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Care Home: Treelands Care Home

  • Greenhurst Crescent Oldham OL8 2QQ
  • Tel: 01616267173
  • Fax: 01616289793

Treelands is owned and managed by Southern Cross Health Care Services Limited, which is a private company with a number of other homes in the area. Treelands is a purpose built home, located in the Fitton Hill area of Oldham. 40 040 20 0 40 419062009 Treelands provides general nursing and personal care for up to 40 service users, specialist dementia care for a further 40 service users and care for service users with other mental health needs. The home does not provide care for service users under the age of 55 years. Accommodation is provided over two floors, the first floor being accessible by a lift. Each floor is divided into two units, which are separately equipped with bath and shower rooms, treatment rooms and lounge/dining rooms. The general nursing unit occupies the ground and first floors on one side of the building, whilst service users with mental health needs occupy the ground and first floors on the other side. All bedrooms provide en-suite facilities. Separate self-contained, secure gardens are accessible from each unit. The current weekly fees (as at June 2009) range from 375.00 pounds to 754.70 pounds. Further details regarding fees are available from the manager.

  • Latitude: 53.518001556396
    Longitude: -2.1040000915527
  • Manager: Manager post vacant
  • Price p/w: £565
  • UK
  • Total Capacity: 80
  • Type: Care home with nursing
  • Provider: Southern Cross Healthcare (Kent) Ltd
  • Ownership: Private
  • Care Home ID: 16948
Residents Needs:
Old age, not falling within any other category, mental health, excluding learning disability or dementia, Sensory impairment, Dementia, Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Treelands Care Home.

Key inspection report Care homes for older people Name: Address: Treelands Care Home Greenhurst Crescent Oldham OL8 2QQ     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: Steve Chick     Date: 0 6 0 4 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Treelands Care Home Greenhurst Crescent Oldham OL8 2QQ 01616267173 01616289793 treelands@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare (Kent) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: No Service User to be admitted into the home who is under 55 years of age. The manager must be supernumerary at all times. Date of last inspection Brief description of the care home Treelands is owned and managed by Southern Cross Health Care Services Limited, which is a private company with a number of other homes in the area. Treelands is a purpose built home, located in the Fitton Hill area of Oldham. Care Homes for Older People Page 4 of 32 Over 65 40 20 40 40 0 40 20 0 40 4 1 9 0 6 2 0 0 9 Brief description of the care home Treelands provides general nursing and personal care for up to 40 service users, specialist dementia care for a further 40 service users and care for service users with other mental health needs. The home does not provide care for service users under the age of 55 years. Accommodation is provided over two floors, the first floor being accessible by a lift. Each floor is divided into two units, which are separately equipped with bath and shower rooms, treatment rooms and lounge/dining rooms. The general nursing unit occupies the ground and first floors on one side of the building, whilst service users with mental health needs occupy the ground and first floors on the other side. All bedrooms provide en-suite facilities. Separate self-contained, secure gardens are accessible from each unit. The current weekly fees (as at June 2009) range from 375.00 pounds to 754.70 pounds. Further details regarding fees are available from the manager. Care Homes for Older People Page 5 of 32 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: The quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Treelands knew the visit was going to take place. Three inspectors spent approximately 7 hours at the home. The inspection process also included a visit from one of the our pharmacy inspectors on a subsequent, but still unannounced, day. All the key inspection standards were assessed at these site visits. Information was obtained from various sources which included observation and talking with people who live in the home, visitors, the manager and other members of the staff team. We also looked at a selection of service user and staff records as well as other documentation including medication records and the complaints log. Care Homes for Older People Page 6 of 32 Before the site visit we asked the management of the home to fill in a questionnaire called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they had improved on. Where appropriate some of these comments have been included in the port. We also arranged for some surveys to be distributed to staff and service users. A small number of these were returned to us, some of which arrived too late to be incorporated in the report. We have been made aware of concerns about some care practices which were being investigated by staff of Oldham Metropolitan Borough Council. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care planning processes must be undertaken and maintained more thoroughly and in a way which reflects the individual needs of each service user. Whilst there was evidence of good practice in this area the appropriate standards were not maintained within all the units of the home. Records, particularly, in connection with social activity with individuals and the consumption food by people on special diets should be more detailed. Some aspects of the storage, administration and accounting for medication needed to Care Homes for Older People Page 8 of 32 be improved. Risk assessments must be undertaken and recorded wherever a hazard is identified. In seeking to minimise risk, weight must also be given to maintaining service users independence and dignity. An application for the registration of a manager at the home must be made to the Commission. Routine audits of quality within the home should be undertaken more thoroughly to ensure that practice which has fallen short of the required standard is identified and improved at an early stage. 