CARE HOMES FOR OLDER PEOPLE
Little Trefewha Praze-an-Beeble Camborne Cornwall TR14 0JZ Lead Inspector
Diana Penrose Announced Inspection 29th November 2005 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.V258802.R01.S.doc Version 5.0 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.V258802.R01.S.doc Version 5.0 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.V258802.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To include one named person under 65, outside the category of registration 4th May 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 two residents. 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.V258802.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Little Trefewha Care Home on the 29 November 2005 and spent five and a half hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to requirements identified in the last inspection report dated 04.05.05. In addition the inspector focused on the following key areas of care: choice of home, assessment and care planning, leisure, complaints, adult protection, some of the environment, training and quality assurance. On the day of inspection 20 service users were resident in the home, 2 of these were receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, staff, the registered manager and one of the company directors 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 clean and safe for residents, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. There is a non-smoking policy in the home but those who wish to smoke can do so in the porch. There is a friendly welcoming atmosphere and residents say they are more than happy living in the home. Both residents and visitors say the staff are very kind and welcoming, refreshments are on offer all day long and visitors can feel free to ask for a cup of tea or coffee. Residents are only accepted into the home following an in depth assessment of needs. From this each resident has a written care plan detailing their individual requirements and directing 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. A range of activities including religious services take place regularly and residents are aware of what is on offer. One resident said, “Staff respect the fact that I stay in my room and do not join in with the social events”. Residents are able to maintain contact with their family and friends as they wish. The food served is to a good standard with homemade cooking, fresh fruit and vegetables. One resident said he eats more than he did when he came into the home. The home has a policy to protect residents from harm and abuse and staff receive training in this area. Training needs for staff are identified through the supervision and appraisal system and opportunities are given for staff to
Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 6 attend courses to improve their knowledge. 55 of care staff have already achieved an NVQ qualification. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Prospective residents are given information about the home enabling them to make an informed decision. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: There is a suitable statement of purpose and service users guide in use and available in the home. The registered manager said these documents are given to prospective residents or their representatives. The registered manager said she visits prospective residents or they sometimes come to see the home prior to admission. She undertakes a thorough needs assessment with the resident and often their family; this is 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 gets information from other health professionals as necessary prior to deciding to accommodate anyone. The Registered Manager explained the system to an enquirer during the inspection. It should be documented who is involved in the initial assessment and signatures obtained when possible. Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 9 Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 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 and 10 Individual care plans are generated for each resident that inform and direct the staff in their care provision. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. EVIDENCE: Each resident has an individual care plan that informs and directs 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. Daily records are maintained and are informative. Residents’ privacy was upheld during the inspection. Residents said they are treated with respect and their privacy is upheld at all times. Shared rooms are provided with appropriate screens. Privacy and dignity is included in the home’s statement of purpose. Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 11 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): 12,14 and 15 The home provides a range of activities and aims to offer a lifestyle that meets individual residents needs. Residents are helped to maintain control over their lives and staff respect their individual preferences and choice. Dietary needs of residents are well catered for with a varied selection of food available that meets their taste and preference. EVIDENCE: Activities take place regularly and a list of what is on offer is given to residents and a copy displayed. There is a very full event list for the Christmas period that residents are aware of. Records of attendance are maintained. Fundraising events take place for charities and trips out are organised. Some residents said they enjoy the activities but others were happy not to participate and this was respected. Residents are asked what activities they would like. Story reading was being enjoyed during the inspection. 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. All residents have their own belongings in their rooms.
Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 12 Residents said the meals are very good and they have plenty to eat. Fresh fruit and vegetables are included on the menu. Staff and residents said there are choices available at each meal. Likes and dislikes were recorded and available to staff. Appropriate food records are maintained. Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 13 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 and 18 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. Arrangements are in place for the protection of residents safeguarding them from harm or abuse. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been no complaints. Thank you letters and cards are kept. The home has a copy of the Local Authority inter agency procedures, alerters guide and a draft copy of the national framework for safeguarding adults. 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. There is a secure facility for the storage of money in the home. Five staff have attended POVA training, staff said it has been difficult getting onto a course. Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 14 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 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. The home is clean and from offensive odours making it a pleasant place to live in. EVIDENCE: 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. The kitchen has been refurbished and new units installed; new flooring is soon to be fitted. The laundry facilities are suitable and red dissolvable laundry bags are used. Residents had no complaints about the laundry service. There were appropriate hand-washing facilities for staff. 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.V258802.R01.S.doc Version 5.0 Page 15 Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 16 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): 28, 29 and 30 Residents are in safe hands and benefit from the number of care staff that have an NVQ qualification. 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. EVIDENCE: 55 of care staff have achieved the NVQ level 2 in care and one the level3. Other staff are currently studying for a 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. Job descriptions are included in the employee handbook. All staff are issued with terms and conditions of employment. Training and development needs are identified through the annual appraisal and supervision sessions. Each member of staff has a training record sheet. There is an induction programme in place for new staff. Various courses have been attended including the safe handling of medications, Infection Control and health and safety. The Registered Manager said she has attended dementia awareness training. Statutory training includes food hygiene, fire safety and moving and handling. The cook is going to undertake the Intermediate Food hygiene course. Staff said there is plenty on offer but certificates can take a long time to arrive.
Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 17 Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 18 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): 33 The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place EVIDENCE: A Quality Assurance questionnaire is circulated to residents annually. The views of relatives and stakeholders should be sought as part of the process and 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. Residents and staff were informed of this inspection. Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 19 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 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 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Little Trefewha DS0000009097.V258802.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP33 Regulation 24(2) Requirement A copy of the quality assurance annual report must be sent to the Commission Timescale for action 06/02/06 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 4 Refer to Standard OP3 OP18 OP26 OP33 Good Practice Recommendations It should be documented who is involved in the initial assessment and signatures obtained when possible. 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.V258802.R01.S.doc Version 5.0 Page 21 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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