Inspection on 21/08/06 for The Troc Residential Home

This inspection was carried out on 21st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Troc Residential Home 24/07/07

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

CARE HOMES FOR OLDER PEOPLE The Troc Residential Home 256 Beacon Hill Road Newark Nottinghamshire NG24 2JP Lead Inspector Vanessa Gent Key Unannounced Inspection 21st August 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 The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Troc Residential Home Address 256 Beacon Hill Road Newark Nottinghamshire NG24 2JP 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) 01636 671342 01636 671914 soniaghai@hotmail.com Reason Care Limited Mrs Lesley Ann Lanham Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 Brief Description of the Service: The Troc is a care home providing accommodation and personal care for up to twnety-five older people of both sexes. The home was opened in the 1980’s and consists of a two-storey building in its own grounds. In February this year, the home was bought from Mr and Mrs Turner by new owners. The home is situated in a suburban area on the outskirts of the historic market town of Newark. It is two miles from the town centre with its shops, leisure, entertainment, historic sights and other facilities. Public bus services pass the home, offering transport into Newark. The home has twenty-three single and one double bedroom (currently used as a single room), none en-suite. Communally, there are three lounges and a dining room area. There are three bathrooms and six communal toilets to meet the needs of the residents. Inside, the home is pleasantly decorated throughout. Some bedrooms, a bathroom and two toilets have been re-decorated since the new owners took over. The extensive gardens are beautifully maintained to provide a secure, tranquil outdoor area. There is car parking space for approximately ten cars at the front of the building. The fees range from £339 to £360 per week. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit was made to the home as part of a key inspection. It started at 15.30 and lasted 4¼ hours. Information already held on file was used to plan the visit. On the day of the visit to the home, twenty-four residents were living in the home. The main method of inspection used is called ‘case-tracking’, which involves selecting a proportion of residents, and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. No survey comment forms were received prior to the visit to the home, either from residents, relatives or staff. The site visit focused on whether key standards and requirements from previous inspections had been met and how the residents feel about the service provided. Three residents’ assessments and care plans were examined. This is to check the health, safety and welfare of the residents and that they are given dignity, autonomy and choice. A partial tour of the home was made and a sample of various records, examined. The inspector spoke with nine of the twenty-four residents, including those being case-tracked and three staff. Many residents have relatives who visit regularly although none were available at the time of the inspector’s visit to the home. The manager was present for most of this visit and spent time discussing issues that arise in the running of a care home. What the service does well: The home is well-run and provides a comfortable and homely place for the residents. High standards continue to be maintained in the home and the manager and owners are working to improve them further. Residents praised highly the friendly atmosphere, the quality of care given, the devotion of the staff and the openness of the manager. Measures have been put in place since the arrival of the new owners to make sure the health care needs of the residents are well met. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 6 The home is attractively decorated and kept clean and hygienic. What has improved since the last inspection? What they could do better: The manager and providers are meeting or exceeding most of the key standards. However, they need to develop a few areas. One is to extend dementia awareness and safeguarding adults training to all staff to ensure that the residents are kept safe at all times. Another is to keep the radiator temperatures at a safe level or cover them to prevent residents from burning themselves. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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 The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good admissions procedure in place and residents are assured that the home can meet their needs. EVIDENCE: A statement of purpose and service user guide are in place and clearly describe the facilities, services and philosophy of the home. They have been updated to include information of the new owners. They are available for all present and future residents. Residents are fully assessed prior to coming to live at the home. This is so that the manager can make sure that the home can meet the needs of all new residents. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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. Good care planning and thoughtful care mean that residents are happy and well-looked after. Staff take advice from health professionals to make sure that that residents get the care they need. EVIDENCE: Care plans are now clear, easy to read documents that enable staff to provide good care for the residents. They set out the residents’ health care needs and how these should be met. They also show the residents’ preferences, likes and dislikes. Risk assessments in the care plans are detailed and care plan issues explained clearly. Daily records are maintained to enable the reader to see how the lives of the residents develop over a period of time. The care plans examined are all The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 11 reviewed monthly. Some of them have a residents’ signature to show their occasional involvement, although this could be further developed. Clearly, when residents have a special health need, liaison with health care professionals is well-recorded. These include doctors, district nurses, continence advisors, skin care advisors, nutritionists, chiropodist, dentist and optician. Medication practices have improved with the staff now using a monthly, monitored dose system. Staff are trained to give out medicines and were seen to do so safely. Safety would be further enhanced by the medication sheets containing a photo of the resident and other basic details about them such as allergies and special needs. Residents say they are treated with respect and dignity at all times. All spoke highly of the staff and the care they get. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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. All aspects of the residents’ lives are catered for to keep them happy and comfortable. EVIDENCE: The manager and staff say that activities are provided regularly. A document provided by the new provider shows the following take place weekly: bingo; craft class; piano-playing by previous owner and a relative; and monthly: reminiscing sessions; outside entertainers; Holy Communion; visiting library. A ‘knitting circle’ has been established to provide winter garments for children in Eastern European countries. Several residents were pleased to show the inspector the items they are working on. Other residents said they are kept busy and occupied with enough to do. One resident said they were bored but their care plans show that this person gets one-to-one attention when necessary, including hand massage, chatting and reminiscing sessions. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 13 The visitors’ book indicates that plenty of visitors come regularly to the home. The manager said that the visitors also chat with those who do not have their own families and residents confirmed this. Many of the residents are able to walk around unaided. They say they can choose what they want in all aspects of their lives. One resident said, “I’m happy and comfortable here.” Fresh fruit and vegetables are provided at every meal. Plenty of fresh fruit is displayed in dishes around the lounges and dining room and available for residents to take whenever they want. Residents said “The food is lovely, delicious”. “We have wonderful meals.” “It’s all homemade you know; beautiful cakes.” “A good variety and choice.” “It’s excellent. I’ve put weight on since I’ve been here – the food is so good. I can’t resist it.” The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe, comfortable and happy at the home. However, some staff are not fully trained in all aspects of keeping residents safe, to protect them from the risk of harm. EVIDENCE: All residents spoken with are pleased with the quality of care that the staff provide. No-one had any negative things to say about the staff or the manager or the care they receive. Resident comments include, “This is the best home in England!” “Everybody’s nice.” “It’s a good home.” “It’s the next best place to home.” “The staff here are lovely and very thoughtful.” Neither the home nor the commission have received any complaints since the last inspection. The manager said that some basic training for safeguarding the residents was included in the induction package and in the National Vocational Qualification (NVQ) that some staff have done. About a third of staff have already had a two-day training course to make them aware of how to safeguard adults from harm. The rest of the staff need to do this training to keep residents safe from abuse. Training by the providers, manager and all staff to protect residents was identified as a need at the previous inspection. The previous inspector set The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 15 a recommendation for this to be done. However, the new owners must make sure that they, the manager and all staff are well trained in these aspects of the residents’ lives to keep them safe. Some staff are booked on a course in September to learn how to manage ‘challenging behaviour’. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 16 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, 21, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most aspects of the home are pleasant and suitable to meet the needs of the residents. However, the heating system has not been adequately controlled to make sure that the residents are safe from a risk of injury. EVIDENCE: At the last inspection, the bedrooms were attractively decorated and residents had ornaments and furniture arranged as they wanted. This is confirmed at the present visit to the home, further rooms having been decorated and new carpets and curtains put in. The home is clean, fresh-smelling and hygienic. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 17 Communally, one bathroom and two toilets have been pleasantly decorated to give them a homely touch. The radiators in one bathroom, several bedrooms and the entrance hall were very hot to touch. All radiators need to be either covered or have thermostatic valves fitted to ensure residents are not at risk of harm. This is outstanding from previous inspections and must be dealt with by the new owners without further delay. The garden provides a secure, attractive, tranquil area for residents to sit in. There are ten car parking spaces at the front of the home. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 18 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, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by adequate staffing, recruitment procedures and training. EVIDENCE: The staff duty rotas supplied with the pre-inspection questionnaire show that enough staff are on duty at any time. This was confirmed at the visit to the home. Residents say the staff are marvellous and always there when you need them. You don’t have to wait long for staff when you need them. Staff files seen contain the necessary information to ensure that residents are protected from harm. Criminal Bureau record checks have been obtained, as was required for all staff, since the last inspection. A good level of training was evidenced at the previous inspection and confirmed in staff records examined at this visit. Staff say there is plenty of training available and they are encouraged to take courses, including National Vocational Qualifications (known as NVQs). The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run safely for the benefit of the residents and the staff. EVIDENCE: The manager has worked in the care field for many years and was Also employed by the previous owners. She achieved her Registered Manager’s Award in 2004. The new providers visit the home several days per week. It was discussed with one of the owners about monitoring the quality of the service provided at the The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 20 home and asking residents what they want. The inspector saw evidence that resident questionnaires are slowly being put into place. Residents’ finances were examined at the previous inspection and found to be satisfactory. Only a few residents’ personal allowances are dealt with by staff. Appropriate receipts are kept and measures taken to ensure that residents’ finances are kept safe. The manager has started having supervision sessions with staff although says she is struggling to conduct all the supervisions herself. It was recommended that senior staff be trained to share this task. The manager has not as yet availed herself of training to appropriately supervise staff. Training should be undertaken to ensure that staff supervisions are appropriate and relevant to their needs. Although door wedges had been used to prop residents’ bedrooms open, this practice was not seen at this visit and the manager reported that at night all doors are kept closed. Residents say they feel safe, are well-cared for by staff, they get on well with all the staff and they feel that their views are listened to. The pre-inspection questionnaire completed by the manager prior to the visit to the home states that all policies and procedures and records are in place and up-to-date. The provider and manager monitor the health and safety practices to make sure the residents are safe and well cared for at all times. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 3 X X X X 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 18(1)(c) Requirement The responsible person must make sure that all staff are trained in protecting vulnerable adults to keep the residents safe at all times. Radiators must be maintained at a temperature that will not put residents at risk of harm or injury. Timescale for action 31/10/06 2. OP25 23(c)(p) 30/09/06 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. Refer to Standard OP33 OP36 Good Practice Recommendations It is recommended that obtaining the opinions, views and wishes of the residents should be continued, enlarged and reviewed regularly. It is recommended that the manager does training in how to supervise staff herself and teach senior staff to supervise staff, to ensure that staff supervisions are appropriate and relevant to their needs and done six times a year as advisable. The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 The Troc Residential Home DS0000066952.V303815.R01.S.doc Version 5.2 Page 24 - 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. 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