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 9 of 32 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 10 of 32 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. Service users needs are appropriately assessed before moving to the home to ensure that their needs can be appropriately met. Evidence: We were told in the AQAA that prior to admission a full health and social care plan is obtained and a preadmission assessment completed, other than in an emergency. At the previous inspection there was evidence that this was being undertaken. The home had not admitted any new service users since September 2009. We looked at a selection of service users files, all of which had an assessment of the persons needs. Treelands does not offer intermediate care. Care Homes for Older People Page 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care needs are potentially not fully met due to the inconsistent implementation of policies and procedures. Service users privacy and dignity are promoted by staff. Evidence: We were told in the AQAA that each service user had an individual and comprehensive care plan which was regularly reviewed. The home is divided into four units, each being able to accommodate up to 20 service users. We looked at a selection of service users files and talked to some staff about care practices. The quality, and hence the effectiveness, of the written care plans was inconsistent. Examples were seen where there was an adequate level of physical, emotional and psychological planning which was documented in the care plans. However in several of the care plans personal, spiritual and religious preferences and support was not considered and there was variation in the level of life mapping (a record of the Care Homes for Older People Page 12 of 32 Evidence: individuals personal life history) across the units. The quality of the care planning was variable from unit to unit. There was a good level of documentary evidence of reviews of care being undertaken with the service user and their relatives. One relative we spoke to said we have been fully involved and updated in all care arrangements and are very happy with the level of support and care. Another relative told us they were confident that good communication took place and they were made aware of any changes in their relatives health or circumstances. However, some care plans lacked detail. For example the care plan relating to one service user who was prone to epileptic fits said monitor for early signs of fitting, but did not identify what symptoms or possible triggers, staff should be aware of. Another example was seen where the plan had not always been amended to reflect a change following a reassessment or review. The effect of this would be that staff would need to rely more on personal knowledge of the service user and verbal updates, than the specific written care plans. Another example was seen where the care plan required the regular weighing of one service user. However, this had stopped some six months earlier, with no recorded reason why. Similarly this service user had only been bathed in bed, but the records did not appear to clarify if any alternative bathing method had been explored or discussed. Similarly, it was not clear from the records what, if any, attempts have been made or explored to enable this person to spend some time out of bed. Discussion with the manager indicated that staff were aware of this issue. We were also told that the service user and family were involved in discussions about moving them to a different unit within Treelands which may better meet their physical needs. There was evidence that risk assessments had been done for a range of issues. However, examples were seen where risk assessments for the use of bed rails did not appear to demonstrate how identified hazards had been addressed to minimise the risk. Several of the bed rails inspected were found to have gaps between the mattress and the rails, the manager was made aware of the risks identified and agreed to review all this area. Service users were observed to be well dressed and supported to maintain personal cleanliness and hygiene. One visitor commented that [X]is well looked after and her clothes are always clean, she has lots of support from staff and is taken to the toilet on request. Staff interactions with service users served to maintain their privacy and dignity. On one unit it was noticed that all bedrooms doors were locked (when the service user Care Homes for Older People Page 13 of 32 Evidence: was not in the room) and service users needed to ask a member of staff to unlock the door if they wished to return to their room. Staff explained that this practice was to prevent some service users from inadvertently going into other peoples rooms and potentially disturbing the contents. Whilst the motivation for this practice was understandable, it reduced the independence of some service users. It was not clear, from discussion with staff, if alternative strategies, for managing the potentially undesirable behaviour of some service users, had been considered. There was evidence that service users can access all medical services which are available in the community. There are records in the service users files which demonstrate a multi-disciplinary care meeting with other key professionals such as district nurses and social workers, to review the care plans. However these records could be more detailed to describe the outcome of the review and actions taken by the home and other agency workers. Three out of the four surveys returned by, or on behalf of, service users said the home always made sure they got medical care they needed. One relative said that amongst what service does well was, always get a doctor if they feel [X] is unwell. As part of the inspection a pharmacist inspector visited on 6th April 2010 to look at how medicines were being handled. We checked a sample of medicines stocks, medicines