CARE HOMES FOR OLDER PEOPLE
Little Trefewha Praze-an-Beeble Camborne Cornwall TR14 0JZ Lead Inspector
Diana Martin Unannounced 04 May 2005 09:45 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 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 D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Little Trefewha Address Praze-an-Beeble Camborne Cornwall TR14 0JZ 01209 831566 01209 831566 enquiries@tregennahousenursinghome.co.uk Little Trefewha Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jacqueline Jane Elliot Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1) To include one named person under 65 outside the category of registration. Date of last inspection 02/12/04 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 service user. 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 service users. Suitably experienced care staff provide personal care within a relaxed, friendly, welcoming atmosphere. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Little Trefewha on the 4th may 2005 and spent 6 hours at the home. This was an unannounced visit. On the day of inspection 20 service users were resident in the home and 1 was attending for day-care. The inspector met with 8 service users, a number of staff and the Assistant Manager to gain their views on the service that Little Trefewha provides. In addition the inspector examined records, policies and procedures and 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 service users, 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 one service user said “It is a happy ship, if the staff are happy you can’t go wrong”. Comments from service users generally include “It’s a lovely home”, “Staff are wonderful”, “I am very happy here and I like my room” and “Staff stay here which is always a good sign”. Service users said they are well cared for in the home. Each had a written care plan detailing their individual needs and guiding staff on how needs were to be met. The plans were compiled with the service user, 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 a medicines policy and staff receive training in the safe handling of medicines. Medication records are kept for each service user. A pharmacist visits the home regularly to check the systems in place. A range of activities including religious services take place regularly and service users were aware of what was on offer. Service users 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. The home has a policy to protect service users from harm and abuse. Staffing levels meet the needs of service users and staff morale is good. The management run the home in the best interest of the service users. Service users can control their own money for as long as they wish and are able to do so. Money is only held for a few service users and this is managed well. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 6 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 D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 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 standard(s) 1 and 4 Service users are given information prior to moving into the home, it is unclear as to whether this is sufficient make a fully informed choice about where to live. The home demonstrates that it provides training and involves external healthcare professionals to ensure it can meet the needs of the service users living in the home. EVIDENCE: There was a suitable service users guide in place that was available to service users and visitors. The statement of purpose could not be found. The statement of purpose must be available for inspection. One service user said he was provided with written information prior to moving into the home. Several said their family had visited and chosen the home for them. Service users said the staff met their needs, visiting Doctors and District Nurses. The Assistant Manager said that other health professionals have input as required for example physiotherapists, speech therapists and occupational therapists. Staff have received training in dementia care, diabetes and care of the dying. NVQ training was available to care staff. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8 and 9 Each service user has an individual care plan setting out their health, personal and social care needs; these are detailed to guide and direct the staff providing care. Service users have access to health care services as necessary to ensure their assessed needs are met. There are suitable policies in place for dealing with service users medicines, however the recording procedures need some improvement to safeguard service users from the risk of harm. EVIDENCE: The care plans have been reviewed and updated giving much clearer guidelines for the staff providing care. Documentation used by another home in the group has been implemented but it duplicates previous work and is not as suitable for the home as the care plans now in use. Relevant risk assessments are undertaken and reviewed. Care plans are reviewed every three months and signed by the service user / representative. All service users are registered with a GP, records are kept of visits by healthcare professionals. Equipment for moving and handling purposes is provided. Pressure relieving mattresses are provided by the District Nurses. Keep fit classes are held in the home twice a week. Specialist Nurses give input as required. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 10 A monitored dosage system is used and the medicine round was observed to be satisfactory. There was a copy of the ‘The Royal Pharmaceutical guidelines for the administration of medicines in care homes’. Staff receive training in the safe handling of medicines. Records were well maintained for receipt, administration and disposal of medicines. The transcribing of medicines onto the MAR charts must be witnessed with two signatures recorded. Suitable signage must be displayed where oxygen is stored. A pharmacist visits the home regularly. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15 Service users could enjoy a lifestyle to suit their preferences, their social, recreational and religious needs were catered for. The home ensures that service users have ample opportunity to maintain contact with their family and friends as they wish. Service users dietary needs are well catered for with a selection of meals on offer, records must detail that all service users receive a balanced diet. EVIDENCE: Activities including religious services take place regularly and a list was displayed. Service users were aware of the activities and which days they took place. Records were maintained. Some service users said they enjoy the activities but others were happy not to participate and this was respected. Service users said they were able to maintain contact with family and friends as they wished by visits or telephone. Some said they go out with their family regularly. There is a record kept of visitors to the home. Service users said the meals are very good and there is plenty to eat. The lunchtime meal was nutritious and homemade. Fresh fruit and vegetables are included on the menu. There was a set menu but staff and service users said there were choices available. Likes and dislikes were recorded and available to staff. Food records must be maintained in sufficient detail to enable inspectors to determine that the diet is satisfactory in relation to nutrition.
Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18 Some arrangements are in place to protect service users from possible risk of harm or abuse, however improvements to documentation and staff training must take place. EVIDENCE: The home had an adult protection policy that referred to the ‘No Secrets’ document. The home also had a copy of the Local Authority procedures. The homes policy is still required to be reviewed and updated in line with the Local Authority procedures. There must also be a whistle-blowing policy in place. The assistant Manager said she is booked to attend Adult Protection training in June 2005, she will then pass on her knowledge to the staff. All staff must receive Adult Protection training regularly. There was a secure facility for the storage of money in the home. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20, 21 and 23 The home and grounds are well maintained providing a safe environment for service users, staff and visitors. The decoration and furnishings are to a good standard creating a comfortable home. Service users have access to communal areas that are spacious and safe. There are sufficient baths and toilets to meet the standard but service users said there could be more to avoid having to wait. EVIDENCE: The home was well maintained, decorated and furnished to a high standard. It was very clean, homely and comfortable. The grounds were very tidy and accessible. Service users said they were very happy in their surroundings. There is a large lounge and a smaller quiet room, the dining room is light and airy and can seat all service users. The home is non-smoking but the two smokers can utilise the front porch. The home provides adequate washing, bathing and toilet facilities to meet the standard however service users said they often have to wait to use the toilets. The upstairs bathroom was used for storage but was due to be cleared. There
Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 14 are 19 single rooms and one double room; five of the single rooms have ensuite facilities. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels meet the needs of service users and staff morale is good. EVIDENCE: The assistant manager said the skill mix of staff was suitable for the service users living in the home. The rota showed that three care staff were on duty in the mornings, two in the afternoons and evenings and one waking at night. The staff duty rota is required to show whether the rota was actually worked. The Registered Manager lives on site and is on call overnight. Staff and service users felt the staffing numbers were suitable. Service users said the staff are very kind and their needs are met. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 37 and 38 The home is run in the best interest of the service users and they are safeguarded by the financial procedures employed. There are policies in place to safeguard service users, the abuse policy still requires updating. The records required by legislation are maintained but food records must be introduced. Appropriate training and safety checks are undertaken to ensure the health, safety and welfare of service users and staff. EVIDENCE: Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 17 There is a procedure for the safekeeping of service users money, which is included in the service users guide. Service users can control their own money for as long as they wish and are able to do so. The home keeps pocket money for eight service users. It is recommended that a form be introduced for service users to sign as agreeing to the home handling their money. A record is kept of all transactions and receipts are kept for purchases. Money is stored securely. Service users said they had their own bank accounts. Record keeping is good generally, transcribed medications must be witnessed with two signatures (standard 9) and food records must be maintained in more detail (Standard 15). Statutory training takes place. Moving and handling training has been arranged with another home in the group. All necessary service and equipment checks are undertaken regularly. Accidents are recorded and reported appropriately. Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 3 3 3 x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x 3 x 2 3 Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 19 yes 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. Standard 1 9 Regulation 4 (2) 13(2)(4)( c) Requirement The home must have a statement of pupose that is available for inspection Transcribing of medicines onto the MAR charts must be witnessed with two signatures recordedand apropriate signage must be displayed where oxygen is stored Food records must be maintained in sufficient detail to enable inspectors to determine that the diet is satisfactory in relation to nutrition The adult protection policy must be reviewed and updated in line with the Local Authority procedure and must include whistle-blowing. Staff must receive regular adult protection training. The staff duty rota imust show whether the rota was actually worked The registered provider must seek the views of external stakeholders in relation to quality reviews Timescale for action 27/06/05 01/06/05 3. 15 17(2) Sch 4 01/06/05 4. 18 13 (6) 27/06/05 5. 6. 27 33 Sch 4 (7) 24(3) 01/06/05 25/07/05 Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 20 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. 5. Refer to Standard 26 26 2 36 Good Practice Recommendations A sluice with a washer disinfector should be provided for Infection control purposes. Disposable face masks with visors should be provided for staff undertaking tasks such as washing commode pots The room to be occupied by the service user should be included in the contract Any documents or policies reviewed should be dated and signed by the person responsible for the review Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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
© 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 Little Trefewha D52-D04 S9097 Little Trefewha V226454 040505 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
