Care Home: Treetops Care Home

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What the care home does well Medicines are stored securely for the protection of residents and the temperature of the room where the medication is stored is monitored and recorded regularly to ensure medication is of suitable quality. Improvements continue to be made to the home so as to ensure that people live in a safe, well maintained and comfortable environment. People who use the service are able to express their concerns and are protected from abuse. The service has a very low incidence of complaints and safeguarding referrals. The manager maintains a well organised record of complaints. People who live at the home told us they are very happy living there and like the staff who provide support. Comments included "I like living here" and "I am happy here".People confirmed they are enabled and supported to maintain close relationships with family members and to see friends and to receive visitors. There is an appropriate system in place to ensure that staff receive regular formal supervision. What the care home could do better: Staff must make sure residents are only given medicines, including the use of creams, from containers labeled for them. Records made when medicines are given to people must be accurate and complete. Any omission must be promptly investigated and refusals of medication must be documented with the reason for refusal. Any variations to prescribed instructions for medicines must only be with the documented agreement of the prescriber. Where people are prescribed medicines on a "when required" or variable dose basis there must be clear guidelines for staff on the circumstances such medicines are used. Where people are at risk of losing weight/have a reduced appetite, ensure this is detailed within their plan of care and there is a risk assessment in place detailing how this is to be managed. Ensure that nutritional records are fully completed so as to determine meals provided to people. Take adequate precautions against the risk of fire and ensure appropriate steps are taken to maintain people`s safety and wellbeing. This refers specifically to ensuring that people`s doors are not wedged open, that alarms fitted to exits are fully operational and staff working at the home are prompt in responding to any alarms that may go off. Ensure that further developments are made to the home`s care planning system so as to ensure these fully reflect individual`s care needs. Ensure an effective system is provided at the home, that provides people with a safe, but comfortable, water temperature. The outcome of Regulation 26 visits by a nominated person of the organisation must be formalised in a report each month and made available for inspection. Random inspection report Care homes for older people Name: Address: Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH two star good service 09/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Love Date: 1 9 0 5 2 0 1 0 Information about the care home Name of care home: Address: Treetops Care Home 23/25 Station Road Epping Essex CM16 4HH 01992573322 01992570241 treetopsepping@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Epping Care Home Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 52 Number of places (if applicable): Under 65 Over 65 52 old age, not falling within any other category Conditions of registration: 0 Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 52 persons) Date of last inspection Brief description of the care home Treetops Care Home is a large detached property set in a residential area within five minutes walking distance of the town centre of Epping. Epping Care Home Ltd owns the home and the manager is Hayley Dawkins. Treetops Care Home is located close to the railway station and a bus service runs regularly. Local shops, banks, post office, library and other facilities are within easy reach in Epping Town centre. This is an adapted property that provides accommodation for older people on four floor Care Homes for Older People Page 2 of 13 0 9 1 1 2 0 0 9 Brief description of the care home levels, which are serviced by passenger lifts. Premises refurbishment work is currently taking place. The home provides a residential care service for older people. The fees at Treetops Care Home range from between 550.00 and 600.00 per week. There are additional charges for items of a personal nature. These should be discussed directly with the home. Care Homes for Older People Page 3 of 13 What we found: This was an unannounced random inspection. The visit took place over one day by two inspectors, of which one was a pharmacist inspector and the inspection lasted a total of 5.5 hours. The purpose of the site visit was to monitor compliance to the Outcome Groups relating to Personal Care and Healthcare, Concerns, Complaints and Protection and Conduct and Management of the Home. We also undertook a tour of the premises soon after our arrival to the premises. As part of the process a number of records relating to people who live in the home, support staff and the general running of the home were examined. Prior to the site visit, surveys for people who live at the home and care staff were requested to be sent to the home for distribution. We received completed surveys from 4 people who live at the home and 1 from a member of staff. We also looked at all the information we have received, or asked for, since the last key inspection on 9th November 2009. Prior to this inspection, the manager submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report where appropriate. The manager has been at Treetops Care Home for the past 15 months. The manager told us they have recently applied to the Commission to be formally registered. The manager told us that both the management team and care staff team continue to work hard to achieve positive outcomes for people in the home. The manager believes that staff are working very hard and that systems to improve the service are progressing well. At the time of the site visit there were 37 people living at Treetops Care Home. The manager confirmed to us that as a result of staff sickness the morning shift was short of two members of staff. As a result of this the manager had stepped in and was working as a member