CARE HOMES FOR OLDER PEOPLE
Little Trefewha Praze-an-Beeble Camborne Cornwall TR14 0JZ Lead Inspector
Diana Penrose Unannounced Inspection 1st April 2008 09:30 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 Little Trefewha DS0000009097.V359920.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. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Little Trefewha Address Praze-an-Beeble Camborne Cornwall TR14 0JZ 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) 01209 831566 01209 831566 Little Trefewha Limited Mrs Jacquelyn Jane Elliott Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To include one named person under 65, outside the category of registration 8th November 2007 Date of last inspection Brief Description of the Service: Little Trefewha is situated in the village of Praze-an-Beeble, close to the towns of Camborne and Helston. It is set in its own spacious, very well tended grounds and has reasonable parking space for staff and visitors. The home is part of a group of homes owned by a locally based company and provides residential care for up to twenty elderly people. The premises consists of a two storey detached building with a ground floor extension at the back. There is adjoining accommodation occupied by the Registered Manager. The upper floor is accessible by a stair lift. There is one shared room, the rest are single. Four rooms have en suite facilities. The home provides ample shared space including a large lounge and a smaller quiet lounge. Meals are prepared in the kitchen on the ground floor and served in the dining room, or individual bedroom if preferred. Outside there is a patio and extensive lawns with seating and tables accessible to residents. Suitably experienced care staff provide personal care within a relaxed, friendly, welcoming atmosphere. Information about the home is available in the form of a residents’ guide, which is available in the home and can be supplied to enquirers on request. A copy of most recent inspection report is also available in the home. Fees range from £309 - £375 per week; this information was supplied to the Commission on the day of inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Little Trefewha DS0000009097.V359920.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 1 star. This means the people who use this service experience adequate quality outcomes.
An inspector visited Little Trefewha Care Home on the 01 April 2008 and spent seven hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that people’s needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that peoples’ placements in the home result in good outcomes for them. All of the key standards were inspected. This home has been subject to an improvement plan which they have progressed very well. On the day of inspection 20 residents were living in the home, One was receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered manager to gain their views on the services offered by Little Trefewha Care Home. Records, policies and procedures were examined and the inspector toured the building. CSCI have received completed surveys from 10 residents, 4 staff and 6 healthcare professionals and these have helped to inform this inspection. Residents expressed satisfaction with the care and services provided at the home and the environment is relaxed friendly. This report summarises the findings of this inspection. What the service does well:
The home provides a comfortable homely environment that is very clean and well maintained for the people using the service, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. There are spacious grounds that are accessible to the people using the service. There is a friendly welcoming atmosphere and the people using the service say they are happy living in the home. They say the staff are very kind and caring and work well together. Comment from a relative “We have nothing but thanks and praise for the reception we have had at Little Trefewha. The atmosphere, attitude and care are always calm and reassuring; everyone seems happy and contented”. Information about the service is available in the home and provided to people who enquire about the home.
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 6 People are only accepted into the home following a full assessment of their needs. From this each person has a written care plan detailing their individual requirements; this directs staff on how best to meet their needs. The plans are compiled with the resident, reviewed regularly and signed. Doctors, nurses and other healthcare professionals visit the home to provide care when necessary. Survey results show that professionals are very satisfied with the service provision. One said, “I would be happy to live there”. Equipment is provided for moving and handling purposes and for the prevention of pressure sores. People say their privacy and dignity is respected at all times and this appeared to be so during the inspection. People using the service are able to maintain contact with their family and friends as they wish. Visitors are welcome in the home and some residents go out with their families. A range of activities are on offer in the home, including a monthly religious service, and residents can join in as they wish, some said they stay in their rooms most of the time and this is accepted. Staff said they do try to spend time on a one-to-one basis with residents as well. People using the service said their individual preferences are respected and they are supported to maintain their independence. They get up and go to bed when they wish and go out according to their ability. All the bedrooms are personalised with resident’s own belongings. One healthcare professional commented, “I get the impression the residents are supported to live life as they choose”. The food served is to a good standard with homemade cooking, fresh fruit and vegetables. Special diets and individual needs are catered for. Comments about the food were very good although two people felt there could be a choice of two hot meals at lunchtime. There is an appropriate complaints policy available in the home and there is a method for recording complaints, the action taken and the outcome. There have been no complaints. Residents said that staff are kind and caring and there are enough of them to meet their needs. 78.5 of care staff have an NVQ qualification in care. The home employs a registered manager who is competent and experienced to run the home. Staff, residents and healthcare professionals feel she is approachable and listens to what they have to say. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
A few adjustments are needed to the statement of purpose, for example it refers to the NCSC and the policy included regarding the resident’s monies needs updating. This was discussed with the registered manager who said she would ensure the work was done.
