Care Home: Trees Nursing Home

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What the care home does well The service offers a very spacious and well laid out home to the people living there, and from the evidence that we gathered on our visit, and the further information provided, clearly puts the interests of the people living in the home at the forefront. They ensure that the needs of those living in the home are fully assessed before anyone moves into the home, and kept under review, and provides full care and support for both health and nursing needs. The home has a very welcoming feel, and visitors are made very welcome, and many of the people living in the home are from the local area. A core of established staff are in the home, and all receive good levels of training. What has improved since the last inspection? There have been no major changes since we last visited the home, apart from ongoing redecoration. More information is now obtained about residents likes and dislikes in respect of activities, reflected in the wide range of activities and events available. Staff have received additional training, and the supervision process improved, and a programme of landscaping the garden is almost finished What the care home could do better: There were no significant requirements found during our visit, although the work indicated above on social interests needs to be reflected within the care plans. Ongoing refurbishment should maintain the high environmental standard seen on our visit. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Trees Nursing Home 12 Candlers Lane Harleston Norfolk IP20 9JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Buttery     Date: 0 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Trees Nursing Home 12 Candlers Lane Harleston Norfolk IP20 9JA 01379853919 01379855307 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) : Mrs Susan Nolan care home 21 Number of places (if applicable): Under 65 Over 65 20 0 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 1 The home is situated in the centre of the small market town of Harleston. The services and facilities are of a good standard and all sited on the ground floor. The home can accommodate 20 older people over the age of 65 years who may have care or nursing needs, and one service user who may have a physical disability. There are 21 single rooms (17 with en-suite facilities). There are attractive landscaped gardens with flower-beds and paths around the property that can be accessed by service users. There is ample parking space to the front of the premises. The home is supported by local GP surgeries and appropriate health care services. A copy of the current inspection report is always available and fees currently are set at Care Homes for Older People Page 4 of 25 Brief description of the care home 535 GBP per week. Care Homes for Older People Page 5 of 25 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: two star good 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: This was an unannounced inspection, carried out over a period of about four hours. During our visit, we were provided with information and records required by the manager of the service, and were also able to speak to a number of residents and staff members, whose views are reflected within the report. An Annual Quality Assurance Assessment (AQAA) was also submitted prior to our visit, and a number of residents and staff completed our survey forms, and again all of these have been used in compiling the report. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 set out 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 8 of 25 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 9 of 25 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. Prior to a new resident moving into the home, their care needs are assessed to ensure that the home is able to meet those identified needs in a safe way, and in a way suited to the individual. Evidence: Previous inspection reports indicated that a detailed assessment is carried out to identify the needs of any possible new resident, and the manager of the service advised that this system has remained in place. Following initial enquiries, and on occasions a visit to the home, the manager visits the prospective resident, either in their own home or in hospital and completes a detailed assessment, looking at the specific needs of the person as well as their expectations. Assuming that the manager is happy that the identified health and social care needs Care Homes for Older People Page 10 of 25 Evidence: can be met, and a room is available that suits the person, arrangements are then made for the person to move into the home. The person would be registered with the local GP practice, unless it was suitable to remain with their current GP, and initial care plans prepared. The care plans are developed further over the first few days, and discussed with the new resident and their family to ensure that they are appropriate. During our visit, we looked at four care plans, mainly for people who had moved into the home in the past few months, and including one for a resident with some complex support needs. These all showed evidence that the initial assessment information had been obtained. In addition we spoke with three of these people, who confirmed that the admissions process was as described by the manager and seen in the records examined. The service does not offer intermediate care. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans show how the support needs of the people living in the home should be met, and how the individuals preferences are met. Evidence: As already intimated, individual care plans are in place, and were seen during our visit for four of the residents living in the home. In addition we were able to speak with three of these people. The plans show how the needs identified in the assessment process should be met, giving staff information to enable them to offer support suited to the individuals preferences. There was also evidence on the records we looked at that the care plans are reviewed on a regular basis, and the manager of the service told us how they include family members in some of the reviews, normally at least twice a year. Care Homes for Older People Page 12 of 25 Evidence: The plans do need to show more information on the social needs of the individuals living in the home, and the planned outcomes for the person concerned. This information is available elsewhere but needs to be reflected in the actual care plan. From discussions with three of the residents whose plans were looked at, it is clear that they are consulted about their individual plan and their likes and dislikes, and able to contribute to them, and as mentioned earlier, family members have an involvement in some reviews, although there was no no formal record of this. This is something that the service should address. Care Homes for Older People Page 13 of 25 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. A variety of events and activities are available for people living in the home to enjoy if they choose, and a varied menu including fresh local produce always available. Evidence: A range of activities and events are available to people living in the home, depending on their individual likes and dislikes, although as indicated earlier, more information should be included within the individual plans. Regular events include musical entertainment, music therapy, quizzes, aromatherapy, keep fit and Bingo, and