locally and includes fresh fish, fresh meats and fruit and vegetables. On the day of the unannounced visit, Andy was baking a fresh fruit crumble and cherry sponge for tea. Food stocks were viewed and good quality products were plentiful in supply. Weekly menus are completed and these are discussed with the residents at their meetings should they wish to make any changes. The chef introduces alternatives, such as pasta to try and vary the meals provided. The chef starts at 7:00am for breakfast and commented: They can have whatever they want for breakfast. Cereal, toast, bacon or eggs. Hot food for the main meal is transported to Delphlands via Hot locks. Breakfast and tea is prepared by the staff in the units kitchen. The chef uses the Safer food, better business system, which ensures continual monitoring of the safe system of cooking food, The kitchen has recently received a four star rating for its standard of cleanliness and food preparation. Andy commented, I am very happy here and have no wishes to move on as they let me run my kitchen as I wish to a high standard. Residents spoken with provided very positive comments regarding the food available. The food is excellent. Surveys received from residents and relatives provided the following positive feedback. The food is of an excellent standard and variety All the meals are excellent. Plenty of choice. My compliments to the chef The meals are very appetising. Care Homes for Older People Page 21 of 36 Evidence: Residents are encouraged to handle their own finances, where possible. Any financial transactions made by the home are recorded and audited. Care Homes for Older People Page 22 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints policy and procedure in place and available to all residents and visitors should they wish to make a complaint. The residents are protected from harm by staff who are trained and recruited following robust procedures. Evidence: Tree Tops has a full complaints policy and procedure which is available in the service user guide. The AQAA reported the management listen to, take all complaints seriously and act upon all complaints made immediately. Complaints are fully documented in the complaints book and details regarding the actions taken and the outcomes are recorded fully. A grumble book is also provided on each unit for staff to log non serious complaints, which are also dealt with fully. Records showed the complainant is kept fully informed of all actions and a meeting is arranged to discuss the outcome following the investigation. All complaints are investigated fully and an outcome is made within a maximum of 28 days of receiving the complaint. The service has set itself a target of seven days to investigate all complaints made. The AQAA reported that one complaint and one safeguarding issue has been made to the home and investigated to the satisfaction of all parties. Each resident has a copy of the service user guide outlining the complaints procedure available in their own room. The newsletter also makes reference to Compliments and complaints and how to make a complaint and who to speak to. This information is available in the entrance to view by all visitors to the home. Care Homes for Older People Page 23 of 36 Evidence: Tree Tops has policies and procedures in place to ensure the protection of the residents at all times. Staff receive training in the protection of vulnerable adults and are aware of procedures to follow should they witness or suspect abuse. Staff records seen confirmed that staff are trained in abuse. Discussion with staff also confirmed they had a clear understanding of what action to take should they witness any concerns. All staff employed are recruited following robust procedures to ensure the people they care for are safe from harm. The management is aware of the procedures for the Deprivation of Liberty (under the Mental Capacity Act 2005. To safeguard people who may lack the capacity to make particular decisions). Training in this area is to be provided to all care staff to ensure they have the knowledge and enable them to provide positive outcomes for the people they care for. Information on the Deprivation of Liberty and safeguarding is available in the entrance for all visitors to access. An advocacy service is available to assist residents and their relatives should they wish to use it. Residents commented They listen to you when you have a problem No concerns at all If there is anything I am not happy with I can go to them and talk about it knowing it will be sorted Care Homes for Older People Page 24 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, comfortable and homely place for the residents to live. Furniture and fittings are of a high standard and the environment is well maintained. Evidence: A full tour of the communal areas in both units and some residents rooms was conducted. We found Tree Tops to provide a safe, well maintained and comfortable environment for the residents to live. There is a variety of internal and external communal areas, which are easily accessible to all the people who live there. The residents were observed to move around the home freely and chose to sit in the communal area or in the privacy of their own rooms. All the communal areas are decorated and furnished with good quality furnishings. The standard of cleanliness is high and this is maintained by domestic staff who have worked at the home for many years. Discussion with them confirmed that they take pride in their work and commented I love working here. The management are so nice. I wouldnt work anywhere else. The residential unit has two lounges (one smoking) and a conservatory. Residents were observed to use this to meet their visitors, sit and watch the flat screen TVs, read or take part in the days activities. There is pleasant dining area for the residents to use to have their meals. Tables are neatly set and the area is spacious. There was a pleasant atmosphere throughout the day and residents, visitors and staff interacted Care Homes for Older People Page 25 of 36 Evidence: well together. A number of residents rooms viewed were found to be personalised, attractively decorated and very clean. Delphlands communal areas include a main lounge and dining area. These too are comfortably furnished and clean. Discussion took place with the management for more furnishings to be purchased to aid communication and stimulation for the residents. It was recommended that information be obtained on dementia care environment settings as this will lead to more positive outcomes for the people who live there. The management agreed to look at making improvements to the EMI unit furnishings for the benefit of the residents. There is a very large well maintained garden with