Care Home: Treetops

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What the care home does well The environment of the home is particularly suited to individuals who have mental health difficulties and the small contained units and associated staffing arrangements offer a continuity and security that can only benefit the health and welfare of individuals who live in the home. In talking and observing staff there was a real sense that staff had a good understanding and knowledge of the individuals in the home. Care planning is of a solid and through nature and whilst improvements could be made they were detailed and specific in terms of tasks and support needs of the individual. The home clearly has developed a service over the years which has been able to accommodate individuals who have complex needs and at times challenging behaviour. There has historically been a long standing staff group and over the past year with the new manager is post this has resulted in staff having to face change. In the inspectors view from discussions with staff and management there was some resistance to this new "regime" however this has slowly been addressed leading to improved morale and care practice in the home. What has improved since the last inspection? A number of requirements were made at the last inspection and these were looked at on this visit. It was found that they had been met resulting in improved practice in care planning and activities. What the care home could do better: Care Planning practice whilst good needs to be improved by providing more person centred information about the individual specifically around their routines, likes and dislikes, personal history. Medication records relating to the use of PRN medication needs to be more rigorous in the administering record and reasons being given. CARE HOMES FOR OLDER PEOPLE Treetops St Clements Road Keynsham Bath & N E Somerset BS31 1AF Lead Inspector Jon Clarke Unannounced Inspection 21st May 2008 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treetops Address St Clements Road Keynsham Bath & N E Somerset BS31 1AF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9869700 0117 9860063 treetops@shaw.co.uk Shaw healthcare (Homes) Limited Mr Joseph Caine Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24) of places Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (Code MD) Dementia (Code DE) The maximum number of service users who can be accommodated is 24. 2. Date of last inspection Brief Description of the Service: Treetops is registered as a Care Home for a maximum of 24 residents with dementia and or mental disorder requiring nursing care. The Home is situated in the grounds of Keynsham hospital, which easy access to local community facilities and is within easy access to Bristol and Bath. It can be accessed by car or by bus with a short walk. The Home is purpose built, providing a mix of single, double and en-suite rooms. Care is offered on the ground floor only, which is divided into 3 units. Each unit offers bedrooms, lounge-dining room and bathroom facilities. There is a communal common room and quiet room. There are also pleasant gardens to the rear and side of the property. All parts of the home are accessible to wheelchair users as well as the able-bodied. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of an inspection. A number of records were looked at including care plans, staff records (training and recruitment), medication storage and administering arrangements and health and safety practice in the home. There was also an opportunity to observe staff and discuss with individuals who live and work in the home their views of the service provided. A number of Have Your Say questionnaire were sent to the home before this inspection responses were received from 3 residents 4 relatives and 3 health professionals and 2 from members of staff. This is a disappointing response particularly from relatives and staff. Because of the mental health of individuals who live in the home it is not expected to receive a greater number. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: The environment of the home is particularly suited to individuals who have mental health difficulties and the small contained units and associated staffing arrangements offer a continuity and security that can only benefit the health and welfare of individuals who live in the home. In talking and observing staff there was a real sense that staff had a good understanding and knowledge of the individuals in the home. Care planning is of a solid and through nature and whilst improvements could be made they were detailed and specific in terms of tasks and support needs of the individual. The home clearly has developed a service over the years which has been able to accommodate individuals who have complex needs and at times challenging behaviour. There has historically been a long standing staff group and over the past year with the new manager is post this has resulted in staff having to face Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 6 change. In the inspectors view from discussions with staff and management there was some resistance to this new “regime” however this has slowly been addressed leading to improved morale and care practice in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: A number of pre-admission assessments were looked at and showed detailed and through information about the health and social care needs of the individual with specific emphasis on their mental health. Included were mental capacity assessments. There are good links with the mental health team and consultant as part of the admission’s process and this continues once the individual is made permanent. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and included information as to care needs and associated tasks. Dietary information with where required weight monitoring charts which in one instance had been completed as required. Risk assessments as to behaviour had been completed and reviewed regularly as were nutritional risk assessments again with reviews taking place. Falls, Mobility and Waterlow assessments had been completed. In one instance an Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 10 individual was prone to developing pressure sores and the appropriate assessments had taken place. Night care assessments are also completed. There was limited information about the personal life, routines, likes and dislikes of the individuals. Where bed rails are in use it is the practice to obtain consent from the individual or third parties such as relative and GP. In one instance there was no recorded consent. Individuals who live in the home have access to the full range of community based health care such as optician, dental. The home has an allocated GP from the local surgery who visits weekly. There are strong links with the local mental health team who are involved in reviewing individuals in the home. One health professional who responded to Have Your Say questionnaire stated “the home takes the hospital’s most difficult patients with complex needs and in most cases manages them extremely effectively” Medication administering records were looked and had been completed as required with no gaps in records. However in one instance there was no record as to whether individual had been offered PRN medication. A number of individuals are given their medication covertly because of their mental health. Consent to administer in this manner had been obtained from GP and relative. A number of individuals have PRN medication the home needs to make sure there is a protocol in place for each individual it is not sufficient to state “give as necessary”. There also needs to a running stock total of PRN medication as a safeguard for inappropriate use. Where given a full record needs to be made as to the circumstances. Controlled drug (CD) records were checked and had been recorded as required with two signatures. Balances of medication were checked against record and found to be accurate. There is a daily check on CD drug stock this is good practice. Storage of CD was secure and as required. A returns book is kept however there is no signature of returns, a spills/refusal book is also now being kept. In observing staff particularly when assisting with personal care it was evident that staff have a sensitive and supportive approach to individuals. In one instance a staff member was observed dealing with challenging behaviour this was done in a calm and professional manner. An individual I spoke with said that they always felt staff treated them with respect and that their privacy was always seen as important by staff. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,12,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are satisfactory however improvements could be made and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home however improvements could be made to make sure individuals are given every opportunity to have meals of their choice. EVIDENCE: There is a good effort made to provide activities with a full time activities organiser. On the day of the visit there was an outside entertainer. Staff when able take individuals out to local shops and use local facilities. Staff stated that they would like more one to one time. A keyworker system is in place however this is not on the rota as specific part of their duty which would help in Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 12 focusing this task on a regular basis. One individual I spoke with was positive about what is going on in the home in the way of activities and this is an area the manager recognised could be more focused on the individual preferences. Religious services are held in the home and one individual of ethnic origin is supported by Asian befriending service. The AQAA stated, “Our area manager will be facilitating a series of activity coordinator meetings to re-focus their attention so that our delivery of activities so they are more person-centred. It is envisaged that all our residents irrespective of their dependency or condition will have a written programme of activities in accordance with their social and health needs. The activities will continue to be varied and will range from the more complex to the very simple but equaly important social interventions. In doing so we will build upon the achievements of the past year. Menu were looked at and offered a varied choice of meal. On the day of the visit the meal looked appetising. However the arrangements whereby individuals are offered a choice is in the inspectors view not in a real sense offering choice. Because of the mental health of individuals offering choice should be about providing a visual choice (picture menu) and at meals time actually showing individuals what is available. I observed staff working hard to encourage individuals to have a meal but there was not a sense that staff felt able to approach the kitchen staff for alternatives where what was on offer was rejected. This was confirmed by some staff members. There needs to be more flexibility perhaps using the facilities available to staff to prepare light meals and snacks. It was also noted that the dining areas in the units did not present as eating areas i.e. there was no condiments, tables were not laid for the meal. There is real effort to meet the nutritional needs of individuals in the home with Dietary Information sheets and involving specialists such as in one instance the speech therapist in advising as to meeting specific needs around eating and food preparation. For an individual of Indian origin alternative meals are provided. In talking with the cook it was clear that they make a real effort to make the meals as appealing and appetising as possible and they had a good understanding of the importance of food and mealtimes in the daily lives of individuals in the home. The kitchen has been awarded 5stars Food Safety Award for their good practice in food hygiene. This is to be commended. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: I looked at the response to a complaint that had been made by a relative a through investigation was carried out by the manager of the home and the appropriate action taken. The complaint was partly upheld. As part of this complaint there were concerns as to the behaviour of a member of staff. A referral was made as required to the Adult Protection team. Following investigation it was established that the actions of staff whilst of some concern in their response to challenging behaviour there was no evidence of abuse. Action has been taken regarding the staff members involved and the inspector is satisfied that the complaint had been dealt with in a professional manner. The home has a Safeguarding Adults policy and procedure and staff undertake Adult Protection training. There was an opportunity to talk with staff about Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 14 their understanding of what constitutes abuse and their response. Staff were clearly aware of the more subtle forms of abuse that may occur in a care home and of their responsibility to take action if they had concerns about abuse possibly taking place. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In walking around the home it was evident that there is a good standard of cleanliness and the home is well maintained. Improvements have been made in the environment of the home since the last inspection including redecoration of a number of areas and these have been in colours that may assist individuals with orientation and identifying areas of the home such as toilets. A sensory room has also been established where individuals who may Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 16 be distressed or agitated can go a member of staff said they had used this room and it had been effective in calming and relaxing the individual. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing rota were looked at and showed that there are adequate numbers of staff in duty in the home. There is generally 6 care support workers on duty am and 5 pm with 2 waking night this is in addition to RGN/RN. A positive of the staffing arrangements and this was confirmed by staff is that whenever possible staff work in specific units. Recruitment records were looked at and they showed the required documentation was in place: two references, Criminal Record bureau check and full application. Staff undertake 4 day induction period that includes moving and handling training, health and safety. Staff had also received Introduction to Dementia and Dementia and Person Centred Approaches training. In talking with staff they were satisfied with the level and quality of Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 18 training provided. Twelve of the twenty one staff have completed NVQ 2/3 professional qualification. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: The manager of the home has extensive experience and is well qualified for the position of managing Treetops. In talking with the manager and staff it was evident that real improvements have been made over the past twelve months particularly in the area of communication and team working leading to improved morale confirmed by staff. The manager acknowledged that there Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 20 still remain challenges in achieving the changes and staff commented that the manager at times could be more approachable. The Investors In People report recognised the areas of strengths in the home being improved leadership, improved communication and the quality of teamwork in the home. Of particular note is the perception from staff that Treetops is “good place to work” 25 , “very good place to work” 55 and “a great place to work” 12 . This is to be commended and re-enforces the improvements that have been made in the home with support of all staff and management. An area of development is that of Quality Assurance and the home has been the subject of two audits around care planning and medication. It is hoped that that efforts will be made to seek the views of individuals who live in the home, relatives and professionals as part of these quality assurance audits. The manager plans to organise relatives and residents forums that will provide an opportunity for individuals to express their views about the service at Treetops. The previous inspection noted that health and safety practice in the home is of the required standard with regular tests and servicing of fire equipment and system. A fire risk assessment of the environment of the home has been completed. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The manager to ensure that full records are completed in the use and administering of PRN medication. (This refers to protocol for use of PRN medication and record of circumstances where given) The manager to ensure that full records are kept of returned medication and signed for by the appropriate individuals as record of receipt. Timescale for action 30/06/08 2. OP9 13 (2) 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 23 1. 2. OP7 OP15 3. OP27 Care plans to be more person focused so that the care provided is centred on the individual. Improve the arrangements for providing meals so that individuals have an opportunity to exercise real choice taking into account their mental health. Improve the environment and experience in relation to having meals which gives greater independence. The staffing rota to include allocated period for keyworker time. This would improve the opportunity for staff to have one to one time with individuals in the home. Treetops DS0000020257.V362658.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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