CARE HOMES FOR OLDER PEOPLE
Little Trefewha Praze-an-Beeble Camborne Cornwall TR14 0JZ Lead Inspector
Diana Penrose Key Unannounced Inspection 25th April 2006 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.V290342.R02.S.doc Version 5.1 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.V290342.R02.S.doc Version 5.1 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.V290342.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To include one named person under 65, outside the category of registration 29th November 2005 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 home also provides day care for one resident. 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. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Little Trefewha Care Home on the 24 April 2006 and spent seven hours at the home. This was an unannounced visit. The purpose of the inspection was to undertake a statutory inspection and to gain an update on the progress of compliance to the requirement identified in the last inspection report dated 29.11.05. All of the key standards were inspected. On the day of inspection 18 residents were resident in the home, 1 of these 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. Records, policies and procedures were examined and the inspector toured the building. 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 safe for residents, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. There is a friendly welcoming atmosphere and residents say they are more than happy living in the home. They say the staff are very kind and considerate and work well together. Residents are only accepted into the home following an in depth assessment of their needs. From this each resident 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. Equipment is provided for moving and handling purposes and for the prevention of pressure sores. There is an appropriate medicines policy and records in respect of medicines are well maintained. All medicines are stored safely and correctly. Resident’s say their privacy and dignity is respected at all times. A range of activities, including a monthly religious service, is provided and residents are aware of what is on offer. Residents say they can join in as they wish, some said they stay in their rooms most of the time and this is accepted. An Easter bonnet competition proved popular and the winner was proud of her bonnet. Staff also spend time on a one-to-one basis with residents. Residents are able to maintain contact with their family and friends as they wish. All residents spoken with 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 residents’ bedrooms are personalised with their own belongings. One resident said, “It is home from home”.
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 6 The food served is to a good standard with homemade cooking, fresh fruit and vegetables. Special diets and individual needs are catered for. All residents spoken with said the food is very good. There is an appropriate complaints policy available in the home and there is a method for recording complaints, the action taken and the outcome. The home has a policy to protect residents from harm and abuse and staff receive training in this area. Residents said that staff are kind and caring and there are enough staff on duty. 78.5 of care staff have an NVQ qualification in care, which is excellent. Training needs for staff are identified and opportunities are given for staff to attend courses to improve their knowledge. There is a comprehensive recruitment system in place with all the necessary checks included. New staff are supervised during their induction period. The home employs a registered manager who is competent and experienced to run the home. Staff and residents feel she is approachable and listens to what they have to say. There is a good system for the safekeeping of resident’s money however residents are encouraged to manage their own money for as long as possible. The management endeavour to make sure working practices are safe and statutory training is provided for staff on health and safety, food safety, fire safety, infection control, and moving and handling. All necessary service and equipment checks are undertaken regularly. What has improved since the last inspection? What they could do better:
A copy of the annual quality assurance report must be sent to the Commission as required in the Care Home Regulations. It maybe beneficial to seek the views of relatives and external stakeholders. All staff must attend fire training in accordance with statutory requirements; at present it is only once a year. Induction training takes place but records must be kept. There is a toilet upstairs that requires a lock fitting to ensure privacy. A sluice with a washer disinfector should be provided for Infection control purposes. A flow chart or simplified adult protection procedure should be compiled for staff to reference easily.
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 7 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. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 8 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.V290342.R02.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: The registered manager visits prospective residents or they come to see the home prior to admission. She undertakes a thorough needs assessment with the resident and often their family; this is well documented and forms the basis of the care plan. She said she makes sure she has a Social Services assessment for prospective residents if appropriate and these were seen in the files. She also gets information from other health professionals as necessary prior to deciding to accommodate anyone. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A care plan is generated with the resident to inform and direct staff in the care provision. Residents said they have access to health care services as necessary; there is a suitable system for dealing with their medicines and their privacy is respected. Residents feel their needs are being met by the home. EVIDENCE: Person centred care plans are in place for each resident that inform and direct the staff. The plans are reviewed every 3 months or more frequently if necessary. The care plans are signed as agreed by the resident or representative. Relevant risk assessments are undertaken including falls, nutrition, and moving and handling. Detailed daily records are maintained and are very informative. Resident’s said their healthcare needs are met, two GP’s and an optician visited during the inspection. Resident’s talked about doctor’s visiting and one said the district nurse visit’s regularly and is very efficient. Two residents told the inspector they had needed hospital treatment recently. Suitable equipment is available to staff for moving and handling purposes and pressure relief.
