Care Home: Yew Tree House Residential Care Home For The Elderly

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What the care home does well The home has begun undertaking regular 1-1 counselling sessions for service users as a means of determining emotional needs. Staff training has improved and although there is still more to be done, the registered provider and manager stated that they were actively seeking suitable courses within a reasonable time frame. What has improved since the last inspection? The home has undertaken annual questionnaires for relatives, health care professionals and clients. The results of some of these were seen and they included very positive comments. Staff training is now more comprehensive and includes service specific training for understanding dementia. NVQs for staff are well underway and include levels 2,3 and 4. Although not all staff has yet received all training, this has either been booked or suitable training courses are being sought by the home. What the care home could do better: Improvements to some documents was discussed and agreed by the manager and the registered provider. These are mainly to do with increasing information in documents already in place. A more detailed self - administration policy is to be added to the medication procedures. There is one dedicated cabinet for medication but another larger cupboard for medication is not suitable although in a locked facility. The manager discussed this and agreed that although there are plans for an extension to be built next year to include dedicated facilities she would review the medication storage. The kitchen is in need of some cabinet repair but is to be rebuilt if plans for the proposed extension take place. The complaint recording procedure is to have further information added. The manager agreed to all of these. CARE HOMES FOR OLDER PEOPLE Yew Tree House Residential Care Home For The Elderly Yew Tree House 9 Station Road Headcorn Ashford Kent TN27 9SA Lead Inspector Wendy Gabriel Unannounced Inspection 11th November 2008 11:00 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 Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.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. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Tree House Residential Care Home For The Elderly Yew Tree House 9 Station Road Headcorn Ashford Kent TN27 9SA 01622 890112 Address 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) Mr Michael Francis Discombe Mr Michael Francis Discombe Care Home 13 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (11) of places Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Provision of railings to the disabled access slope leading to the entrance of the new building. The conversion of existing private en-suite bedroom on first floor which is proposed for residents use, is to have an additional fire alarm sounder installed in the lobby outside the room as advised by the Fire Officer. 20th November 2007 Date of last inspection Brief Description of the Service: Yew Tree House is comprised of two detached properties - the original building and a new building. Both buildings share a drive and small parking area. The original building offers a choice of ground and first floor accommodation but does not have a shaft or stair lift installed. The new building offers ground floor accommodation only. All bedrooms except for one are single occupancy. There are toilet and bathroom facilities on each floor in the original building. Each bedroom in the new building is en-suite and has a kitchenette and living area. The home is located in Headcorn village near to bus stops and the railway station. There are shopping facilities, churches and pubs in the village and the doctors surgery is within walking distance. For up to date information about the range of fees, please contact the provider. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.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 inspection was unannounced. The registered provider was on the premises as well as the deputy manager. The deputy manager is in the process of applying for registration and for the purpose of this report will be referred to as the manager. The home was fully staffed and there was one service user vacancy. We viewed and cross-referenced a selection of care plans, day reports and health care records. Some staff files, training matrix and the staff rota were looked at. Staff were introduced and three staff spoke to us including the manager and two senior members of staff who have particular duties within the administration of the home. Several service users spoke to us and an accompanied tour of the premises was undertaken. Previous requirements made were met or partially met. Plans for future refurbishment in the home were discussed. What the service does well: The home has begun undertaking regular 1-1 counselling sessions for service users as a means of determining emotional needs. Staff training has improved and although there is still more to be done, the registered provider and manager stated that they were actively seeking suitable courses within a reasonable time frame. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 6 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. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.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 Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.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): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have their needs assessed prior to moving into the home. EVIDENCE: The registered provider said that they mainly have private service users and only one social services referral currently living in the home. The home uses a simple admission pack. This includes a simplified version of the statement of purpose. The manager said the statement of purpose could be provided in large print as required. When the home first receives an enquiry about a possible admission, they will speak to people concerned and visit the prospective service user either in their own home or in hospital. An initial assessment will take place including any Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 9 information from others including health care professionals. As an example, a new person to the service has had a physiotherapist appointment arranged by the home for when they move in, in response to assessed needs. The assessment covers basic needs and the manager agreed to make information gained at the time more fulsome. Once the person moves into the home, the assessment forms the basis of the individual care plan. The manager was reminded to make sure risk assessments, made prior to being admitted to the home, confirm abilities such as mobility and any self care. The manager and the registered provider agreed to this. The registered provider said the home has forwarded some matters to a power of attorney and of CROP (Citizens Rights for Older People) on behalf of some residents to deal with any ongoing issues. The home does not offer intermediate care. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 10 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. People have health needs assessed and met by the homes procedures. Medication procedures are in place and will be improved by a review of storage. People said their rights are respected. EVIDENCE: The manager agreed to obtain the up to date version of the administration of medication in care homes, available from the Royal Pharmaceutical Society of Great Britain and review the medication administration in the home using the document as a guide. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 11 One of the two medication cupboards is not a dedicated cupboard and the manager said that although there are plans to include a dedicated medication area in the proposed extension to the premises next year she would seek suitable storage in the meantime. The only people who are allowed to undertake medication administration the registered provider stated, was himself and the three senior people in the home including the manager. There was written evidence of the home accessing health care professionals for support and advice. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know their lifestyle preferences are enabled by the home. Contact with family and friends is encouraged. People said they could make choices. People benefit from a healthy, varied diet and dietary needs and preferences are supported. EVIDENCE: The manager said that despite offering activities, many people prefer to not attend. There is not an activity organiser but staff arranges activities between them. A carer was reading aloud to a group of people in the lounge at one point during the inspection. A person spoken to in her room said that the home respected her wishes. The person said she had lived for many years at the Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 13 home and staff had always respected her privacy. Two people said they had their preferred routines that the home supports. Families and friends are welcomed in the home and staff like to keep them informed of events at the home. The registered provider said he and the staff thought it was important to welcome and encourage families to visit as they could otherwise feel left out of their loved ones life. All bedrooms have telephone points but only one person has their own telephone. People who wish for their own phone line meet the expense themselves. Some people are able to walk to the local shops and newsagent. The manager said there is a local elder club but people have so far refused offers to attend. The manager and senior member of staff said that they are continually seeking suitable entertainment and activities for people that are age appropriate and that they would enjoy and be prepared to participate in. The home has a cat seen at one time sleeping in a bedroom where the resident allowed it to be. Communion is undertaken once a month. There are four churches in Headcorn. The kitchen is in need of refurbishment and the registered provider said this would be rebuilt once the planned extension is completed next year. The kitchen was clean and tidy. The menu can accommodate dietary needs and choices. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 14 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. People know their complaints will be taken seriously. Systems are in place to ensure peoples legal rights are protected. Improved staff training helps protect people from abuse. EVIDENCE: The home maintains a complaints policy and procedure. The current procedure the home employs for recording complaints needs further information to ensure a complainant is responded to within the time frame that the home promotes. The home has a copy of the multi agency protocol regarding adult protection. Since the last inspection, more staff have undertaken adult protection training and the home is organising further training for the remaining staff. The manager said that staff has a different policy every week to read and be reminded of. The manager said she would ensure that the staff are reminded of adult protection and reporting procedures by use of the weekly policy and at regular supervision. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 15 The registered provider, manager and senior member of staff were very aware of the importance of reporting to the adult protection team should a suspected event be brought to their notice. The registered provider has used a range of independent services to support peoples rights for example, advocacy, Citizens Rights for Older People and Age concern. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. People live in a homely environment. The home is clean and hygienic. Proposed refurbishment will improve the kitchen. EVIDENCE: A tour of the premises was undertaken accompanied by the registered provider. The large upstairs office had a lounge area provided at one end to meet the needs of a particular resident and although the registered provider said it was now rarely used, it could compromise the privacy of people using the office Confidential information was locked in cupboards or filing cabinet. The office will be relocated once the proposed extension is completed. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 17 Bedrooms were varied and included personal possessions of the occupier. There is one double room that is due to become single when the proposed extension is undertaken next year. Although the staff has taken care to divide it and make each section fairly private, it could be problematical should one of the occupants require attention whilst the other occupant is sleeping. Furnishings and décor is older style and decoration is on going. The premises were seen to be clean and homely. The laundry has a washing machine capable of high temperatures. The kitchen has some broken fronted cupboards and drawers but this is due to be completely replaced next year. The kitchen was otherwise, clean tidy and well organised. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 18 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): 27,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Numbers and skill mix of staff meet peoples needs. Staff are trained and competent to do their jobs. EVIDENCE: The manager said the home was fully staffed. The rota was seen and the registered provider and the manager said extra staff would be made available to meet any particular ongoing needs of people should further assistance be required. The staffing matrix showed an improvement in the numbers of staff undertaking mandatory training and NVQs since the previous report. There are still some staff who have to undertake some training but the manager confirmed that the home is currently seeking suitable training packages for this. Ten members of staff have undertaken dementia awareness training. Nine members of staff have obtained or are taking, NVQ levels 2,3 or 4. Staffing includes three carers on duty in the morning plus one person in the kitchen and two carers on in the afternoon. The home has also employed an extra carer between three to seven pm. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 19 In addition to the carers, the registered provider is available daily and there is the manager and two senior administration members of staff who have specific duties including counselling, staff training and policy reviews. A recommendation was made at the last inspection regarding documenting action taken to pursue emotional needs or interests. This has been robustly met by the employment of a trained councillor who regularly spends 1-1 time with people, sometimes for up to two hours according to individual preferences. A comment in one of the homes questionnaires from one family states that the atmosphere and togetherness shows a social and community spirit which is engendered by all. Another person has written that the home has a very friendly, happy atmosphere. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 20 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, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from the management and administration of the home that is based on openness and respect. Peoples know their financial situation will be referred to appropriate advocates as required. Health and safety and welfare is promoted by the home. EVIDENCE: The registered provider is available in the home daily and has employed a deputy manager (manager) who is in the process of applying for registration. The manager is currently undertaking suitable training towards registration. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 21 Greetings and conversations between the registered provider and people living in the home were noted to be warm and appropriate. The registered provider had a good understanding and knowledge of people and their preferred choices. One person said that the registered provider and staff were very kind and let her lead the lifestyle she preferred. The registered provider has used a range of independent services to support peoples rights for example, advocacy, Citizens Rights for Older People and Age concern. The home supports peoples rights to vote. The fire safety book was in date. The home was due a pat test the day following the inspection. The home has begun quality assurance with the provision of questionnaires. Responses seen were positive. The home has staff meetings and the regular 1 – 1-counselling sessions for residents enables emotional needs to be discussed. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 22 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 2 OP9 OP16 Refer to Standard Good Practice Recommendations Review the medication storage according to the Royal Pharmaceutical Guidelines. Further information is to be added to the complaints recording procedure. Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection CSCI South East The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Yew Tree House Residential Care Home For The Elderly DS0000024096.V373055.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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