Care Home: Treetops Nursing Home

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What the care home does well The manager ensures that people`s needs are fully assessed before they move into Treetops; this is so that she can be sure that the facilities and staff skills can provide the care and support to maintain health and promote independence. The manager has liaison with health care professionals which ensures that people`s physical health needs are met so that people remain comfortable and healthy for as long as possible. People said: `Any medical problems reported are dealt with straight away.` People at Treetops are supported in achieving a good level of personal grooming. This helps to promote good infection control and indicates that people`s personal choice is respected. The meals served at Treetops are wholesome and enjoyed by the residents. The manager makes sure that Treetops is a clean and comfortable place to live. The manager ensures that complaints and concerns are dealt with openly and fairly, and that processes are in place that protect vulnerable adults from abuse. Staff receive training and are employed in sufficient numbers to meet the majority needs. Health and safety issues concerned with the running of the building are well managed. What has improved since the last inspection? Since the last inspection the manager has made sure that care plans are individualised and provided detailed instructions to staff about the actions they needed to take to meet people`s needs. Since the last inspection the manager has made sure that staff work in the home only after she has completed a thorough vetting process. This is to guard against employing people with a history of abuse or violence that will make them unsuitable for working with vulnerable people. CARE HOMES FOR OLDER PEOPLE Treetops Nursing Home Carthage Street Oldham Lancashire OL8 1LL Lead Inspector Michelle Haller Unannounced Inspection 24th September 2008 09:15 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 Nursing Home DS0000025457.V371204.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 Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treetops Nursing Home Address Carthage Street Oldham Lancashire OL8 1LL 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) 0161 628 6811 F/P 0161 628 6811 Mrs Christine Ann Shaw Mrs Christine Ann Shaw Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (33), Physical disability of places over 65 years of age (33) Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 33 service users to include: *up to 33 service users in the category of OP (Old age not falling within any other category); *up to 33 service users in the category of PD (Physical disability under 65 years of age); *up to 33 service users in the category of PD(E) (Physical disability over 65 years of age). Where 24 or less service users are in residence requiring nursing care, 1 registered nurse to be on duty 24 hours per day. Where 25 or more service users are in residence requiring nursing care, 2 registered nurses to be on duty 8am - 5pm and 1 registered nurse to be on duty 5pm - 8am. Other specific conditions relating to staffing requirements may be identified at the announced inspection of the home. 25th September 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Treetops has 33 beds in total, all of which can be used to provide nursing or personal care. The home is owned and managed by Mrs Shaw, who is a registered nurse. Treetops is a purpose built home, situated a short distance from Oldham town centre. Accommodation is provided over two floors and consists of 27 single rooms and three double rooms. None of the rooms have en-suite facilities but toilet and bathing facilities are located nearby. Access to the first floor is provided by a lift. There are two communal areas within the home that allow service users to socialise together and participate in activities as they wish. Fees for accommodation and care at the home range from £360.00 to £768.75 per week. Additional charges are also made for hairdressing, aromatherapy, newspapers and personal toiletries. Treetops Nursing Home DS0000025457.V371204.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 star. This means the people who use this service experience good quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the registered manager did not know in advance that we were coming to do an inspection. During the visits we looked around the building, talked to residents, relatives and staff, including the deputy matron. We observed the interactions between people living at Treetops and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how Treetops has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications.’ We also received three Commission for Social Care Inspection (CSCI) service user surveys and which were returned to us by people using the service and from other people with an interest in the service, such as staff and relatives. Information about the services including the statement of purpose and previous CSCI inspection report was readily available in the foyer of the home. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection the manager has made sure that care plans are individualised and provided detailed instructions to staff about the actions they needed to take to meet people’s needs. Since the last inspection the manager has made sure that staff work in the home only after she has completed a thorough vetting process. This is to guard against employing people with a history of abuse or violence that will make them unsuitable for working with vulnerable people. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 7 What they could do better: The manager must ensure that people’ social history, interest and communication and mental states are assessed and recorded so that staff are aware of the things they might enjoy talking about or doing, this will help staff to develop more meaningful relationships that will help to raise the self esteem of the residents. The manager should make sure that the way in which people are moved around the home is in keeping with professional moving and handling guidelines and meets with best practice in relation to maintaining mobility and promoting independence. The manager must make sure that maximum assistance is given to make sure that staff can identify the correct resident when administering medication, such as photographs. This will help to identify people and prevent medication mistakes. The manager should make sure that daily records provide detailed information about the events that have occurred in a person’s day, and also relate to the care plan. This is so accurate monitoring can take place in relation to the effectiveness of the care provided and changes made quickly, and also demonstrate that staff are actually working to the care plan. The manager needs to provide more activities and events for people to participate in so that they remain mentally alert and stimulated. The activities programme should include an element of physical exercise so that people can maintain some physical strength for as long as possible. The manager should assist staff in developing a more stimulating environment for people living at Treetops. People said: ‘It can get boring’ and ‘Not a lot happens - occasional singer and … joins in with that.’ The manager should make mealtimes more of an event for people so that they can become aware of the people they share the home with and have the chance to develop positive social relations. This may encourage a sense of wellbeing and belonging. The manager needs to make sure that all staff understand their role in dealing with and reporting different types of accidents and incidents; this is so she can be certain that the correct changes and checks are made in keeping with protecting people from avoidable risks and prevent harm. The manager must undertake a detailed risk assessment and risk reduction plan for use of the conservatory during hot weather, the manager must show that staff, visitors and residents are aware of the plan and the actions they must take to prevent people from suffering from the effects of excess heat and dehydration. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 10 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 (Standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Treetops benefit from being admitted to the home based on assessments that fully identify their health and personal care needs. EVIDENCE: During the site visit the assessment records for five people were examined. Each contained detailed information about people’s health, physical and personal care needs. Assessments in place had been provided by the referring agency, such as social workers and nurses from the Primary Care Trust (health service). The Matron (registered manager) or Deputy Matron had also assessed people’s needs prior to accepting the admission. This was so that they could be sure that the facilities, staffing levels and skills available at Treetops could fully meet people’s needs. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 11 The assessments identified specific health needs such as diabetes or multiple sclerosis; nutritional needs, such as special diets or methods of feeding, communication needs, oral health, mobility and medication. The information was used to develop detailed care plans and risk assessments, this would ensure that people were safe and remained well for as long as possible. Mental health and mood were only superficially assessed unless this was identified as a need from the referring agency. This is not generally a problem, however, in light of staff interaction that was observed throughout the day of this inspection, the manager should consider paying more attention to this area. This is so staff can be provided with clear instructions in how to promote good mental health and a sense of wellbeing. The manager has introduced a document called ‘Getting to know all about you’. This is a document that allows the person or their relatives to provide information about a person’s social history and interests. This had been completed for one of people whose records were looked at. People who returned surveys all felt that they had received enough information about the home before admission. One person stated that they: ‘Used Age Concern Oldham’s information package and CSCI website. Also visited Treetops prior to my mother’s discharge from hospital, was shown round home and was able to choose own room. The owner was available to answer any questions we had.’ In the information she returned, the manager stated that: ‘When a room is accepted we always go to assess the service user in their present environment to ensure that they would be happy with us.’ This information is recorded and this document was seen on each file that was examined. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Treetops have their health and personal care needs met. EVIDENCE: The care plans for five people were looked at. Each contained information about how people’s needs must be met. In the main, the instructions were clear and detailed. The care plans were individualised and person centred. Modifications and updates confirmed that care plans had been reviewed. Risk assessments concerning pressure area care, nutritional screening, falls, continence care and catheter care, and other health related matters were in place. Those that were examined provided detailed information. Equipment in place included pressure relieving mattresses and cushions. Staff used moving and handling equipment effectively. People at risk of developing pressure sores were helped to move their position and this was recorded. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 13 The care plans, records of professional visits, letters and other correspondence confirmed that specialist and routine health care was made available when needed. Health professionals regularly involved in Treetops included general practitioners, district nurse, podiatrist, dietician, speech and language therapists, dentist and opticians. The way in which medication was administered was observed and the records examined. Trained nurses who have received the training to do this safely administer medication. Staff sometimes placed medication into people’s mouths, it would be more dignified and acceptable if they offered medication using a spoon. The medication record sheets (MARS) were examined, no missed signatures were noted, medication that was hand written was checked by two members of staff. The MARS did not have pictures of the residents on them. This matter was discussed with the manager, as pictures are an essential tool for helping to confirm people’s identity, and so prevent medication errors. The manager showed that photo’s had been taken so that they could be updated and were due to be put in place on the day of inspection. Although people do change while living at Treetops, it is unlikely that they change beyond all recognition, and so it would be better if old photos were left in place until they were replaced with new ones, so that staff still have some additional guidance in relation the identity of residents. Controlled medication was received and managed safely and securely. All medication had been entered in a controlled drugs book and the numbers were accurate. The manager stated that she was in the process of changing the chemist who supplied medication to the home, to a pharmacy able to dispense medication when it is prescribed later in the day, so that people received treatment as soon as possible. This pharmacy will also provide training for staff and audit the medication system that will be introduced. In the course of the inspection we found that nursing staff need to be made aware of the pharmaceutical and clinical guidelines to follow if they discover that a medication mistake has almost occurred, or ‘near miss’. This is so that the incident can be fully investigated and strategies put in place to prevent an actual incident occurring. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 14 During the inspection the interaction between staff and people living at Treetops was observed for the majority of the day. People were well dressed and groomed. They were fully dressed, wearing tights or stockings and socks and slippers or shoes. A podiatrist, new to the home, visited during the inspection and all the people she saw were dealt with in privacy and staff worked well with her. Random checks confirmed that people had their own clothes returned to them. The hairdresser was working in the home on the day of inspection, and many of the ladies had their hair washed and set. The manager also said that an aromatherapist was now visiting the home and people had enjoyed the sessions that were offered. The main issue relating to dignity and respect was the manner in which many staff related to the service users. Staff did not take time with people, they called loudly across the room to people who were asleep in order to wake them up and give instructions and so people seemed ‘unco-operative’ and nonresponsive. People were not always given the chance to speak or respond to what staff said to them. One person who was interviewed was able to describe how he felt and his frustrations and concerns about his situation but this was not reflected in his care plan or in the way staff approached him. Although staff techniques using moving and handling equipment, such as wheelchairs and hoist, were safe, staff did not always explain to people what was happening or how to assist in the process. If staff explained what they were about to do, some people would be able to assist better with the process. Staff also moved people around the home in the easy chairs that had coasters. This was done by pulling the chair backward while people remained seated. The chairs were from a company called Kirton. The manager stated that risk assessments had been completed for this use, however there was no evidence that these chairs should have been used for this purpose. Also, being pulled along backwards is not dignified and can cause anxiety, particularly when done without explanation and preparation. When asked about who had assessed people for these chairs, the manager stated that this had been done by the nursing staff. This is not best practice in terms of moving and handling, safe positioning and promoting independence. The manager must involve professionals with the skills and competency to carry out this task, such as a physiotherapist or occupational therapist. Residents had purchased these chairs themselves following these assessments. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 15 Observations made also highlighted the fact that during the inspection the majority of people sat in the same position for the majority of the day. They were not encouraged to mobilise or supported to move from one place to another, even at mealtimes. The manager needs to make sure that staff understand how to communicate effectively with all residents at Treetops. Staff need to understand their responsibility and the conduct that is required to promote a sense of wellbeing and belonging for people who have more complex communication needs or emotional needs. Staff need to understand the importance of supporting people to remain independent for as long as possible. Daily records were examined and were written using respectful language. There were times, however, when the information did not relate to the care plans, were repetitive and did not show what had happened for a person from day to day. This means that it was not always possible to fully monitor a person’s progress and response to the care provided. One member of the care staff and the cook did sit and talk to one lady in the afternoon and the deputy manager was seen spending time making conversation with people. People who were spoken to, however, were very satisfied with the health and personal care provided at Treetops. People said ‘They get health care quickly.’ And one person commented in a survey that: ‘Any medical problems reported are dealt with straight away.’ Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 16 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, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People at Treetops do not have a lifestyle or access to recreational activities that fully match their needs or expectations. EVIDENCE: The manager has employed an activities co-ordinator to work at Treetops each Monday. The manager stated that activities that were organised included quizzes, outings and entertainers. Daily records did not have any information about the activities people had enjoyed. The manager stated that the activities co-ordinator did not keep a record of who participated in what activities. Social needs and interests were not fully assessed for each person and care plans did not include instructions about the things people could do to keep them stimulated and interested in life. One ‘Getting to know you’ booklet was looked at. This assessment about a person’s social history, including past interests, work and family life, but this was not used to inform the care plan, and there was no evidence to confirm that it was considered when planning any activities programme. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 17 People who were interviewed were aware that activities were organised one day each week but were not aware of additional events. When asked about activities people said: ‘Not a lot happens - occasional singer and … joins in with that.’ This person also said that they hadn’t seen any activities other than each Monday. Staff stated that ‘There was an activities co-ordinator once a week and general conversation the rest of the time.’ People are able to visit their relatives anytime except between 12 midday and 2pm because the manager feels that people eat better if they are undisturbed. People who were interviewed stated that this was not a problem and the system was still flexible enough to enable visitors to come at their convenience. ‘Yes we can come early if we need to.’ People who returned surveys felt that activities only ‘sometimes’ met their needs. Positive comments were made about the activities which were organised and included: ‘Treetops has an activities co-ordinator Monday mornings who organises quizzes, sing alongs, etc., my mother really enjoys her visit and talks about the activities she has taken part in.’ In the information returned, the manager said the aim was: ‘To continue to maintain and build on our already extensive services which will encourage service users’ interests in their daily life and activities and improve their well being and self esteem.’ This plan now needs to be acted on. On the day of inspection the people who were observed slept for all the morning, except for when they given drinks or requested support to attend to personal care. No activities were organised during the inspection. The food and meals provided at Treetops were varied and enjoyed by people living at the home. For breakfast people could have whatever they wanted, including a cooked breakfast. Lunchtime was a choice beef stew and dumplings. The menu was discussed with the cook. Meals were traditional and home cooked. Dishes included: cheese and onion pie, braised heart, haddock and other fish based items, and assorted meat casseroles and roasts. Desserts included homemade milk pudding and pies, as well as branded items that people enjoy, such as Angel Delight. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 18 Meals were, mostly, served where people sat in easy chairs. Nearly all people were given a spoon and adapted plates. One person who sat at a table did so alone, and staff did not encourage people with similar abilities to relate with each other in a positive way through sharing a table at meal times. The tables were not laid in readiness for a meal, for example, with a tablecloth, cutlery or salt and pepper. The person said, when asked to sit down for her meal, ‘Oh I didn’t know it was dinner-time.’ Staff then put her meal in front of her without any further comment. Although staff sat with people who needed assistance, they did not really speak to people unless it was obvious that they could hold a full conversation. Those who fell asleep over their meals were spoken to loudly to wake up and eat. People who were observed ate all their meals, however mealtime was not used as a chance to develop relationships or as a social event. This area could be improved if eating at the table was encouraged through having the table set for meals. People who commented stated that the food was good, the four people who returned surveys said that they usually liked the meals, one person commented: ‘It’s obvious that the cooks are very keen to ensure meals are enjoyed by the residents and will discuss with them what they would like to eat. Alternatives are offered if there is nothing on the menu the resident fancies.’ One person who was spoken to said ‘Yes, the food is good, like what you get at home.’ Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 19 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Treetops can be confident that the manager will listen to and take actions to remedy concerns and complaints. EVIDENCE: The complaints policy was looked at. This provided information about how people can make a complaint and the amount of time by which a complaint would be investigated. This policy does need to be updated to show the current contact details for CSCI. A copy of the complaints procedure was seen in some rooms. People who were spoken to said that they were confident that concerns would be taken seriously. Comments included ‘I rarely have any complaints, would talk to (senior staff) and I’m confident that it would be dealt with.’ All who returned surveys said that they felt listed to. requests are generally acted upon’. One person said ‘Any Staff who were spoken to have received protection of vulnerable adult training and were clear about the actions they would take if they suspected that abuse were occurring. This included the action the take in response to incidents between residents. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 20 The complaints and incidents records were looked at; there has been one anonymous complaint concerning the heat in the conservatory at the weekends. This was investigated by Oldham Adult safeguarding team and assessed as unfounded, but in response to the complaint, blinds have been fitted. One person who has returned a CSCI survey since this complaint also commented that, at times, the conservatory is very hot. This matter was discussed with the manager who agreed to conduct a further risk assessment and introduce a clear action for staff and visitors to the home to follow. This will be displayed in the conservatory to safeguard against people who use this room, becoming over heated and dehydrated. The manager stated that she was in the process of developing a means of auditing complaints and concerns so that common themes can be identified and repeated problems solved. While looking at the complaint and adult protection records it was found that, at times, staff did not know when some concerns needed to be brought to the attention of senior managers. For example, the manager had not been alerted to a near-miss incident concerning medication, and so had not been able to deal with the matter in as much detail as was expected. This was discussed at the time of the inspection. People said that they felt safe living at Treetops. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People living at Treetops benefit from living in a home that is comfortable and clean. EVIDENCE: As a part of the inspection process, a tour of the shared and private parts of Treetops was made. The reception area has just been redecorated and was warm and welcoming. Rooms were pleasantly decorated, many bedrooms had been personalised with items people had brought from home, and these reflected their interests, such as animals, following a faith or family life. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 22 Not many people mobilised unescorted, however aids and adaptations including heightened toilet seats, handrails and rise and fall baths were in place. The lounge area and the conservatory were clean; carpets and furniture were free from unsightly marks or stains. Bedroom doors were labelled with names and large print signs were used to label communal areas, such as the bathroom and toilets. The majority of bedrooms were clean and free from unpleasant odours. Where this was noted, the manager confirmed that she was aware of the problem and remedial action was planned. This included replacing carpet or changing the type of flooring, according to individual need. Kitchen and food hygiene is managed under the Local Authority’s scheme ‘Safer food, Better Business.’ The laundry room was clean, well-organised and washing machines had a ‘hygienic’ wash programme. Staff used aprons to support people with personal tasks. Improvements in this area could be achieved if communication such as labels and signs were available in different format, such as symbols. The main issue, however, that needs to be fully resolved is temperature control in the conservatory. The manager has employed a service manager who has charge of the health and safety aspects and maintenance within the home. One person stated that the conservatory became very hot in summer months. This issue had also been the source of a complaint that was on record, and this showed that the manager and social workers involved felt that this had been satisfactorily dealt with, as a risk assessment had been completed and special heat reducing conservatory blinds installed. The comment was discussed and the manager agreed to take additional steps to make sure that people using this room remained safe. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People at Treetops should receive appropriate support as staff receive adequate training opportunities and are employed using procedures that protect against employing unsuitable people. EVIDENCE: On the day of inspection there were 27 people residing at Treetops nursing home and the staff on duty were the registered manager, deputy matron, five care staff, domestic staff and a cook. People who commented felt that there were always enough staff on duty to meet people’s needs. The manager employs agency in order to make sure that there are always enough staff on duty. One person observed ‘Room bells are answered quickly and it’s usually possible to locate staff if needed.’ Staff are given training opportunities so that they can be competent at their jobs. All staff, including domestic staff, have completed courses run by the Oldham Training Partnership and Registered Nurses can also attend courses available through the local Primary Care Trust (health service). Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 24 The training records at Treetops confirmed that staff had completed a variety of courses since the previous inspection. These included the Skills for Care induction workbook, dysphasia awareness, toenail cutting, communication, enternal (PEG) feeding in the community; health and safety, handling medication, first aid, protection of vulnerable adults, infection control and hand washing, basic life support; suction and management courses, such as supervision. The manager stated that there were 19 care staff and 11 of these had completed the National Vocational Qualification (NVQ) level 2 in health and social care. She also said that two care staff had recently enrolled on this course. Nursing staff confirmed that they were supported to gain higher qualifications, such as diplomas or degrees, in specialist health related subjects. Recently recruited staff felt that their induction had been thorough and prepared them for working with people at Treetops. Four staff files were looked at and each held a copy of a completed Criminal Record Bureau check, a completed application, proof of identity and references that had been verified when necessary. Staff meetings regularly occur and the notes from the previous meeting were read through. The topics that had been discussed included recent health care guidance, such as the information in pamphlets about dealing with a heat wave, the importance of a flu injection and hand washing. The minutes showed that the manager