seating for the residents to use in the summer months. A raised patio area with a water feature has been installed since the last visit and provides a pleasant area for residents and their visitors to use. Delphlands has a secure garden area available to provide a safe place for the residents. All external areas have security lighting. All exit doors are alarmed for residents safe keeping. Some areas have radiator covers and those without have risk assessments in place to ensure residents are safe. Each residents room has a list of key worker duties and their responsibilities to ensure residents rooms are kept clean, safe and well maintained. Any repairs required are reported by the key worker to the maintenance man. All personal rooms have lockable facilities and the residents have keys to their rooms if they wish. Access is available to toilets and bathing facilities, which have adaptations for those with mobility needs. One residents room has an en suite facility. The laundry was very well organised and clean. Systems are in place to help prevent cross infection. Delphlands have their own laundry for the residents who live there. The laundry assistant has worked at the home for 18 years and is very well organised and aware of residents needs. Plenty of bedding and towels are in supply. The laundry assistant commented:If we need any new bedding Kate the manager will get them no problem. There are hand washing facilities throughout and paper towels and soap dispensers. To help minimise cross infection. Notices are posted to inform visitors of the dangers of the swine flu pandemic when accessing the home. Care Homes for Older People Page 26 of 36 Evidence: There is a treatment room for the residents to use when receiving health care treatment. If they wish to use their own rooms for this their wishes are protected. Environmental risk assessments are completed by the management and updated monthly to ensure the home is safe. All contracts for services are up to date as recorded in the AQAA and some were checked to ensure this. The home has an ongoing improvement plan to ensure it is maintained to a high standard. A maintenance man is employed to carry out day to day repairs and contractors undertake the large project works. Since the last visit to the service many improvements have been made to the environment to maintain the high standard provided. These include new leather chairs and furniture, new occasional tables, television cabinets, bookcases and HD ready flat screen televisions with built in free view in preparation for the digital switchover. Some toilets have had new flooring fitted. The treatment Room on Tree Tops has been repainted, new flooring fitted and the chairs replaced. New carpets have been fitted in a number of areas. New curtains fitted to match new decor. The outside has been re painted and a new roof installed. New fire doors installed for safety. Several individual residents rooms re furbished. The cellar has undertaken extensive work to remove asbestos. A new walk in shower has been installed. The entrance is now fitted with wall mounted displays which hold information for all visitors to access. These include quality assurance questionnaires, past inspection reports, information on safeguarding people and newsletters. Residents provided positive comments on the environment. Comments include: Hygiene standards are high Accommodation is to a good standard Clean, tidy, fresh and no smells Very clean and fresh Care Homes for Older People Page 27 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment and selection procedures are robust to ensure the people who live there are protected from harm. The staff are trained to provide the care and support to the residents in a safe manner and in a way in which they prefer. Evidence: Staff files viewed showed Tree Tops has a robust recruitment and selection procedure in place, which ensures that all potential employees have a criminal record bureau (CRB) check following receipt of two satisfactory references from previous employers. This ensures the residents they care for are safe. All new employees are given a full internal induction which includes job related policies and procedures and health and safety. New employees undertake the skills for care induction standards within the first 12 weeks of their employment to ensure they have the skills to carry out their roles. The training plan and staff training files viewed showed that continual training is provided throughout the year and a wide range of subjects are offered to all levels of staff. These include the mandatory training, such as fire safety and first aid. Other relevant training courses are provided to ensure the staff have the skills and knowledge to provide the correct care for the residents. These include training in dementia care, dental and oral hygiene, equality and diversity and death and dying. Discussion took place with the management regarding the time scales for manual Care Homes for Older People Page 28 of 36 Evidence: handling training to be updated. Immediate action was taken by the manager and training dates confirmed at the time of the visit. A recommendation was made and agreed by the manager to review the manual handling training plan in line with current legislation. Staff are encouraged and supported to develop their skills and abilities within their job role. Staff spoken with confirmed the training was very good and they are supported within their roles by the management. The staff were observed to be very happy in their roles and were responsive at all times to the needs of the residents. A very pleasant, caring atmosphere was present throughout the visit. Staff were seen to welcome visitors to the home at all times of the day and evening and discussed any issues regarding the care of their relatives. The staff were seen to be approachable at all times. Relatives spoken with and surveys received provided very positive comments regarding the staff employed. Their comments include: The staff are very helpful Staff always friendly and helpful Staff are friendly and caring, which is a great comfort Staff are very understanding with regards to my Fathers needs I call three time a week at any time and the staff are always available to talk to me Staff spoken with provided positive comments on the management of the home. There is a low staff turnover and many of the staff spoken with have worked at the home for many years thus providing continuity of care to the residents. Staff comments include: Good training We make the home a happy place for the residents to live There is a low staff turnover. This means staff are happy in their work Staff are always involved I love it here We are like a big family Sufficient staff were found to be