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 8 An up to date copy of the royal pharmaceutical guidelines (now titled the handling of medicines in social care) is required for staff to refer to and to enable the medicines policy to be updated. The medicines policy is very generic and long and does not specify the procedures used at Little Trefewha. This was discussed with the registered manager who said she would work on it and send a copy to the Commission. People on as required medicines, self-medicating and so on need to have a medicines care plan to instruct staff. A doctor needs to approve and sign the homely remedies list. Handwritten instructions on the medicine charts are not always witnessed with two signatures but this has improved since the last inspection. There must be evidence that medicines training has taken place. It is recommended that the registered manager audit the medicine records each month to ensure staff are following the correct procedures and that charts are signed correctly. There are activities but attendance is low, there is no evidence that people have been asked about the activities they would like; the registered manager said she would undertake a survey. The new adult protection policy, with flow chart included has yet to be provided by the administration office. There were two other policies that do not give clear specific guidance to those using them. It is not easy to evidence training attendance as the certificates are held in individuals’ files. It is recommended that the registered manager compile a matrix to record staff training so she can see who has attended courses and when. There is little evidence that staff undertake training other than NVQ’s and statutory updates, further training in respect of the diseases of old age for example would be beneficial. Moving and handling, and first aid training are outstanding despite the registered manager chasing these up with one of the company directors. This training must take priority. Recruitment procedures have improved however photographs of all employees must be on file and the registered manager said she would address this promptly. The dates on which people commence work, the position held, the work that they perform and the number of hours for which they are employed each week must be held. The registered manager agreed that letters offering employment with this information should be held, as contracts are not issued until the three-month probationary period has passed. The registered manager is now back in charge of the home and has put systems in place for staff should she be absent again for a long period of time, these need to be recorded in a policy. Policies generally need reviewing by the registered manager to ensure they reflect the home’s procedures. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 9 Quality assurance systems still need to be put in place with systems for continuous improvement. Regular meetings with staff, residents and relatives will help people to air their views and implement changes. The registered manager stated that formal staff supervision has not been kept up to date but she intends to commence this again now she has settled back to her role. The five-year electrical wiring test certificate must be found to ascertain when this is next due and the commission informed. 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. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 10 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 Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 11 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): 1 and 3 (6 is N/A) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a statement of purpose available in the home. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide suitable care. EVIDENCE: The statement of purpose was available for inspection and accessible to staff. It has been updated recently but there are a few adjustments needed, for example it refers to the NCSC and the policy included regarding the resident’s monies needs updating. This was discussed with the registered manager who said she would ensure the work was done. The registered manager said that she or her deputy visit prospective residents or they come to see the home prior to admission. Records show that a thorough needs assessment is undertaken with the resident and their family. There were assessments on file undertaken by the department of adult social
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 12 care and nurses. These help the home to make a decision as to whether they can manage the person’s needs. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 13 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. Residents said their healthcare needs are met and they have care plans to ensure that staff know how to care for them. There is a medicines system in place, which the registered manager intends to audit for consistency. EVIDENCE: Each person using the service has an individual care plan and three were inspected. The plans are detailed and include social and religious needs. They are developed with the individual resident and signed by them or their representative when possible. They are reviewed every three months to keep them up to date, however this does not always appear to involve the resident. There are sheets included for visits by doctors and other health professionals. Daily records are maintained and informative. The night staff now write in the records rather than pass information on to the registered manager to write up which could lead to errors. Relevant risk assessments are undertaken for example for pressure sore risks, falls, nutrition and moving and handling. No forms of restraint are used in the home at present however bumpers have been purchased if bed rails need to be used, for safety. The registered
