Inspection on 26/03/10 for Tremona Care Home

This is the latest available inspection report for this service, carried out on 26th March 2010.

CQC found this care home to be providing an Excellent 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 Care Home 04/05/07

Tremona Care Home 09/02/06

Tremona Care Home 11/11/05

Tremona Care Home 09/02/05

Tremona Care Home 19/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Tremona Care Home 18 Parkers Cross Lane Pinhoe Exeter Devon EX1 3TA The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Gurnell Date: 2 6 0 3 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. They reflect the things that people have said are important to them: 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 Care Homes for Adults (18-65 years) Page 2 of 29 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Tremona Care Home 18 Parkers Cross Lane Pinhoe Exeter Devon EX1 3TA 01392460945 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Melanie Louise Brunsdon care home 2 Number of places (if applicable): Under 65 Over 65 2 0 learning disability Additional conditions: The manager must obtain the NVQ4 in Care by 2005 Date of last inspection 0 4 0 5 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home The house is the same as the other houses on either side. Two people lived at the home. There are two lounge rooms, a dining room and a large conservatory for people to use. Both people share a bedroom. The home has a nice garden. The fees are £64.10 a day. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home This inspection was carried out by one inspector who visited the home without telling anyone she was going to come. She was on Friday, 26th March 2010. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission. We looked all round the home and spoke to both people who live there. Care Homes for Adults (18-65 years) Page 7 of 29 We looked at the care records for both people who lived in the home. We also looked at other records about medicines and health and safety. Before the inspection an Annual Quality Assurance Assessment (AQAA) was completed by Mrs Brunsdon and this gave us lots of information about the home. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 29 People live as apart of Mr and Mrs Brunsdon’s family. The home is large with plenty of space; it is comfortable, clean and homely. The home is also very good at helping people have happier lives through friendships. And by doing lots of different things, both at the home and at other places. Care Homes for Adults (18-65 years) Page 9 of 29 Meals include their favourite foods and healthy food. What has got better from the last inspection Mrs Brunsdon is exploring ways of making peoples money easier to check by paying each person’s money into separate bank accounts. Care Homes for Adults (18-65 years) Page 10 of 29 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Care Homes for Adults (18-65 years) Page 11 of 29 Jane Gurnell CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 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 Adults (18-65 years) Page 12 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Good systems are in place to get to know, inform and support each individual thinking about moving in, to ensure the home is a suitable choice for each person. Evidence: There have been no admissions since the last inspection, with the intention that the current residents will be at the home long-term. But Mrs Brunsdon described an appropriate, gradual introduction to the home for prospective residents - visiting the home for lengthening periods of time, etc. She uses a comprehensive assessment form to get as much information about people as possible, so as to be clear about their capabilities, needs and the support they would need. Information about the home has been updated since the last inspection, some of it being in easy read form. Care Homes for Adults (18-65 years) Page 14 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Good knowledge of each persons needs, capabilities and preferences ensures they receive support they need to make choices and to take risks that enhance the quality of their lives. Evidence: Time was spent in conversation with both people living in the home. Both said they were happy and received help from Mrs Brunsdon when needed. Each had a care plan that explained their daily health and personal care needs and these had been updated regularly and were individualised. There was evidence that the people who live at the home had been involved in reviewing their care. The plans included enabling peoples privacy and any limitations on that, such as when help was needed with personal care. People talked about their preferences and daily activities, reflecting the accuracy of the care plans. Care diaries were used to record significant events that involve them - health matters, diet intake and outings, for example - to inform reviews of care. Mrs Brunsdon is appointee for both people, in the absence of another suitable person. Personal monies records were checked. These were kept individually for each person, Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: with receipts for purchases numbered so as to make it easier to check them against the records. Cash held was found to be the same as balances recorded, showing money is kept well by the home. Mrs Brunsdon said there was a residents monies bank account for which both people were signatories, but money she received as appointee was first paid into a business account as it included the fees due to her. Mrs Brunsdon said that, as the money for both of the people living in the home was paid into the residents account making it was difficult to identify over a period of time how much money belonged to each person, therefore she would ensure these were separated: one person had a separate bank account of their own. Risks had been assessed - relating to the home environment, going out, vulnerability, and health needs, for example - and reviewed regularly as well as when circumstances changed. Action to minimise risks did not restrict people unreasonably, if at all - support being given so they could still enjoy going out, preferred activities such as cooking, etc. See also the following sections on Lifestyle and Personal & Healthcare support for other evidence of how people are supported to make decisions about their lives. Care Homes for Adults (18-65 years) Page 16 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home get excellent individualised support that enables them to have fulfilling lives with positive relationships and enriching experiences within and outside the home. Evidence: During the inspection, the people spent time with the Mrs Brunsdon - including whilst with us, or spent time in their bedrooms or the lounge room. They spoke about how they spend their time watching the television or listening to music, going shopping, swimming, to the local park and horse riding, as well as gardening and cooking. They said they were planning a holiday later in the year to the Canary Islands. Enablers from their day centre also take them out several times a week including to a makaton course. The care diaries showed the different places each person went out to and included a record of the meals they had. There was also evidence of helping out around the home tidying their room, hoovering and dusting and emptying the dishwasher, for example. They said they also had writing books (which Mrs Brunsdon said she bought them), to Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: practice copying letters in them. Diaries showed they had a varied and healthy diet and both people said they enjoy various different meals: both said they can request meals and had planned fish and chips for the following evening. All the family, including Mr and Mrs Brunsdons children, sit together in the evenings to have their meal. Care Homes for Adults (18-65 years) Page 18 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having a carer who has excellent knowledge and understanding of their individual needs and preferences, ensuring they are supported as they need and wish. Evidence: Both people living in the home said they liked living at Tremona, and they seemed relaxed and happy. Mrs Brunsdon showed in conversations with them and with us that she clearly knew their preferences (foods, activities, etc.), what they might worry about (- changes in their usual routine, etc.), and so forth. Care plans are very individualised, including individual needs and preferences as to how needs should be met. One person talked about various friends and what they did with their enablers at the day services they attended. Their conversation showing clearly these were positive, beneficial relationships. Care records included health checks by community services (such as eye tests, a visit to the dentist, and at hospital appointments), and general observation of their health by Mrs Brunsdon on a regular basis, including recording their weight. They enjoyed their swimming sessions, and trips to the park or riverside, which provided a balanced level of exercise needed in view of health needs (- reflected in care records). A risk assessment was seen regarding a sensory impairment one person had. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Only one person had medication at the home and this person had expressed a wish to be as independent with this as possible. Therefore they were enabled through use of a weekly dosage box that was prepared Mrs Brunsdon from medication prescribed by the GP. As there was only two tablets involved once a day, and only Mrs Brunsdon had access to where the medicines were stored, this was deemed to be safe. Medication records included full information about each persons health needs and health risks, a photo of the person, pictures of any tablets they take, and contact numbers for their pharmacist, doctor, etc. Both medication received into the home and then taken by the person were recorded by Mrs Brunsdon, with a running total kept of stock held which tallied with stock that was checked. We also saw a record of medicine returned to the pharmacist. Care Homes for Adults (18-65 years) Page 20 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Excellent attention to and support for people living at the home ensures they speak about their views and concerns, and are taken seriously. Good knowledge of people living at the home ensures that they are given protection from harm. Evidence: The people living at the home seemed very happy and relaxed. They did not raise any concerns during the inspection. We saw an easy read complaints procedure in a lounge, which encouraged them to speak about any worries. Mrs Brunsdon said that one person was clearer about what they liked or wanted than the other, so she tried to get the views of the other, quieter person first - to be sure of getting their true view before they simply agreed with other people. She was clear that she would contact Social Services, the police or the residents GP, if she had any concerns about peoples wellbeing or welfare, or thought they were being abused or harmed. Mrs Brunsdon explained that both people had regular enablers from their day centre who knew them well and who would also recognise if there were any changes in their well-being. Care notes and risk assessments for people included situations when they might be more vulnerable to harm and so need extra support to prevent this. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Mrs Brunsdon had current public liability insurance as a self-employed carer, and personal accident insurance; we saw the policy requires her to abide by a specified, nationally recognised code of conduct for social care workers. She said her house insurance covered peoples property. These measures safeguard their rights as individuals, and their property. Since no other staff are employed, there is a written emergency procedure to be followed should the Brunsdons suddenly be unable to care for people living at the home. Care Homes for Adults (18-65 years) Page 22 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Good, well-kept accommodation provides people with a pleasant, homely and clean place to live. Evidence: The residents live very much as part of the family and have access to all areas of the home. The home was very clean and orderly when we arrived. The two people living at the home showed us around, seeming very happy with their bedroom; they said they liked living at the home, showing us their music CDs and the televisions in the lounges and their bedroom. When asked if repairs were carried out quickly when needed, Mrs Brunsdon said her husband did all the day-to-day repairs and redecoration. The family share the bath room and shower rooms as well as the laundry: Mrs Brunsdon confirmed laundry is not handled during food preparation as the laundry room is accessed through the kitchen. Care Homes for Adults (18-65 years) Page 23 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Quality in this outcome group was not judged as no staff are employed. Evidence: N/A Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 living at the home benefit from good management, with their views used to improve the care service provided, although aspects of regular maintenance Evidence: We saw Mrs Brunsdons certificates for nationally recognised management and care qualifications, obtained in August 2006. She has a first aid certificate and was due to renew her food hygiene certificate shortly to remain up-to-date on such matters. During the inspection we saw that there were good, respectful relationships between the people living in the home and Mrs Brunsdon and Mrs Brunsdon was seen to check peoples understanding and ask them their opinion. She said she had an easy read survey which she uses from time to time to gain peoples views of the home and views of others such as their enablers about the support they received: the results of a recent review were very favourable. People said they hadnt had any accidents recently, and none were recorded in the accident book. We saw the most recent electrical safety check, dated April 2006, and Mrs Brunsdon was advised to consult with an electrician to ensure this gave assurances that Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: the homes mains electrical system was safe. We also saw the safety check for gas appliances ensuring they are safe to use. An easy read fire procedure was seen in one lounge and fire safety checks and practices had been recorded regularly, a different fire alarm being tested each time. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 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 Description 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 Description 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 1 38 The home owner should consult with an electrician to ensure the homes main electricity supply is safe. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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