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 11 There is a suitable medicines procedure and the home has a copy of The Royal Pharmaceutical Guidelines for the Administration of Medicines in Care Homes available to staff. The records were complete and up to date. A photograph of each resident is held with their medication administration record. A monitored dose system is in use. Insulin is stored correctly and the medicine fridge temperature is checked and recorded. Residents said the staff administer their medicines on time, one resident administers her own medicines. Residents’ privacy was upheld during the inspection. Residents said they are treated with respect and their privacy is upheld at all times. Residents said they receive their post unopened and the telephone arrangements in the home are satisfactory. The shared room is provided with appropriate screens. Privacy and dignity is included in the home’s statement of purpose. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents said the home provides a range of activities, encourages contact with friends and family and aims to offer a lifestyle that meets their needs. There is a varied diet that meets the resident’s needs and preferences. EVIDENCE: Activities take place in the home and residents were aware of what was on offer. Residents can choose whether to join in organised activities; some prefer to stay in their rooms. The registered manager said one to one sessions take place with individual residents, for example a chat; nail painting or reading a book. Records are maintained within the care files, the registered manager said these do not show enough detail and need revision. Activities include bingo, entertainers, story and poetry readings, chair aerobics, quizzes and board games. One resident said she won the Easter bonnet competition, an event that seemed to be enjoyed; several residents had their bonnets in their rooms. A church service takes place in the home each month. Residents said they could receive visitors at any time they wish or contact them by telephone. Some said they go out with their friends and relatives; one resident went out during the inspection. Mail is given to residents promptly, unopened.
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 13 All residents spoken with said their individual preferences are respected and they are supported to maintain their independence. They said they could go out when they wish and the daily routines are flexible. Three residents control their own money. One resident helps in the kitchen, does her own laundry and goes out shopping. She visits her family regularly. One resident goes into Camborne regularly. All residents have their own belongings in their rooms. One resident said it is home from home. There is a nutritious menu with choices available, special diets are catered for. Fresh fruit and vegetables are included and there are homemade cakes at teatime. One resident said that fish is on the menu each Friday but she has an alternative because she does not like fish. Likes and dislikes are recorded in each residents file. One resident said the staff know what he does not like and there have been no problems. All residents spoken with said the food is very good and there is plenty of it. The food records are now recorded in more detail. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon and arrangements are in place for the protection of residents safeguarding them from harm or abuse. EVIDENCE: There is a suitable complaints procedure available to staff, residents and visitors. There had been one complaint since the last inspection, dealt with and recorded appropriately by the registered manager. There is an adult protection policy and information on local authority procedures. Staff spoken with were aware of this and staff sign when they have read the policy. Several staff have attended the local Social Services alerters training which was felt to be helpful. It is recommended that a flow chart or simplified procedure be compiled for staff to reference easily. It needs to be clear on who to report to and state that CSCI must be notified. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 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 clean, comfortably furbished and well maintained; along with a tidy accessible garden the environment is safe for residents, staff and visitors. EVIDENCE: There have been no changes to the premises since the last inspection. One of the corridors is in the process of being re-decorated. Several carpets have been replaced and some rooms re-decorated. New flooring has been laid in the kitchen, which has completed the refurbishment. The home is well maintained, decorated and furnished to a good standard. It is very clean, homely and comfortable. The grounds are very tidy and accessible. Residents said they are very happy in their home and surroundings. The home is non-smoking but smokers can utilise the front porch, staff have voiced concerns over this and the registered manager is trying to find solutions. An extractor fan has been fitted to reduce the amount of smoke accumulating in the porch.
