Inspection on 03/07/09 for Tremona

This is the latest available inspection report for this service, carried out on 3rd July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tremona 31/07/06

Tremona 15/11/05

Tremona 04/05/05

Tremona 11/11/04

Tremona 24/08/04

Tremona 27/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tremona 18 Alexandra Road Watford Hertfordshire WD17 4QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 0 3 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Tremona 18 Alexandra Road Watford Hertfordshire WD17 4QY 01923228211 01923226982 tremona@bmcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): B & M Investments Ltd t/a B & M Care care home 39 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Tremona is a residential care home provided by B & M Care for 39 service users in the Old Age category, some of who may have dementia. The home is situated in a residential area within walking distance from the town centre of Watford. There are parking spaces to the side of the building and in front. The building is a three-storey detached house with 37 single bedrooms and one double bedroom (for a couple). The bedrooms are on the first and second floor with toilet and bathroom facilities nearby. All floors are served by a lift. The administrative office, the laundry room, kitchen, dining room and all 4 lounges are on the ground floor. 0 0 Over 65 12 39 Care Homes for Older People Page 4 of 25 Brief description of the care home The home has a large back garden and a patio with attractive garden features and ample seating for service users. The garden is wheelchair-accessible. The home charges £450 - £650 per week. Further information can be obtained from the Statement of Purpose and the Service User Guide. A copy of the CSCI inspection report should be available in the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was dated 09/08/2007 and the last annual service review was on 04/08/2008. This unannounced key inspection was carried out on 03/07/2009. The home manager and the deputy managers were present. There are 38 people in residence. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents before and during lunchtime. Residents and staff were interviewed. Several residents were eager to give their feedback about the care and service provided. Documents were examined. The inspection ended with a detailed discussion with the managers. Information received by us included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The Care Homes for Older People Page 6 of 25 AQAA focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the care home does well: Residents appeared well cared for. They are treated as individuals and their wishes and preferences are respected. Residents are encouraged to mobilise and those who are able to are encouraged to lead independent lifestyles, and they are encouraged to use the local amenities and to mix with the local community. Residents live in a homely and safe environment. They have access to all communal areas and to the attractive and spacious garden which is accessible to wheelchair uses. The service is well maintained and there is an effective staff team. During the inspection, it was noted that members of staff were helpful to individuals and have knowledge of residents conditions, likes and dislikes and assisted those who needed help accordingly. Residents and their relatives spoken with were complimentary about the service and the care provided. There were no negative remarks received on the day of the inspection. Comments received included: The staff are always pleased to help out. They are always helpful, cheerful and do everything they can for us. I couldnt speak too highly of the staff. They are very good. They are very nice to me. There is plenty to eat. I have no complaints. They are all very nice. They are very helpful. I have no problems. I am glad to have found this home. Its like a hotel. Excellent food. Plenty to eat. The food is perfect. Couldnt get better food. Happy with the service. The staff are very welcoming. They are very friendly and very helpful. They take my (relative) out to the local pub for meals. The place is very clean. The clothes are washed and nicely folded. I am always made welcome. The place is lovely. They are all kind and very helpful. Care Homes for Older People Page 8 of 25 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that a thorough pre-admission assessment will be carried out to ensure that the home can meet all their personal, healthcare and social needs. Evidence: The admission files for two residents were examined and they have detailed information regarding the pre-admission assessment that was carried out by the home manager. The home uses the version known as the Bethel system introduced by the provider. It would be more user friendly if the front page of the pre-admission form had a different title to distinguish it from the care planning version to avoid confusion to the reader. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that their care needs will be discussed with them and that care will be delivered as required in accordance with the assessment process, and that each person will have a written care plan so that staff know what care is required, and how to deliver that care to best meet individual needs. Evidence: Each resident has a written care plan. Since the last inspection the staff are familiar with the new care plan format known as the Bethel system. The three care plans examined were detailed and reflected the person-centred care provided except for the information on healthcare conditions such as Parkinsons disease and diabetes which could be more detailed. The management is updating this aspect of the written care plans accordingly. The key worker carries out a monthly review of each residents care needs and there is a yearly review of care needs that involves the resident, their next of kin and the relevant healthcare professionals. Appropriate records are kept. Care Homes for Older People Page 12 of 25 Evidence: Residents have access to their own doctor and to healthcare and other specialist and therapeutic services when required. The home works closely with the district nursing team who have supported the home in recent months in caring for some residents who had been admitted into the home with pressure sores. Currently there is no resident with pressure sores. All the residents are encouraged to be mobile each day. There are a number of residents who are using their own wheelchairs. All medicines are kept in the medication storage room that has a cooling unit to maintain the temperature below 25 degrees centigrade. Within the storage room is a controlled drug cupboard. The medication trolley is kept secured in the storage room when not in use. A trained member of staff administers the medication. There were records kept for two residents on temazepam tablets, which were found to be correct and agreed with the records kept. The Medication Administration Record (MAR) charts were examined and they were found to be accurately recorded except for one chart where there were three gaps where the drug was given and not signed for. The deputy manager confirmed that the drug was given but in each case the member of staff concerned had forgotten to sign the MAR chart. This has since been justified at the back of the MAR chart and the two members of staff responsible had been retrained. The home manager arranged immediately for a weekly audit of the MAR charts thereafter to ensure that such errors do not happen again. The deputy manager has been assigned to carry out the audit and to ensure that all gaps are explained and justified at the back of the MAR chart. Prior to this incident, random checks had been carried out every few weeks which appeared to have been insufficient. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that choices will be offered and that their wishes and preferences will be respected. They can be assured that there will be planned activities to suit their lifestyles and that the meals provided will be nutritious and balanced. Evidence: All the residents, including those with dementia, share the same communal areas. Residents are provided with recreational exercise and mental stimulation through activities and one-to-one attention as required. Residents who wish to do so are accompanied by a member of staff to the local pub for meals. Others are taken out for walking exercise and shopping. A member of staff spoken with highlighted how staff encourage a resident to use their mobility scooter to travel around the local vicinity and to use the local amenities that are available close to the home, including the shopping centre. Since then the person has had a daily routine of going out whenever they want. A risk assessment has been carried out and the resident has been reminded about the road traffic rules. There was a summer fete organised for the weekend to which friends and families were invited. Both managers and staff volunteered to help out during the social event. Care Homes for Older People Page 14 of 25 Evidence: On the day of the inspection, there were some residents watching a film in the television room while others were in the second lounge having a rest or chatting to a volunteer, a placement student, who was on the last day of their work experience. There was no activity conducted in the activity room on the morning of the inspection visit as it was used as a room for staff training. However, by teatime, the place was in use by some residents. The corridor is always occupied and busy with residents doing their walkabout exercise. The deputy manager confirmed that the home has activities everyday except that it was not always reflected on the noticeboard. She said that she will make sure this is regularly updated. The activity co-ordinator ensures that the activity file for each resident is updated regularly. The manager said that the care workers assist with activities and further arrangements have been made for residents to have aromatherapy twice a week as part of their therapeutic exercise. During lunchtime members of staff were seen assisting residents to the dining room. Two members of staff assisted two of the residents who needed help with their meals. Mealtime was unhurried. Residents gave positive feedback about the food provided. The chef confirmed that healthy eating is encouraged and that the residents are consulted daily and given a choice of meals. It was noted that one of the residents was late for lunch and the chef and another member of staff were eager to assist them with an alternative as the resident had changed their mind about the first choice made earlier. Desert included fresh banana cake baked on the premises. It was noted that there are bowls of fresh fruit in the television lounge and as it was a hot day, ice lollies and drinks were frequently offered to residents. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has a robust Complaints Policy and Procedure and that their concerns will be listen to and prompt action will be taken to remedy and improve the service. Evidence: There are regular Residents and Relatives Meetings and minutes are taken. Immediate action is taken to resolve any issues raised. Since the last inspection, there have been no complaints made concerning the service. Staff have training on safeguarding issues and they are aware of the Whistle-Blowing policy and the joint safeguarding procedure of the Hertfordshire County Council Social Care Services. There have been no safeguarding referrals since the last inspection. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that the home is clean, safe and comfortable and that they will have access to all communal facilities and have the specialist equipment they require to maximise their independence. Evidence: On the day of the site visit, the home appeared clean and tidy. The premises and bedrooms are cleaned daily. The home manager confirmed that all wheelchairs and aids have been serviced regularly. The residents interviewed said that they are quite happy with their bedrooms, which have personal items and potted plants on display. The rear landscaped garden with a patio and garden furniture is attractive and accessible to all residents including wheelchair users. In order to improve the appearance of the home, the flooring in the corridor has been replaced with parquet flooring. However, there is more work to be done to improve the interior decor especially in the corridor and one of the communal lounges. The brown coloured handrails that blend in with the colour scheme of the wallpaper need a contrasting colour to aid those with impaired eyesight. The home manager hopes to choose a brighter and more contrasting colour scheme to aid vision and reduce disorientation for those with dementia. On the day of the inspection, the marketing manager was in the building assessing the Care Homes for Older People Page 17 of 25 Evidence: work to be done. Since the inspection, the home manager confirmed that the workman has been in to get an estimate of the cost and hopefully redecoration will be carried out in the next few weeks. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the homes robust recruitment policy and procedures. Evidence: The number and skill mix of staff were adequate on the day of the site visit. The home manager confirmed that all the staff records have been updated and that the staffing level is in accordance with the needs of the residents rather than being at the minimum level. The training programme is according to the needs of residents and refresher courses are arranged at regular intervals. One of the senior care workers has been appointed as the new deputy manager since the last inspection. The recruitment procedure is in accordance with legislation. A new member of staff interviewed confirmed that they are working under supervision as the Criminal Record Bureau (CRB) clearance has not come through. However, the person has had the Protection of Vulnerable Adults (POVA) First clearance and is currently undergoing induction training which will be for a few more weeks. The service follows the Skills for Care induction programme. The home has a rolling training programme. On the day of the site visit, the providers training manager was in the home conducting medication training for those care staff Care Homes for Older People Page 19 of 25 Evidence: who needed it. Other topics arranged for staff included prevention of pressure sores, infection control, dementia care and advanced dementia training. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the standards of administration and management of the service are well maintained and that their health and safety are promoted and protected. Evidence: The general standards of administration and management of the service are well maintained. The home manager has undertaken periodic training to update her knowledge and skills whilst managing the home. She recently attended a five day course on Leadership in Dementia Care and she hopes to implement positive changes that will enhance the quality of life for the people living in the home. Team working was evident on the day of the site visit. Residents and visitors interviewed were complimentary about the service and the care provided. The home is not involved in the residents finances but the management oversee the personal allowances for some residents and proper accounting records are being kept. The home has a current Liability Insurance Certificate and the CQC Registration Care Homes for Older People Page 21 of 25 Evidence: Certificate was on display. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. In addition, the provider conducts a monthly visit and produced a monthly report as required by legislation. The Annual Quality Assurance and Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and was included in this report. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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