of care staff leaving the shift short of one member of staff. We advised the manager to complete a Regulation 37 Notification detailing the circumstances of the staffing shortfall. The manager told us she was unaware that the Commission needed to be informed. A Regulation 37 Notification relating to the above was forwarded and received by us on 25th May 2010. As part of this site visit we looked at a total of 4 care plans (2 in full and 2 in relation to specific healthcare needs). Records showed that each person had a plan of care detailing their individual care needs and how these are to be met by care staff. Records showed that admissions are not made to the home until a full needs assessment has been undertaken except in exceptional circumstances whereby someone is admitted to the care home as an emergency admission. Records showed that for each person newly admitted to Treetops Care Home, a pre admission assessment was completed by the management team of the home prior to their admission and information recorded was noted to be detailed and informative. Where the person is referred from a Local Authority or NHS Health Trust a copy of their assessment was evident within their file. The care plan format includes a Resident Profile and this provides to the reader a snap shot of the persons specific care needs. In addition the plan of care makes reference to Care Homes for Older People Page 4 of 13 10 specific areas and these include communication, personal care, mobility, eating and drinking, elimination, social activities, spiritual/expressing sexuality, finance, safeguarding risks and night care plan. Additionally formal assessments are completed in relation to manual handling and pressure area care. We looked at the care plan for someone who is diabetic. At the previous key inspection to the home in November 2009 we highlighted shortfalls in relation to information recorded being generic and not person centred around how peoples diabetes should be monitored and/or their treatment. Records showed at this inspection that the care records were more detailed, identifying the persons specific type of diabetes and treatment provided by a healthcare professional. Records showed for one person that they have a progressive neurological condition. While we recognise there was a plan of care and risk assessment in place for this, information recorded did not provide sufficient information as to the impact this has on their ability to carry out everyday tasks and the associated risks. However on inspection of their pre admission assessment, this informed us that the person had a history of falls, that they could experience tremors and spasms as a result of their condition, some tasks take a long time to complete, mobility can fluctuate and as a result of their physical decline and deterioration they have found this distressing. None of this information had been used to inform the plan of care or risk assessment. We were unable to confirm this information with the resident as they were not present at the home at the time of the site visit. The AQAA details that all information is gathered from the persons pre admission assessment and this informs the plan of care. This did not fully concur with our findings. We also looked at one persons care plan in relation to their nutritional needs. Records showed that following a long period of time in hospital they had lost a significant amount of weight. Following their re-admission to the care home their care plan and risk assessment had been reviewed and amended to reflect their current care needs. However records showed that since their re-admission to the home and within a one month period, they had lost approximately a further 5KG. It was unclear from the records as to why their risk assessment remained green low risk especially as on inspection of their daily care records, there was consistent evidence to show that they ate and drank little most days. The care plan also made reference to the person being weighed weekly however we could find no evidence to support this being undertaken. The manager confirmed to us that this is recorded within the plan of care and not held anywhere else. As part of case tracking we also examined their daily nutritional records and found these to be inconsistently completed with gaps, little evidence of alternatives to the menu being offered and on some days no information was recorded. We looked at a further 5 peoples daily nutritional records and found the same issues. When discussed with the manager during feedback they confirmed they were aware of the shortfall and recognised this requires reviewing and improvement. Records showed that people have access to a range of healthcare professionals and services as and when required and these include Chiropodist, GP, Dentist, Optician, District Nurse Services and Consultant Psychiatry. People who live at the home are supported by staff to attend appointments and other healthcare checks. During the site visit staff were observed to go about their tasks and to provide care and support to people in the home. The impact of the staff shortage meant that staff were unable to spend lots of time with individual people and verbal interactions with people Care Homes for Older People Page 5 of 13 who live at the home were not as positive as witnessed at past inspections. During the site visit we overheard a person who lives at the home state to a member of staff that they had the wrong glasses on. The manager was observed to bring 3 other pairs of glasses and overheard to say to try before the resident decided one pair of glasses was OK. We also observed the same person being assisted into a wheelchair which had only one foot plate fitted. We observed both the manager and a member of care staff place both feet onto the one foot plate and then to take the person to the toilet. We also witnessed two occassions whereby staff did not knock before entering a persons bedroom. Information relating to how people can make a complaint, raise concerns and the timescales by which they can expect a response was displayed in the main entrance to the home. The manager maintains a well organised record of complaints and this was evidenced through a monthly audit of the number and types of complaints received. Records