Inspection on 27/06/05 for Priory Manor [formerly Trebursye Manor]

This inspection was carried out on 27th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Priory Manor [formerly Trebursye... 24/02/09

Priory Manor [formerly Trebursye... 02/04/08

Priory Manor [formerly Trebursye... 25/07/07

Priory Manor [formerly Trebursye... 10/01/07

Priory Manor [formerly Trebursye... 04/07/06

Priory Manor [formerly Trebursye... 01/12/05

Priory Manor [formerly Trebursye... 12/10/04

Priory Manor [formerly Trebursye... 07/06/04

Priory Manor [formerly Trebursye... 01/10/03

Priory Manor [formerly Trebursye... 26/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Trebursye Manor Trebursye Launceston Cornwall PL15 7ES Lead Inspector Philippa Cutting Unannounced 27 June 2005 09:30 a.m. th 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. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Trebursye Manor Address Trebursye Launceston Cornwall PL15 7ES 01566 774752 0207 5159993 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) HealthCare Trust Limited Mr Robert Edward Rotchell Care Home 54 Category(ies) of Dementia - over 65 years of age (29) registration, with number Mental Disorder, excluding learning disability or of places dementia - over 65 years of age (29) Old age, not falling within any other category (29) Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users in the category of MD may be admitted at age 55 years and over. Service users to include one named individual under the age of 55 years. Service users to include one named individual aged 53 years from 1 November to 15 November 2004, suffering from a mental disorder. Date of last inspection Brief Description of the Service: Trebursye is an older property situtated in a rural landscape approximately five miles from Launceston. Over the years the main house and annexe have been adapted and extended but the present owners are undertaking further renovations to improve the structure and facilites offered. Trebursye now provides care and accommodation for three groups of people: older people with dementia, people over the age of 55 years with mental health problems and older people not falling within any other category. The latter group are becoming an increasing minority as the home is specialising in caring for people with mental health difficulties. The registered manager has created separate areas to accommodate the groups. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 9.30a.m. & 4.30p.m. It concentrated on the service users in the units for those with mental health problems (Lansye) & older people (Trelawney). The unit for service users with dementia (Lakeview) was not inspected on this occasion. The inspector spoke to service users, staff and the registered manager. Records, care plans and premises were reviewed. Since the last inspection service users with mental health needs and the older people have been required to change their accommodation (with consultation) as the management felt that by ‘swapping’ the two sections of the annexe (Lansye & Trelawney) both would have accommodation more suited to their needs. What the service does well: What has improved since the last inspection? What they could do better: Care plans need to contain more detail rather than a broad brush approach so that progress can be monitored. Staff working with service users with mental health problems need on going training regarding their specialised needs. The home urgently needs a suitably qualified deputy to assist the registered manager. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 6 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. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 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 Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 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) 1,2,3,5 The registered manager takes the needs of a prospective service user and the needs of existing service users into account before offering care & accommodation. EVIDENCE: The registered manager stated that Lansye was a ‘closed unit’. There was a discussion about this and the home was advised to look at its statement of purpose to ensure that this ethos was reflected statement of terms so that potential service users and purchasers were aware before making enquiries. Contracts for service users have been broken down into the component parts of accommodation, care, staffing etc. The registered manager visits any new service user who is referred to the home. An emergency admission would not be accepted as experience has shown this to be disruptive to the existing service user group. People from out of the county are accepted if there are pertinent reasons for doing so. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 9 The registered manager said that trial visits can be arranged and can be anything between a day and a week with a month to decide whether the service user’s needs and the home’s capabilities are compatible. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 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 standard(s) 7,8,10 Service users’ needs are identified in individual written plans that would be improved with more amplification. Their health needs are met and people are treated with respect. EVIDENCE: Care plans were seen for all service users with evidence of reviews. They were, in most cases, very general in their identified aims. From discussion with staff it seemed as if more detailed goals could be identified; for example where a person was identified as having problems with eating/nutrition this could be broken down into areas, agreed with the service user, such as the need to sit at the table, to eat slowly, and stay at the table to allow time for digestion rather than leave immediately. The inspector acknowledges that progress is likely to be slow and variable but if more specific aims were agreed then progress could be measured. Other examples were noted where the inspector could see progress in a person’s behaviour from previous visits but these did not appear to be reflected in the care plans. The registered manager is an experienced registered mental nurse and has the skills to deal with situations that can be demanding. He stated that he had Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 11 very good support from the community mental health team when this was needed. At present medication is undertaken by staff on behalf of service users. Medication was not looked at in detail on this occasion. Risk assessments regarding individual service users were discussed. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15 Service users are offered choice but of those seen on this occasion, many need encouragement and guidance on how to exercise this in their best interests. EVIDENCE: The majority of service users in Lansye (mental health unit) have spent considerable amounts of time in hospital and on arrival at Trebursye some have exhibited extreme and demanding behaviour. This has largely settled now and it would appear that the service users are afforded more freedom and independence that they have experienced previously. They were disinclined to speak at length with the inspector as most spent much of their day in the smoking area. Others retired to their bed. However they took their midday meals together. Service users in Trelawney were more communicative. One commented on the difficulties she was having in adjusting to her new accommodation as she has poor sight and finds the bigger room more difficult to arrange and manage to suit her needs. The registered manager said that both she and her relatives were consulted in advance about the proposed changes but the person concerned does not fully recall this. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 13 Service users said they found the food was to their liking with a choice available. There are facilities for people to make themselves drinks during the day where this has been assessed as safe. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 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 standard(s) 16,18 The home has a complaints procedure which is accessible to service users and families etc. EVIDENCE: Recent training about the protection of vulnerable adults has been undertaken. A service user is being assisted in a legal appeal that she is making. Since the last inspection one complaint relating to a service user in the Lakeside unit has been investigated after being sent to the Commission for Social Care Inspection. It was substantiated in part with regard to general comments about odour control but not otherwise. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,23,24,25. The environment has greatly improved and is now meeting the needs of the majority of service users, although work is still needed on the external fabric and grounds. EVIDENCE: The environment and facilities in the Trelawney and Lansye units of the home have improved significantly in the last two years. A considerable amount of infrastructure has had to be renewed but this has now progressed so that the décor and furnishings of the rooms and passages have been renewed. Bath and shower facilities have been upgraded. The change over of the two units in the annexe has provided communal space more appropriate to the numbers in each unit. The two areas are separated by doors with keypads. A smoking room has been created for the service users in Lansye and was obviously well used. It has been built in the old courtyard garden but the outlook is uninspiring and cheerless, as the entire courtyard Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 16 has been concreted over in patches. In its current state it does not provide its users, or those whose rooms overlook it, with a pleasurable view. However the smokers did not appear to notice the starkness. Service users in Trelawney have arranged their rooms with personal items etc since their move and, with one exception, there appeared to be no problems. Service users’ rooms in Lansye were not visited, as the occupants were not in attendance. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 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 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) 27,28,29,30 Service users’ needs are currently being met by the staff group but the Commission has concerns about their support in the registered manager’s absence. EVIDENCE: Staffing is an area of concern, in that the home has developed a strong emphasis on mental health issues. As stated in a previous section (Health & Personal Care) the registered manager is experienced in dealing with problems that can arise from mental health issues. However the Commission is aware that the home has becoming very dependent on the registered manager’s knowledge and skills and there is no one to deputise for him. This is not a position that can be easily filled and it leaves the home vulnerable if he is away for whatever reason. Staff working on Lansye felt confident in their roles but one, a non UK national, said how different the approach to mental health was from her own country. Initially when the home changed hands, there were insufficient staff and a number of non-UK nationals were recruited. The registered manager says he feels the staffing has now improved and settled to a steady team. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 18 Staff are encouraged to undertake National Vocational Qualifications. However it is important that these include mental health as well as the more usual content of care for the elderly. Evidence of this will be sought at a future date. It was noted that staff had an issue with the home’s owners with regard to their pay. It would seem to be important to reconcile this if staff are to continue as a stable force. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 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 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) 31,32,33. The registered manager promotes the well being of all service users in the home but the home is at risk until a suitable deputy can be appointed. EVIDENCE: The registered manager has been effective in re- establishing the reputation of Treburyse and addressing the numerous difficulties that were present previously. The home does however now have a new focus with the current client group therefore staff support, training and supervision needs to be thorough and on going. This is an area that will be focussed on in a subsequent visit. Other statutory records were not scrutinised in detail but the home is reminded that Regulation 37 of the Care Homes Regulations includes the notification of ‘any event in the care home which adversely affects the well being or safety of any service user’. Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 20 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 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 3 3 x STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x x x Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 21 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 OP1 Regulation 4 Requirement Timescale for action 01.09.2005 2. OP27,28,29 ,30 3. The statement of purpose needs to be reviewed to ensure that it accurately reflects the service offerred, especially in the Lansye unit. Staffing, staff training and 01.09.2005 support must reflect the needs of service users where these are specialised. Risk assessmments regarding 011.09.200 identified service users (as 5 opposed to risk assessments relating to the fabric of the home) must be fully completed. 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. Refer to Standard OP7 OP19 Good Practice Recommendations Care plans should contain more specific details of currently identified needs. Renovations to the property continue. Further separate developments of the site should be discussed with the Commssion for Social Care Inspection prior to any work being commenced. D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 22 Trebursye Manor 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 Trebursye Manor D52-D04 S44111 Trebursye Manor S226539 U 270605 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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