Church services are held twice a month. In addition, residents in the home are able to access facilities and shops in Harleston, often with support from staff members, which is within walking distance of the home, and relatives visiting often go into the town. One resident attends a day service in Norwich once a week, and another has a detailed support package enabling her to go out with a carer every day. A good variety of food is served in the home, with a rotation of menu, and all local Care Homes for Older People Page 14 of 25 Evidence: produce, and on occasions, the residents enjoy fish and chips from the local chip shop, again a short walk from the home. Care Homes for Older People Page 15 of 25 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. Procedures and training are in place to ensure that any concerns complaints or allegations are dealt with quickly, and people living in the home know how to make any concerns known. Evidence: During our inspection visit, we looked at the complaints records held in the home, and it was clear from these that any concerns are quickly dealt with, and no issues remain outstanding. A log of complaints is maintained showing when the complaint is received, and the outcome of the enquiries. This is in line with the regulations. In addition we spoke to several people living in the home, and they were all able to confirm that they were aware of the procedures they should follow if they had any concerns, and who to talk to. All staff working in the home have undertaken safeguarding training, and evidence of this was seen in the staff records examined. Procedures are in place to investigate any safeguarding incidents in accordance with local authority procedures, although no issues have been raised since our last visit. Care Homes for Older People Page 16 of 25 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 spacious accommodation which is clean and safe for the people living there. Evidence: The service is based in a clean and well equipped building, which is very close to the small market town of Harleston, and within easy reach of local facilities, which are widely used by people living in the home. The home is set in secluded grounds which are well maintained and provide seating areas for the residents to use. Most of the individual rooms are en-suite, and the home is generally well decorated, and free from any offensive odours. A refurbishment programme is ongoing, and the AQAA submitted indicated that they hope to carry out more refurbishment in the coming year. Procedures are in place to prevent the spread of infection, including washing facilities and hand gels, and staff were seen to use these, as well as using aprons and gloves. The home has three bathrooms which are all in use, and offers very spacious accommodation to the people living there. Individual rooms are well equipped, and residents are encouraged to bring personal items with them, and evidence of this was Care Homes for Older People Page 17 of 25 Evidence: seen during our visit, for example one resident who is particularly interested in calligraphy and has been able to bring their own desk and pens with them. Care Homes for Older People Page 18 of 25 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. A well trained staff team is in place, able to offer the residents support suited to their needs, and procedures ensue that all required information about staff is in place. Evidence: Appropriate numbers of staff were seen on the day of our visit, and this was confirmed to generally be the case. The service has no difficulties in recruiting staff, a constant stream of local enquiries ensures they are always fully staffed. and most of the staff are local which helps to ensure flexibility. The service is family owned, and at the present time recruitment records are held at their other home. These were examined during a recent inspection visit there, and showed the procedures that are in place do ensure all the required information is obtained. We were also able to look at staff training records, held at this home, which showed that all the staff receive suitable induction training and mandatory training as well as some more specific training aimed at the needs of the people living in the home. The home is managed by a registered nurse who ensures that clinical training is in place for the qualified staff. Care Homes for Older People Page 19 of 25 Evidence: Staff we observed during our visit clearly knew the residents well, and spoke appropriately to them at all times. They appeared unhurried, with time to spend talking to residents, and residents we spoke to during our visit told how good all the staff were. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure the health and safety of everyone in the home, and the management team ensure that the service is run with the residents interest in mind. Evidence: This is a family run business, and the interests of the people living in the home clearly placed at the fore, with regular contact between all the management and residents on a daily basis. The management team has been in place since the home opened, which has ensured a consistency of approach, and discussions with both the manager and the responsible individual clearly demonstrated a commitment to improving the quality of the lives of the people they support. We spoke to a number of people who live in the home during our visit and they told us that the management are always on hand to listen to any ideas they may have and to include them in all decisions that affect them. The management ensure that people are Care Homes for Older People Page 21 of 25 Evidence: comfortable, and that they bring personal items with them when they move into the home. The people we spoke to also told how much they enjoy living in the home, one person who moved in recently said it felt as if he had lived there for years another how lucky they felt to have been able to move to the home. Health and safety procedures are in place which ensure that both staff and residents are safe at all times, and suitable training is provided to all staff. Evidence of the training was seen on the files examined as part of the inspection. Records in the home were well kept, and accessible to us when requested. during the inspection, we saw evidence of ongoing maintenance, and the AQAA confirmed that this will be continued. The AQAA also confirmed that all the required safety checks and maintenance agreements are in place for equipment used in the home. The senior housekeeper in the home has a relevant NVQ qualification, and during our visit we observed all staff using necessary aids such as gloves and aprons to assist in infection control. A detailed quality assurance process is in place, with an annual questionnaire sent to residents and their families, and regular informal residents meetings take place as well as six monthly staff meetings. The atmosphere within the home was relaxed, and for the number of residents, the home appeared very spacious. Care Homes for Older People Page 22 of 25 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 23 of 25 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 7 Individual care plans should detail the social care needs of the individuals in the home, and reflect the involvement of family members Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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 © (2010) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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