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 14 manager has the HSE guidelines regarding restraint and this includes a section on risk assessment so she can develop a risk assessment form for the home. People said that doctors and other healthcare professionals visit when required and records are kept. Staff said there is sufficient equipment for moving and handling and pressure relief in the home. Residents said their healthcare needs are met. Comments from a survey of healthcare professionals include “They call us appropriately” and “Scripts are always ordered on time and are very well organised”. The registered manager said she was going to get an up to date copy of the royal pharmaceutical guidelines for care homes (now titled the handling of medicines in social care). There is a medicines policy but it is very generic and long and does not specify the procedures used at Little Trefewha. This was discussed with the registered manager who said she would work on it and send a copy to the Commission. A monitored dose system is in use and medicines are stored appropriately. Temazepam is held for two people and also stored appropriately. The medicine administration records are generally complete but there were a few gaps where no signature or reason for omission, were recorded. It is recommended that the registered manager audit the medicine records each month to ensure staff are following the correct procedures. The records of medicines received and the disposal records were seen and up to date. A photograph of each resident was seen with their medicine records. There is a new medicine fridge and the temperature is recorded daily. It has been within the normal range. Two residents administer their own insulin and have a lockable facility in their room for storage. The unopened insulin is kept safely in the medicine fridge. The homely remedies list has not yet been signed as approved by a doctor and this needs to be done. Lactulose syrup, prescribed for individuals is no longer being shared. Handwritten instructions on the charts are not always witnessed with two signatures but this has improved since the last inspection. For people prescribed to have medicines administered “when required” we found that although this medicine was administered regularly there is no record made of any assessment made before the administration of the medicine. We also found that there is no reference made in the care plan about the use of this medicine, nor are there any directions on how to make an assessment if this medicine is required. People who are self-medicating also have no directions for staff in their care plans. The registered manager said that all staff that administer medicines have received training, some certificates were awaited from the pharmacist so this could not be evidenced. Staff spoken with said they had been trained. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 15 Residents’ privacy appeared to be upheld during the inspection. Residents said they are treated with respect and their privacy is maintained at all times. Residents said they receive their post unopened and the telephone arrangements in the home are satisfactory, direct lines are supplied on request. The shared room is provided with appropriate screens. Little Trefewha DS0000009097.V359920.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 good. This judgement has been made using available evidence including a visit to this service. Staff encourage residents to socialise and join in activities, visitors are welcome and efforts are made to ensure that residents choices and preferences are respected so they can live a life that suits them. EVIDENCE: Some activities take place in the home and there are posters displaying what’s on. Both staff and people using the service said that residents do not join in very much and it is their choice. It was observed at the last inspection that very few people use the lounge and it was the same this time. Two women were chatting in the lounge and they said that entertainers come in and they are good. The registered manager and staff talked about new social activities introduced recently. There were records of a trip out at Christmas to see the lights with a fish and chip supper. There is no evidence that people have been asked about the activities they would like; the registered manager said she would undertake a survey. Records of social activities are kept in the form of an individual sheet for each person, these include visits by family and friends, hairdresser and chiropodist visits. Staff interacted well with the people using the service and they said they
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 17 try to spend 1:1 time with everyone. The registered manager was sitting in the lounge having a conversation with residents when the inspector arrived. All staff said they try to make sure residents are encouraged to socialise and join in with activities they enjoy. Survey comments include “There are only activities at Christmas”, “There doesn’t seem to be enough OT”, “They do try to provide entertainment on a regular basis. It is quite difficult to please everyone” and “Whenever it appeals to me I attend social functions in the lounge”. All residents spoken with said their individual preferences are respected and they are supported to maintain their independence. They said they choose what they do and are free to go out when they wish; some said they visit their families regularly. Most residents control their own money with the help of their families. All residents have their own belongings in their rooms. There is a set menu but people said there are alternatives available. The lunchtime meal is written on a board in the dining room. Fresh fruit and vegetables are included in the menu and there are homemade cakes at teatime. Likes and dislikes are recorded in the care files. All residents spoken with said the food is very good and there is plenty of it. The homemade pasties still seem to be very popular. Survey comments include “There is a varied diet, mum likes the food, she has put on weight” and two people said “It would be nice to have two hot meals offered every day at lunchtime”. There is no teatime cook at present so the registered manager or care staff have to prepare and serve the teatime food. Residents said they all do this well. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. There is a suitable complaints procedure for the home but the abuse procedure is not so clear. Although staff have been receiving training this could not be fully evidenced and could compromise the safety of vulnerable elderly people in the home. EVIDENCE: There is a suitable complaints procedure in place that is available to people in the home. There have been no complaints since the last inspection. Residents said there are no barriers to raising concerns with the staff or the manager. The new adult protection policy, with flow chart included has yet to be provided by the administration office. One of the company directors said he would issue this as soon as possible. There were two other policies that do not give clear specific guidance to those using them. There are copies of the 2005 multi agency policy, the ‘No Secrets’ document and the alerter’s guide in the registered manager’s office. Staff said they had received in house training about abuse but not all have attended the local authority courses. It is not easy to evidence attendance as the certificates are held in individual files. It is recommended that the registered manager compile a matrix to record staff training so she can see who has attended courses and when. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 19 Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, very clean and very well maintained making it a safe homely place for people to live in. EVIDENCE: The home provides a comfortable, homely environment and all residents spoken with said they are very happy with their surroundings. Everyone said how clean the home is and this was emphasised in the surveys returned to the Commission. The home is well maintained, decorated and furnished to a good standard. Residents have their own possessions around them and have personalised their rooms to their liking. There have been no structural changes to the premises since the last inspection. There is ongoing re-decoration and renewal of carpets, the maintenance person was painting the quiet lounge during this