records and care plans. Overall we found improvements are needed in the handling of liquid medicines and the times medicines are given to people to help make sure their health and wellbeing is fully protected. We found medicines stock to be well organised, records were clearly presented and spare stock was stored securely in clean and tidy rooms. Records of medicines received into the home and given to people were usually signed and up to date. Ordering and recording procedures were efficient and all medicines could be easily accounted for. We saw good information about the use of when required medicines and care plans contained detailed information about specific medicines and the health issues they were prescribed for. However, records of medicines disposed of were not always properly made. We found one medicine in the current disposal bin that had not been recorded and our checks raised concerns that liquid medicines were not always being recorded correctly. Disposal records were not routinely witnessed so there was a risk that medicines could be easily mishandled or misused. We carried out some detailed checks on the current stocks and records and found regularly prescribed medicines were being given correctly. However, we found liquids medicines were not always handled safely because the stocks did not add up. Our stock checks showed numerous doses had either been missed completely or had been Care Homes for Older People Page 14 of 32 Evidence: inaccurately measured and therefore given at the wrong dose. We also looked at the times medicines were given to people and found those that needed to be given before food were wrongly given after because the medicines round had not been properly organised and the records did not have clear instructions on them. We found some people were not given their morning medicines because they were asleep during the normal medicines round but staff did not return to give them later, as they should have done, when the people had woken up. Giving people medicines at the wrong time, wrong dose or not at all can seriously affect their health and wellbeing. We checked how controlled drugs (medicines that can be misused) were handled. Two of the cupboards used for storage were not properly attached to the wall so they did not meet the requirements of the law, we gave some advice about how to put this right and the senior manager on duty said immediate action would be taken. Stock levels of controlled drugs were correct and all entries were properly witnessed in suitable registers. Secure storage and witnessed records help prevent the misuse and mishandling of controlled drugs. We looked at how staff were trained to handle medicines. All had received certificated medicines training and their competency was formally assessed, however, this assessment did not include watching staff give and record medicines. We saw some suitable paperwork to support this and we were told it was to be used as soon as possible. We saw regular checks and audits carried out by the managers to help make sure medicines were handled safely but these had not identified the problems with liquid medicines, the disposal of medicines and the timings of medicines. Regular training, efficient audits and formal competency checks help make sure medicines are handled safely by suitably skilled staff. Care Homes for Older People Page 15 of 32 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. Service users are helped to maintain links with families and friends, and are provided with a balanced and nutritious diet. Evidence: We were told in the AQAA that menus were provided which change daily, incorporating special diets. Drinks and snacks are also provided. We saw that there was a four- week menu in place and a clear choice was provided at each meal time. The content of the menu appeared nutritious and well balanced. At breakfast service users can choose from a selection of cereal, toast, porridge or a hot breakfast option. Mid-morning drinks are served with biscuits or cake. At lunchtime the meal is a light meal. At the time of this visit the choices were cheese and tomato quiche with beans, an assortment of sandwiches or if service users wanted something else, they could have a jacket potato, salad or omelet. The main meal is served at teatime when a variety of dishes is available. Staff asked service users each day what they would like from the menu and that information is passed to the Cook for preparation. We Care Homes for Older People Page 16 of 32 Evidence: observed a service user who did not want her initial meal choice so this was replaced by an alternative which she ate. In the afternoon drinks were provided with home-made cake, and biscuits. We were told by the Cook that at supper time there was a selection of sandwiches, biscuits or toast. If service users were to ask for something different to this then this would be provided if in stock. If the item was not in stock, the cook told us this would be purchased and provided to service users. Service users we spoke with said they liked the meal. We shared a meal time with service users and saw that staff were promoting service users independence to eat and encouraging them to have something at the meal time. In addition we observed a service user who was assisted with eating their meal. The staff member took time and patience in providing support with the meal. They also stayed with the service user for the whole meal, which is best practice. There were cold drinks available to service users if they wanted to help themselves. In one unit these drinks were seen in the kitchen. A number of service users would have difficulty in getting into the kitchen area to help themselves. We were told by staff that one service user did go to help themselves to drinks and sometimes made a hot drink independently. For the remainder of the service users on this unit the placement of drinks in the kitchen doesnt enable them to help themselves. We were told that two service users did like cold drinks throughout the day and would be able to help themselves if the drinks were nearer. Thought needs to be