showed since the last key inspection in November 2010 there have been 5 complaints. These related to missing laundry, missing personal grooming equipment, lack of personal care for one person, one person disturbing others at night and one person not liking some food items provided. Records viewed indicated that each issue had been investigated, dealt with and actions identified and completed where appropriate. Two people spoken with who live at the home confirmed if they had an issue or a complaint, they would discuss this with a member of staff or the manager. Records of compliments were also available and these included Thank you for all your care and kindness, Thank you for everything and Thanks for all your help. The AQAA also details there is an open door policy by the management team to encourage people who live at the home and their families to voice their concerns. Since the last key inspection there has been 1 safeguarding referral. We were notified of this prior to the site visit by the manager and records showed that appropriate action had been taken to promote the wellbeing of the resident and other external agencies notified e.g. Social Care Direct and the police. The AQAA details that all staff undertake safeguarding training. The manager told us there is a quality assurance system in place that includes obtaining the views of people who live at the home, their relatives and/or representatives about the quality of care provided and the homes services and facilities. The manager confirmed that this has not been undertaken since the key inspection in November 2009 however she is due to commence the process for 2010. There are strategies in place for monitoring the quality of the service provided at Treetops Care Home. This includes an external consultant visiting the home once monthly as part of its obligation to undertake Regulation 26 visits and to compile a written report. We requested records of these visits and noted there is evidence to indicate these have not been undertaken as regularly as they should. The last report on file was dated September 2009. When discussed with the manager they stated these have been completed each month but acknowledged there was no evidence to support this. Records of staff meetings were viewed for the period January to April 2010. Records confirmed people who attended and the details of topics discussed. The manager maintains a well organised record of accidents which have been sustained by people living at the home. A monthly record is kept detailing specific information as to Care Homes for Older People Page 6 of 13 whether or not the injured person requires a paramedic, hospital admission, GP visit, District Nurse visit or no treatment. Records were of a good quality and showed there is a low incidence of accidents at Treetops Care Home. We looked at the staff supervision tracker for 2009-2010. Records showed that up until October 2009 staff were receiving regular formal supervision, however in November and December 2009 few supervisions were undertaken and this resulted in some members of staff not having the recommended number of supervisions in line with the National Minimum Standards. When discussed with the manager we were advised that it was possible that more supervisions had been undertaken but the records not kept up to date. The supervision tracker for 2010 showed that the majority of staff have received 2 supervisions and 14 people have had an annual appraisal. A partial tour of the premises was undertaken during the morning. Further refurbishment and redecoration of the home continues and since the last key inspection a further 5 bedrooms have been redecorated. At the last two key inspections (May 2009 and November 2009) to the service, we found that hot water emitting from a random sample of wash hand basins and baths was luke warm and the temperature recorded between 35 degrees centigrade and 38 degrees centigrade. A requirement was made at both inspections detailing that people at the care home must be provided with a sufficient supply of hot water at all times. Following the last inspection the action plan from the manager recorded that by January 2010, a more robust folder has been implemented divided into month order with outcomes and actions for any concerns or reports. At this inspection we found that hot water emitting from a random sample of wash hand basins and baths remains luke warm. Records of hot water temperatures from December 2009 showed on occasions these were above the maximum of 43 degrees centigrade (47 degrees centigrade to 50 degrees centigrade) and for January and February 2010 the temperature range varied from between 29 degrees centigrade to 38 degrees centigrade. This remains unacceptable and the manager must ensure an effective system is implemented that provides people with a safe, but comfortable, water temperature that is not below blood temperature. During a tour of the premises we noted that one of the fire exits on the garden floor were not locked and the alarm fitted was faulty as it did not sound when the door was opened. We waited for a period of 5 minutes and were able to walk to the front of the property. As a result of this we opened a fire exit door to the side of the premises to test that the alarm fitted was in full working order. It was evident that the alarm was fully operational however the alarm was not turned off at the point of call and no member of staff on duty came to enquire and/or check what had happened. This poses a potential risk to people living at the care home as they can leave the building undetected and can access both the rear and front of the building car parking areas, which allow easy access to a main road and people not authorised and/or who have no legitimate reason to visit Treetops Care Home to gain easy access to the premises. This has been highlighted at previous inspections to the home and improvements and/or measures put in place to ensure peoples safety have not been sustained. As a result of the above we left an Immediate Requirement Notice detailing the breach of regulation and they were required by 28th May 2010 to tell us how they intended to meet the requirements. A prompt response was forwarded to us and received by the due date detailing actions taken and to be taken. A