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 16 Possibilities are being considered regarding the installation of a shower with a ‘walk in’ facility. Concerns over restrictions on the use of the bath seat, due to the size of the bathroom, are being looked into. A lock must be fitted to an upstairs toilet for resident’s privacy. 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. It is recommended that a sluice with a washer disinfector be provided for infection control purposes. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels meet the needs of residents and staff morale appears to be good. Recruitment procedures are robust and offer protection to the residents. The home provides appropriate training for staff to help them be more competent in their roles and resident’s benefit from the 78.5 of care staff qualified to at least NVQ level 2 in care. Records of induction training must be kept up to date. EVIDENCE: Three care staff are on duty during the daytime with the registered manager or her deputy. There is one carer at night, the registered manager lives in the adjoining accommodation and is available if required. This has not posed any problems. There is one staff vacancy for a cook. 78.5 of care staff (including the deputy manager) are qualified to at least NVQ level 2 in care. Four have achieved the NVQ level 3 in care. Two staff are currently studying for an NVQ qualification. Prospective employees complete an application form and are interviewed prior to selection for employment. Interview records are maintained. Personnel files inspected contained the records required by legislation. Photographs have not yet been done for two very new employees and one is working under supervision whilst awaiting her CRB disclosure, the POVA disclosure has been received. Job descriptions are included in the employee handbook. All staff are
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 18 issued with terms and conditions of employment following their initial three months. Each member of staff has a training record sheet. There is an induction programme in place for new staff unfortunately the induction training records are not up to date. Staff are supervised during their induction period. Staff said there is plenty of training on offer. They said that palliative care training has been attended recently. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is a person of good character; both residents and staff feel she is fit to run the home. The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place. The system for dealing with residents’ money ensures that the residents’ financial interests are safeguarded. Both management and staff promote the health, safety and welfare of residents; however, more frequent fire training is required. EVIDENCE: The registered manager is comeptent and experienced to run the home. She is qualified to NVQlevel 4 in care and is working towrds the Registered Managers’ Award. She said she attends statutory training and reads care magazines to keep up to date on current issues. Her recent training includes moving and handling, dementia awareness and infection control. Staff said the registered manager is approachable and works well with the team. Residents said she is
Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 20 in control and they can talk to her with ease. One resident said if no one else can help the manager could. A deputy manager has been employed to assist the registered manager all spoken with said she has settled in well. A Quality Assurance questionnaire is circulated to residents annually some relatives complete these on behalf of the resident. The views of relatives and stakeholders should be sought as part of the process and the registered manager said she would like to do this. A report must be compiled on completion of the surveys and a copy sent to the Commission. Staff meetings and residents meetings are held with minutes maintained. There is a policy for the safekeeping of residents money. Residents can control their own money for as long as they wish and are able to do so, seven residents deal with their own money. Money held for residents is stored individually and securely, records are maintained and receipts are kept. Three members of staff deal with residents money and all transactions are signed for. It is recommended that the resident or their representative sign an agreement for the home to handle their money. The management endeavour to make sure working practices are safe. Statutory training is provided for staff. All staff have recently attended a moving and handling update. A health and safety consultant provides a training day covering health and safety, food safety, infection control and fire safety. The registered manager said this has improved staff attendance. Fire training has not been attended in accordance with statutory requirements and must be addressed. There is a member of staff trained in first aid on duty at all times. All necessary service and equipment checks are undertaken regularly. Accidents are recorded and reported appropriately. A health and safety consultant has undertaken the fire risk assessment and audit; issues arising are being addressed. Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 22 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 2 3 4 Standard OP19 OP30 OP33 OP38 Regulation 12(4)(a) 37 Sch 4 (6) 24(2) 23(4)(d) Requirement A lock must be fitted to the toilet on the upstairs landing Induction training must be recorded A copy of the quality assurance annual report must be sent to the Commission All staff must attend fire training in accordance with statutory requirements Timescale for action 31/07/06 31/07/06 31/07/06 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP18 OP26 OP33 Good Practice Recommendations A flow chart or simplified adult protection procedure should be compiled for staff to reference easily A sluice with a washer disinfector should be provided for Infection control purposes. The registered manager should seek the views of relatives and external stakeholders in relation to quality reviews Little Trefewha DS0000009097.V290342.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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