given to relocate drinks so their independence can be further promoted. We noticed in some of the units that the tables were set for meals well before the meal time. We were told that this is company policy. Some service users at Treelands are poorly and have varying degrees of confusion and would use the cutlery before the meal. If this use was not seen by staff, the cutlery could be used by other service users after being inappropriately handled, resulting in poor hygiene. Others we were told, try to eat from the salt and pepper pots or sometimes throw the glass condiments. A written risk assessment should be prepared which addresses these potential risks. Menus are placed on the tables so those who are able can be reminded what the menu choice is. Flower displays were on the tables which made them look pleasing and welcoming. We spoke with the Cook who told us about the options available to service users who Care Homes for Older People Page 17 of 32 Evidence: want a differing diet or menu or who needed a specific diet for medical reasons. Some service users have pureed meals. We were told by the Cook that time is taken in ensuring the presentation of the meal is appetising, with individual scoops of each food item on the plate or bowl. The pureed meal isnt always the same as the menu meals. A record is kept of service users individual selection of each meal. However for service users who have pureed meals the detail of the food served to them is not recorded. This should be recorded to provide evidence that each service user is being given appropriately nutritious food. Visitors who we asked told us they felt welcome when they visited the home. One person said they had particularly appreciated being invited to stay for a meal with their relative. They told us the meal was very good, tasty and nicely presented. We were told by staff that there is a delay for some service users getting their teatime meal as staff are supporting six or seven service users with their meals. And activities coordinator is employed at Treelands who works on weekdays between 10:00 and 17:00. The activities organiser had attended training sessions and has obtained qualifications in social activity related techniques. The activities coordinator is supported by an assistant who works for four hours on four days each week. The activities coordinator is enthusiastic in her interest for creating activity and stimulation for service users. She tries to encourage service users to take part in what is going on, or makes time to spend one-to-one with those service users who are not able to get up and about. We were told of the work staff are doing to coordinate a life history for each service user to provide additional detailed staff about their life and interests before coming into Treelands. The activities coordinator told us that they looked at service users care plans when they first came to stay at Treelands and undertook their own assessment of activities to help them arrange or adapt or introduce new activities to them individually or as a group. There were many activities arranged as group stimulation and on our visit service users were seen planting bulbs which in turn led them to talk about their gardens from home and their interest, or lack of it, with regards to gardening. Time was taken by the activities coordinator to encourage and support service users individually, enabling them to plant bulbs in small pots at the table. There is a weekly activities plan, in addition to a yearly plan. Each unit was recorded Care Homes for Older People Page 18 of 32 Evidence: as having an activity for a short while during the day. We were told that residents from any of the other units can be brought up to unit but the activities being organised, to join in if they wish. Staff on some units said the activity was limited to nail care and not a lot else really happened. We were told that service users who were poorly or were being looked after in bed have one-to-one time spent with them. Records of these interactions did not appear to be well maintained and they indicated that these interactions were infrequent. The activities coordinator and staff have started creating memory boxes. This is a collection of items which individual service users holds dear to them. These were beginning to be attached to the wall outside the service users individual bedrooms. This supports service users to be independent as seeing something which is familiar to them would assist them to find their own bedroom. A hairdresser comes to the home twice a week and service users can go to the hairdressing room to have their hair done. We were told that for service users who are in bed the hairdresser would go to their room to do their hair there, if requested. In addition to activities arranged in the home we were told that staff take service users out once a month for lunch or something similar. This is undertaken in staffs own cars so limits the number of service users who can go out each month. Staff felt that only the more able-bodied service users could use this opportunity to go out. There were boardgames which service users could take part in and care staff were seen carrying out impromptu activities with service users as part of their routine. There are two organised larger outings each year where more service users can take part. We were told of trips out to Stapeley Water Gardens and to Quarry Bank. Some service users were seen to be walking around the home apparently without rest or stimulation. When we asked about this, we were told that for one service user staff walk and talk and read the newspapers with them. Staff were seen interacting with some service users to try to engage them to rest or to give them some distractions in an attempt to settle them. Care Homes for Older People Page 19 of 32 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. Service users are protected from abuse or exploitation and are confident that any complaint they may have will be dealt with appropriately. Evidence: The home has a written complaints procedure. This has been found to be appropriate at previous