number of bedrooms within the home were observed to have their doors wedged open. Care Homes for Older People Page 7 of 13 Records relating to fire drills, the homes fire risk assessment, testing of the homes fire alarms, emergency lighting and fire extinguishers were examined and noted to be well managed and satisfactory. We looked at the practices and procedures for the safe handling, storage and recording of peoples medicines. Medicines are stored securely for the protection of residents and the temperature of the room where the medication is stored is monitored and recorded regularly to ensure medication is of suitable quality. We found a used cream in one persons room which had the name of another resident on the label. Staff must make sure residents are only given medicines, including the use of creams, from containers labeled for them. We looked at the medication and medication records for several people resident in the home and we found a few problems with these records. We found a few gaps in the records made when medicines were given to people giving no indication whether medicines were administered or not and if medication was omitted or refused by the resident then the reason was not always recorded. We found that where people are prescribed medicines when required and in variable doses e.g one or two tablets there was not always guidance for staff on when and what dose to administer. Some medicines were prescribed to be given as directed by the doctor, but we could find no record of what these directions were. In some cases the doses of medication had been changed but could find no record that these had been confirmed by the prescriber. We found that the medication record for one person stated that they had an allergy to penicillin but their care record did not carry any risk assessment or risk management plan about this. On our last inspection on 9/11/09 we found that the records made when medicines are given to people had improved and did not make a requirement following that inspection. This time we have found that the standard of record keeping has fallen and we have made requirements about this. At our last inspection we made a requirement that when people are prescribed medical oxygen there must be documented verification of the flow rate and duration of use and that there must be appropriate risk assessments in place. We looked at the care records for people using medical oxygen and found that the flow rate had been recorded and a risk assessment was in place but this could be improved with an assessment of the relative risk. However, we consider the requirement has been met. What the care home does well: Medicines are stored securely for the protection of residents and the temperature of the room where the medication is stored is monitored and recorded regularly to ensure medication is of suitable quality. Improvements continue to be made to the home so as to ensure that people live in a safe, well maintained and comfortable environment. People who use the service are able to express their concerns and are protected from abuse. The service has a very low incidence of complaints and safeguarding referrals. The manager maintains a well organised record of complaints. People who live at the home told us they are very happy living there and like the staff who provide support. Comments included I like living here and I am happy here. Care Homes for Older People Page 8 of 13 People confirmed they are enabled and supported to maintain close relationships with family members and to see friends and to receive visitors. There is an appropriate system in place to ensure that staff receive regular formal supervision. 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 2. Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 17 Where people are at risk of losing weight, maintain appropriate nutritional records. Previous timescale of 15/5/2009, 24/7/2009 and 14/12/2009 not met. So as to ensure peoples safety and wellbeing. 07/06/2010 2 19 23 People who live at the care 01/07/2010 home must be provided with a sufficient supply of hot water at all times. Previous timescale 18/5/2009 and 14/12/2009 not met. So as to enable people to have a wash, bath and/or shower in the knowledge that the water will be at a reasonable temperature for their comfort. Care Homes for Older People Page 10 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 23 Fire exits must not provide 21/05/2010 easy access for people living at the home to exit the premises unnoticed or for uninvited people to access the care home. So as to ensure peoples safety and wellbeing. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Ensure care plans are completed for all areas of need and there is clear guidance for staff as to how to meet the persons care needs. So as to ensure that staff are able to provide good care. 30/06/2010 2 9 13 Where people are prescribed 30/06/2010 medicines on a when required or variable dose basis there must be clear guidelines for staff on the circumstances such medicines are used. This will protect people from harm by ensuring medicines are not used inappropriately. 3 9 13 Any variations to prescribed 30/06/2010 Page 11 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 instructions for medicines must only be with the documented agreement of the prescriber. This will ensure people receive their medicines as prescribed. 4 9 13 Records made when 30/06/2010 medicines are given to people must be accurate and complete. Any omission must be promptly investigated and refusals of medication must be documented with the reason for refusal. This will demonstrate people receive their medicines as prescribed and justify any reason why they are not. 5 10 12 Ensure people who live at the 07/06/2010 home are treated with respect and their privacy is upheld at all times. So that people feel valued and respected. 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 33 Following a Regulation 26 visit by a representative of the organisation, ensure a report is compiled and available for inspection. Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 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 noncommercial 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. 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