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 21 inspection. Radiator covers have been fitted where necessary since the last inspection as some radiator were very hot. The grounds are very tidy and accessible; there is a ramp from the lounge. The step inside the front door is not good for wheelchair access. The registered manager said they hope to provide a conservatory at the entrance to the home, which will improve this. The laundry facilities are suitable and red dissolvable laundry bags are used. Residents had no complaints about the laundry service. There are appropriate hand-washing facilities for staff and alcohol hand cleansing gel is in use. Protective clothing is provided for staff. A bedpan washer disinfector has been purchased but has not yet been set up for use. Infection control training is provided for staff. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 22 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. There are suitable numbers of staff to meet people’s needs although training must be evidenced and additional training specific to the elderly would enhance their skills. Recruitment procedures have improved but require further documentation to be held. EVIDENCE: Staffing requirements in the home have been reviewed since the last inspection and more care staff have been employed. The night arrangements have changed, there are now two carers on duty that stay awake, there is no one sleeping in. Generally there are three care staff on duty in the mornings and two in the afternoons and evenings. In addition there is a person in charge, usually the registered manager or her deputy. There is one vacancy for a teatime cook, the position was filled but the person has left. Residents said the staff are very kind and they are very well cared for. One resident said, “My bell is answered quickly, even if someone comes and has to go again, I know they will come back and attend to me”. Survey comments include “I find the staff very attentive & friendly”, “Staff are very caring and take an holistic interest in the clients” and “They are always busy as lots of people to care for”. The registered manager said that eleven care staff are qualified to at least NVQ
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 23 level 2 in care, this equates to 78.5 of care staff. Two others are also doing the course. Three staff files were inspected and had improved in their content since the last inspection. The registered manager said that one employee awaiting CRB clearance was working under supervision, although this was not documented. Photographs of all employees must be on file and the registered manager said she would address this promptly. The dates on which people commence work, the position held, the work that they perform and the number of hours for which they are employed each week must be held. The registered manager agreed that letters offering employment with this information should be held, as contracts are not issued until the three-month probationary period has passed. She said she would sort this with the administration office. There was more evidence of staff training taking place than at the last inspection however all records and certificates are held on individual files making it difficult to see if training is up to date. As mentioned under standard 18, it is recommended that the registered manager compile a matrix to record staff training so she can see who has attended courses and when. There was a notice regarding 4 in 1 training provided by a health and safety consultant. The training includes fire, food hygiene, infection control and health and safety. The registered manager said that fourteen staff attended in January and there are four dates available to staff for April. Certificates were seen in some files and some were waited to evidence medicines training. Staff have read and signed the health and safety policy, the list included new staff. The registered manager said that moving and handling, and first aid training are outstanding and she has been chasing these up with one of the company directors. There were notes on a pad by the telephone regarding first aid training. This training must take priority. Induction training records were seen in the files inspected and all areas had been signed as done. The skills for care induction packs are used. Other than NVQ training there is little evidence that staff undertake training other than statutory updates. One member of staff said she would like to do dementia training. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 24 Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 25 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of the residents but there are few quality assurance systems in place to bring about change and improve quality. Health and safety systems have improved but important statutory training has not taken place and policies need to be kept up to date to direct staff. EVIDENCE: Directors of the company worked at the home following the last inspection and have reviewed the management arrangements and staffing. The registered manager is now back in charge of the home and has put systems in place for staff should she be absent again for a long period of time, these need to be recorded in a policy. Policies generally need reviewing by the registered manager to ensure they reflect the home’s procedures, for example the medicines policy, resident’s monies policy and the abuse policy. The registered