on duty to meet the care needs of the residents and Care Homes for Older People Page 29 of 36 Evidence: these included management, senior care staff, carers, domestics, laundry assistants and a chef. No agency staff are used as any short falls are covered by the staff employed to ensure continuity of care for the residents. The AQAA confirmed that over 73 of the staff are qualified in at least National Qualification (NVQ) level 2. Thus ensuring they have the skills to carry out the care and support to the people they care for. Staff meetings are held every few months to ensure the staff are kept up to date with developments and are involved in the running of the home. Care Homes for Older People Page 30 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed and is run in the best interest of the people who live there. Systems are in place to ensure the home is a safe place for the residents to live. Evidence: The AQAA was completed in excellent detail by the manager and contained all the information required to inform the Commission about the progress of the home since the last visit. We looked at records and files to confirm that safe systems of working are in place and these were found to be very detailed, organised and provided clear up to date information. The AQAA reported that there is a management team who consist of the managing director, home manager, deputy manager and the catering manager. All members of the team have their roles and responsibilities to ensure efficient management of the Care Homes for Older People Page 31 of 36 Evidence: home. The manager and deputy manager are both qualified in NVQ level 4 in management. The manager has successfully completed NVQ level 4 in health and social care since the last visit to the service. The manager is experienced in the care of older people. The manager works well with the Commission and keeps us informed of any progress or incidents occurring in the home. Positive comments were received from staff, visitors and relatives spoken with regarding the effective management of the home. Their comments include: Very friendly atmosphere. (Resident) If I have a problem the manager always listens to me, (Staff) The employer is fair and respects the staff. (Staff) The home is well run. (Staff) Staff meetings are held often with the manager to keep us informed. (Staff) Kate (manager) is always there to listen to me whenever I call in. (Relative) There is an open door policy in the home and the management and staff are always available to listen and discuss any concerns that relatives, staff and residents may have. This was observed to take place throughout the day of the visit. There was a pleasant, relaxed atmosphere present and staff were observed to interact well with management, residents and visitors. There are clear lines of accountability within the staff and management and this was confirmed by talking with the staff, residents and visitors during the visit. The staff said they are very well supported by the management and are involved in the running of the home through regular supervision sessions, annual appraisals and staff meetings to keep them up to date and monitor their progress and developments. Staff spoken with commented: We get lots of supervision The home has received the Investors in People Award and a 5 star rating from an external body. Both assess the quality of the service provided to the residents and the involvement of the staff employed. Care Homes for Older People Page 32 of 36 Evidence: The quality assurance systems in place for assessing the efficiency and effectiveness of the care provided are excellent. Some time was spent with the managing director looking at the quality assurance records in place. These include monthly assessments of the environment to ensure the home provides a safe place for the residents to live and for the staff to work. All fire systems, water temperatures, emergency lighting systems and call bell systems are regularly checked and recorded to ensure the home is safe. Records are made of any accidents and injuries and these are monitored closely by the manager and any actions taken to avoid further occurrences. The home seeks the views of residents, relatives and staff by requesting them to complete surveys to offer their opinions on how the home is run. Any comments made which require a follow up are provided by the management who invite the person to a meeting to discuss any issues they may have. The quality assurance systems are shared with the staff at their meetings and regular supervision sessions. Thus ensuring they are aware of the comments made and actions to be taken to make any improvements. An annual quality assessment is completed by the management to ensure the home complies with what is required by the Commission. Action is taken to improve any areas to ensure the home meets the standards and maintains the high standard of care it provides. Regular residents meetings take place to enable them to have their say in how the home is run. A newsletter keeps them informed of progress and future developments and activities. Thus ensuring the home is run in the best interest of the people who live there. Staff spoken with commented: The home gives the clients choice and involves the residents with their opinions All policies and procedures are updated annually or before if these change. Staff are provided with copies of these to sign and acknowledge their understanding of. Thus ensuring staff are kept up to date with changes in practices and procedures. All certificates for services, such as gas are kept up to date to ensure the home is a safe place for the residents to live. Any residents finances dealt with are recorded and audited to ensure they are protected from financial abuse. Care Homes for Older People Page 33 of 36 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 34 of 36 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 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 12 Equipment should be purchased to enable the staff in the Delphlands unit to use to provide stimulating activities to the residents who live their. It was recommended that information be acquired on dementia care environment settings as this will lead to more positive outcomes for the people who live there. It is recommended that the manager reviews the manual handling training for staff to ensure it is provided on a regular basis in line with the current legislation. This was agreed on the day of the visit and immediate action taken to confirm future training dates for staff. 2 20 3 30 Care Homes for Older People Page 35 of 36 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. Care Homes for Older People Page 36 of 36 - 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!