inspections and was not looked at during this visit. We looked at the record of complaints maintained by the home. This presented as being an appropriate record to demonstrate that people can complain and that their complaints are listened to. All four surveys returned by or on behalf of service users said they knew how to make a formal complaint and three of the four said there was someone they could talk to if they were unhappy. All visitors who we asked, told us that they were confident that they could complain if they needed to. We were given a copy of the training matrix which indicated that the majority, but not all, of staff had received training in connection with the protection of vulnerable adults. This information was confirmed by staff who we spoke with, some of whom had received the training and some had not. However all staff who we asked, demonstrated an understanding of what action needed to be taken if there were concerns that any service user was at risk of abuse or exploitation. All staff who returned a survey to us that they knew what to do if there were concerns about the home. Care Homes for Older People Page 20 of 32 Evidence: We have been made aware of safeguarding concerns which the Oldham Metropolitan Borough Council safeguarding team have been investigating. At the time of writing this report these investigations had not been concluded. The manager told us she was aware of the Deprivation of Liberty Safeguarding (DoLS) legislation and that the company had provided written procedures. DoLS is a relatively new legal requirement for care homes to apply to the local authority for authorisation, should any individuals liberty be restricted as a part of meeting their care needs. At the time of this visit the manager had not received specific training in connection with DoLS, but was arranging to have some through the Oldham partnership training group. Care Homes for Older People Page 21 of 32 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. People live in suitably adapted, comfortable and predominantly clean and pleasant surroundings. Evidence: Treelands is a purpose-built home which is divided into four units. At the time of this visit redecoration and refurbishment was in process on one unit with the intention of this being completed on the others. The environment on one unit in particular (Beech) was found to be clean and tidy but with a generally unpleasant smell and the decor being in need of an upgrade. During this unannounced visit domestic staff were observed to be following their cleaning schedules of service users bedrooms and toilet and bathing areas. Visitors who we asked said that the home is usually clean and tidy with no unpleasant smells. We identified no specific remedial requirements in connection with the physical environment of the building. We were told that service users could personalise their own rooms. We saw evidence of the memory boxes (mentioned in section 3 of this report) outside some bedroom Care Homes for Older People Page 22 of 32 Evidence: doors. Care Homes for Older People Page 23 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills mix of staff on duty usually promotes the independence and well-being of service users. Evidence: We were told by the manager that staffing levels are usually maintained during the day (08:00 -- 20:00) as one senior and one or two carers on two units, and on the units with nursing care provided, one nurse and two carers. Night cover is provided by three nurses and five carers. We were given a copy of the staff Rota for the week beginning the 14th of March 2010 to demonstrate this. In addition to carers and nurses, the home employs ancillary staff including domestics, Cook, activity coordinators and an administrator. At the time of our visit, which was unannounced, it appeared that there was sufficient staff available to meet the needs of the service users. Some staff told us during our visit that additional support at mealtimes would be beneficial due to the number of service users who need assistance to eat. We were told by the manager that of the 29 carers (not including the registered nurses) two held NVQ (National Vocational Qualification) II and six held NVQ III. NVQ is the qualification intended to improve the skills, knowledge and understanding of staff. The number of care staff at Treelands with an appropriate NVQ is lower than suggested by the National Minimum Standards. However, we were also told that 11 more care staff were registered to undertake the NVQ II, which would take the Care Homes for Older People Page 24 of 32 Evidence: proportion over that identified in the national Minimum Standards. We saw a copy of the homes training records which indicated that staff have access to a range of training opportunities. The manager had identified in the AQAA that a more robust approach was needed to ensure more staff attended training. Staff who we asked confirmed that training was available and they were encouraged to participate by the homes management. All staff who returned a survey to us said that they received training relevent to their role, and which kept them up to date with new ways of working. Service users who we asked, were positive about the approach and attitudes staff. One said staff are always nice and helpful and another said she was very happy with the support and care she received. The manager had told us in the AQAA that robust recruitment procedures were followed. We looked at a sample of staff files in connection with the recruitment and vetting process. This provided documentary evidence that the recruitment and vetting had been undertaken thoroughly. Appropriate references and CRB (criminal records bureau) declarations had been obtained before an applicant commenced work in the home. There was also evidence that gaps in an individuals employment history had been identified and satisfactorily explored with them. Care Homes for Older People Page 25 of 32 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. The manager has not yet been registered with the Commission. Quality audits are not always successful in identifying