tried to foster good relationships between the different staff groups. The main area for improvement in staff relates to their interaction with people. This could be seen in terms of equality and diversity, as it was evident they related well to people who would initiate conversation; in addition, they did not take the opportunity to correct people who said negative things about service users who were less able. Only the deputy manager, the cook and one care assistant were observed taking time to talk to people and try and hold a meaningful conversation. Staff who were observed did not really take time to sit and talk to people and were satisfied people would sleep or watch television throughout the day. Staff mainly spent periods in the communal area during their breaks, which they all had at the same time. At these times residents who had previously been asleep did look up and become more alert due to the noise and chatter, but soon fell asleep again when they were not involved in what was going on. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 25 Staff who were interviewed enjoyed working at Treetops. One person said ‘It’s great, everyone is friendly.’ One person who was interviewed commented that there were no problems with staff although they were really only seen when they were completing a task. Another resident who was interviewed stated that ‘They’re friendly and you can have a good laugh with them.’ Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 26 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, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at treetops benefit from an ethos that aims to provide for the safety and wellbeing of all who are involved in the home, and take their opinions into account. EVIDENCE: During the inspection time was spent discussing the running of the home with the registered manager (matron) and the deputy matron, both are Registered Nurses. The deputy has completed courses concerned with management skills, such as supervising staff, and practices such as updated infection control training. Discussion with the managers indicated that they were keen to listen to staff and act on what they said. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 27 The manager conducts a formal quality assurance questionnaire. The information is used to influence developments in the home, such as the menu and activities. Residents and relatives’ meetings are also organised. The record of the previous meeting showed that people were able to discuss trips out, additional drinks, the menu and activities in the home. The employment of the activities co-ordinator was in response to feedback from meetings and the previous CSCI inspection. Health and safety issues are effectively managed at Treetops. The training records confirmed that the all staff have received moving and handling, fire safety, food hygiene and infection control training. The majority had received basic first aid training. Cleaning materials were handled safely. The maintenance manual and records held certificates that confirmed that all gas and electrical appliances and equipment had been serviced, in keeping with the relevant legislation, moving and handling equipment had been serviced and checked in accordance with the manufacturer’s recommendation. Accidents and incidents were recorded and the manager stated that she was in the process of developing a system of auditing the information received. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 28 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement Timescale for action 01/12/08 2 OP7 15 3 OP8 5 4 OP9 13(2) The registered person must ensure that assessments include the social care needs of residents. (Previous timescale of 30/11/06 not met). The registered person must 01/12/08 ensure that care plans are developed to address residents’ social care needs. (Previous timescale of 30/11/06 not met). The registered person must 01/12/08 ensure that all moving and handling in the home is dignified and safe, and that all equipment is used in keeping with manufacturers’ guidelines. This is to protect people from accidents and also maintain their sense of self-worth by being treated with dignity. The registered person must 01/12/08 make sure that people’s pictures are placed on the medication record sheet at allt imes; this is to assist staff in making sure that people receive the correct medication. Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 30 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. 5 Standard OP12 Regulation 16 Requirement The registered person must arrange for people to be offered activities and events more frequently so that they can have alifestyle and experiences that keep them stimulated, interested in life and maintain physical abilities. The registered person must be abel to show that the conservatory is a safe and comfortable place to be if the weather is hot. This is so people are protected from excess heat an dehydration. Timescale for action 01/12/08 6 OP19 23(2)(p) 01/12/08 Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered person should ensure that daily records are more detailed, this will help to monitor people’s progress so that changes in the care plans can be made quickly and also show that staff are following these care plans. The registered person should ensure that care plans are more person-centred and detailed and should ensure that all staff follow the actions stated. The registered person should consider how to enhance the mealtime experience for residents so it becomes more of a social occasion. The registered person should make sure that accident and incident procedure is understood by staff so that events that need particular attention are seen by the manager and that people are protected from similar accidents occurring. 2 3 4 OP7 OP15 OP38 Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection NW Area Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Treetops Nursing Home DS0000025457.V371204.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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