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 26 manager is competent in running the home and has recently achieved the Registered Managers Award. There is an open and transparent ethos in the home. Staff said they respect the registered manager and that she is a good leader. People spoken with said, “Jackie is wonderful”, “The home is very well managed that is why it’s a good one” and “Jackie’s boss comes around and speaks to us sometimes”. Survey comments include “The manager is very approachable” and “I personally have a great respect for Jackie in her role”. The registered manager said that the company directors are very supportive to her. There is still no annual development plan or auditing system in place to show the home strives for improvement. The registered manager said that surveys are ready to be distributed to residents and relatives so they can air their views about the home. One of the company directors visits each month and writes a report in compliance with regulation 26 of the Care Homes Regulations 2001. These reports are informative and she includes people’s comments. CSCI surveys were all very positive about the home and the services provided. Comments include “Of all the homes in the area I feel Little Trefewha is a very friendly and caring one. The residents seem happy and at home. It is a home I would feel happy about if my own mother needed care. I would even go there myself if I ever had to” and “Nothing but thanks and praise for the reception we have had at Little Trefewha. The atmosphere, attitude and care are always calm and reassuring; everyone seems happy & contented”. Meetings had lapsed but the registered manager is getting them started again. The last full staff meeting was when the manager was away but there was a meeting with evening and night staff in March. The last resident’s meeting was in May 2007, the manager said the next one will be soon and relatives are invited. Although meetings are few staff said they can talk to the registered manager at any time and she verified this. They said that issues are often discussed during handover. Staff kept coming into the office to ask or inform the registered manager of things during the inspection. Residents said the registered manager sees them every day and they can air their views freely. There is a policy for the safekeeping of residents money but it must be expanded to detail the specific procedures used in the home. One of the company directors said that the new policy has not been sent to the home yet. The home holds cash for nine people, it is stored separately in a locked facility. Records are maintained of all transactions and receipts are kept for purchases and money received. Receipts are not number coded which would help with auditing. Transactions have only one signature recorded and this is usually the registered manager, there needs to be a double check of the accounts regularly. An extra column for money received would make the accounts clearer. The registered manager said that five people deal with their own money and lockable facilities are provided for storage. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 27 The registered manager stated that formal staff supervision has not been kept up to date but she intends to commence this again now she has settled back to her role. There is satisfactory evidence that appropriate health and safety and fire precautions are in place. The accident records were inspected and nothing untoward found, the home has relatively few accidents. One person who was falling frequently was referred to the falls clinic where he was provided with a different walking aid; his falls have since reduced. Machinery and equipment service checks are undertaken regularly. Certificates show that is up to date. The five-year electrical wiring test certificate must be found to ascertain when this is next due and the commission informed. It is evident that statutory training takes place but it will be easier to see that all staff have attended appropriately when a matrix has been produced. Moving and handling and first aid training must be provided for staff as a matter of urgency. Little Trefewha DS0000009097.V359920.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 3 X 3 X X N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 1 X 2 Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 29 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. 1 Standard OP9 Regulation 13 (2) Requirement The medicines policy must be updated to state specifically the procedures to be used in the home. This will improve safety for residents and ensure staff know what is expected of them Medicine systems in the home must be reviewed to include: • Transcribing on MAR charts to be witnessed and signed by two staff • Obtaining a copy of the document ‘The handling of medicines in social care’ • Evidence that medicines training has taken place • The approval of the homely remedies list by a doctor • Appropriate care planning in respect of medicines This will safeguard residents 3 OP18 13 (6) There must be a specific abuse policy for the home that staff are able to follow. This will help to safeguard
Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 30 Timescale for action 31/07/08 2 OP9 13 (2) 31/07/08 31/07/08 4 OP29 19 Sch 4 (6) 17 residents. Recruitment of new employees must be robust and include all of the records and checks required by law: • A photograph of each employee • The dates on which people commence work, the position held, the work that they perform and the number of hours for which they are employed This will help to safeguard residents and staff 31/07/08 5 OP30 13 (5) (6) 17 18 (1) (c)Sch 4 (6) (g) Staff must receive appropriate training that can be evidenced including: • abuse training • moving and handling training • first aid training • training to develop their knowledge and skills This will ensure that staff have the knowledge and skills to care for and safeguard the people using the service. The five-year electrical wiring test certificate must be found to ascertain when this is next due and the commission informed. This will help to ensure the safety of residents, staff and visitors to the home 01/09/08 6 OP38 13 (4) 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 31 No. 1 Refer to Standard OP9 Good Practice Recommendations The registered manager should audit the medicine records each month to ensure staff are following the correct procedures and that charts are signed correctly. The washer disinfector should be installed for infection control purposes. A flow chart or simplified adult protection procedure should be compiled for staff to reference easily The registered manager should compile a matrix to record staff training so she can see who has attended courses and when. The registered manager should ensure that systems pertaining to the management of the home are incorporated into the homes policies and procedures The registered manager should seek the views of relatives and external stakeholders in relation to quality reviews A copy of the quality assurance annual report should be available for inspection to evidence what people think about the home The home’s policy for the safekeeping of resident’s monies and valuables should specifically detail the home’s procedure to inform and direct staff 2 3 4 OP26 OP18 OP30 5 OP31 6 7 OP33 OP33 8 OP35 Little Trefewha DS0000009097.V359920.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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