and rectifying shortfalls which may impact on the safety and well being of service users. Evidence: Since the previous key inspection the manager who was present at that time, had left the home. We had been told by the current manager that she took up her post in July 2009 and was in the process of applying for registration with us. In January 2010 we had been told by the manager that some documentation had been misdirected by a third party which had contributed to the delay in processing her application. At the time of this inspection visit we did not appear to have received a completed application for registration from her. The manager arranged for and undertook a range of quality audits (checks) on aspects of the running of the home. It appeared that these had not identified some of the issues and shortfalls in connection with care planning, bed rail safety and Care Homes for Older People Page 26 of 32 Evidence: medication, identified in section two of this report. In addition to quality audits routinely undertaken by the management team at Treelands, the company organised an annual customer satisfaction report. We were shown a copy of the report which related to a survey undertaken in March 2009 and we were told that this years customer satisfaction survey would be undertaken soon. We also saw evidence of reports on the conduct of the home being written on a monthly basis following a visit to the home by a representative of the company who did not work at the home. We looked a small sample of records relating to money held by Treelands on behalf of service users. These presented as being appropriately maintained to protect the interests of service users. A sample of purchases made on behalf of service users, including hairdressing, toiletry and newspapers, was identified from these records and all were seen to have appropriate receipts. The home presented as being predominantly well maintained with no obvious health and safety concerns other than the potential risk from bed rails identified in section two of this report. Staff training included health and safety awareness. We were told in the AQAA that equipment used in the home was inspected and serviced as required. We looked at a small sample of maintenance records, including the fire detection and alarm system, the lift and food safety records. These records presented as being in order. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 8 The responsible person must 23/10/2009 ensure that an application is made for the registration of a manager . The registration with the Care Quality Commission is intended to ensure that the service is run by a person who is fit to do so and is accountable for the service provided. Care Homes for Older People Page 28 of 32 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 7 15 The registered person must 28/05/2010 ensure that care plans are reviewed so that they address all areas of potential need, including social and spiritual needs as well as physical and health needs. The plans must be up to date and identify if any parts of the care plan have been superseded. This is to help ensure all staff have the same understanding of the best way to meet the needs of each service user. 2 9 13 Controlled drugs must be stored in cupboards that meet the requirements of the law. This will help prevent mishandling and misuse. 30/07/2010 3 9 13 Medicines must be administered to people correctly. 28/05/2010 Care Homes for Older People Page 29 of 32 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 This is important because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. 4 31 8 The manager must ensure that an application for her registration with the Commission is made. 28/05/2010 Registration with the Care Quality Commission is a legal requirement and is intended to ensure that the service is run by a person who is fit to do so and is accountable for the service provided. 5 38 13 The registered individual 28/05/2010 must ensure that risk assessments are undertaken in all circumstances where there is a known and preventable risk, including the use of bed rails. The record of the risk assessment must include any strategies to minimise the risk. This is to ensure that they health and safety of service users is maintained. Care Homes for Older People Page 30 of 32 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 7 The registered person should ensure that records of care given include all instances of dedicated social interaction with the service user. The registered person should ensure that all care plans are written in sufficient detail so that an individuals care needs can be effectively and safely met by staff even if they had no previous knowledge of the persons needs or wishes. Procedures for the disposal of medicines should be improved to help prevent mishandling or misuse. The competency of staff in giving and recording medicines should be regularly assessed to help make sure medicines are handled safely. The registered person should keep a record of food eaten by each service user who has their food pureed. This should be in sufficient detail to be able to demonstrate that they have a balanced and nutritious diet. The registered person should give consideration to amending the policy of setting the tables for meals significantly before the meal time if that constitutes a health or safety risk. The registered person should give consideration to re positioning where cold drinks are placed so that more service users could help themselves if they wished. The registered person should ensure that the improvement and redecoration of Beech unit is prioritised. The responsible individual should consider reviewing staffing levels during the day so that more staff are available at peak times, such as assisting with meals. The registered person should ensure that quality audits are undertaken more rigorously. 2 7 3 4 9 9 5 15 6 15 7 15 8 19 9 27 10 38 Care Homes for Older People Page 31 of 32 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - 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!

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