Inspection on 23/01/07 for Trafalgar Care Home

This inspection was carried out on 23rd January 2007.

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

Trafalgar Care Home 28/08/08

Trafalgar Care Home 31/08/07

Trafalgar Care Home 18/05/06

Trafalgar Care Home 29/12/05

Trafalgar Care Home 28/01/05

Trafalgar Care Home 25/06/04

Trafalgar Care Home 19/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Trafalgar Care Home 207 Dorchester Road Weymouth Dorset DT4 7LF Lead Inspector Marion Hurley Key Unannounced Inspection 23rd January 2007 10:00 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 Trafalgar Care Home DS0000030316.V327523.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. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trafalgar Care Home Address 207 Dorchester Road Weymouth Dorset DT4 7LF 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) 01305 777567 F/P01305 777567 Mr Derek Edwin Luckhurst Mrs Patricia Anne McIntyre Care Home 29 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (5) of places Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: Trafalgar Care Home is registered to provide accommodation and personal care for up to 29 older people, five in the category of old age and 24 with dementia. The home is situated in a residential area of Weymouth about a mile from the sea front and the centre of town. It is set back from the main road and provides an area for parking at the front. The grounds are secured with fencing. Residents have access to the sheltered gardens at the front and rear of the home. Residents accommodation is provided on two floors with a passenger lift that enables residents’ access to the first floor. The home has 23 single bedrooms and 3 double bedrooms. There are two communal lounges and a dining room on the ground floor and a separate smaller lounge with a dining area on the first floor. People who use this room tend to be more physically frail and live mainly on the first floor. At the time of the inspection the home confirmed that the weekly fees ranged from £449.00 - £494.00 depending on the residents assessed needs. Additional charges are made for services such as chiropody, hairdressing and personal toiletries. Information about these costs as well as the day to day operation of the home, including a copy of the last inspection report, can be found in the home’s office. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second key inspection in 2006/2007. It was unannounced and took any previous information held by CSCI about the home into consideration. The inspection involved assessing the key areas identified by the CSCI. The inspection included a site visit conducted over two consecutive days. A tour of the premises was completed and significant documentation relating to the specific standards assessed examined. A random selection of staff and resident files were examined and these were cross-referenced with other records contained in the home. Observations of care practises were undertaken throughout the visit. Residents, a relative, staff and the manager were interviewed informally during the course of the visit. An assessment was also made of the progress by the manager to address the requirements made at previous inspections. The manager was on duty during this visit and the findings of the visit discussed. On the day of the visit 29 people were living at the home. What the service does well: Residents are cared for in a comfortable environment by staff who are aware of their needs. People living at the home indicated they were happy, relaxed and liked the people who cared for them. The home offers a varied menu, which can be eaten in the main dining room, or in the first floor lounge/dining room or if the residents’ prefer in their own bedrooms. The mid day meal was observed and the atmosphere was calm and dignified with those residents requiring help discreetly supported by staff. Many of the bedrooms had been personalised with favourite ornaments and photographs. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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 Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an assessment process in place to ensure that it can meet the needs of the people admitted to the home. EVIDENCE: The home has an admissions policy and procedure, which includes assessing residents prior to admission to make sure that the facilities and staffing arrangements, can meet their needs. Records confirmed that new residents had received an assessment before they came to the home. Other information such as health & social care assessments had been collated to help the manager decide if the home would be able to care for the resident appropriately. Relatives are encouraged to visit the home and be involved in the admission process. The manager confirmed the home is not providing intermediate care. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health needs are being met and improvements have been made but some shortfalls in existing care plans and risk assessments put residents and staff potentially at risk and could lead to residents needs not being met. Medications are stored, administered and disposed of safely. Staff respect the wishes and preferences of the people living at the home while maintaining their privacy and dignity. EVIDENCE: Each resident has an individual a care plan, which contained information relating to his or her care needs. The manager and deputy manager are currently reviewing all the care plans to ensure that they contain all the necessary information. Whilst many of the plans had review dates and some Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 10 had alterations to the plans these details were very minimal and the additions had not been dated or signed. Details need to be clearer so that staff can easily see what support people need. The individual plans would benefit from more detail regarding the residents’ preferences and capabilities. Not all the files examined contained nutritional and pressure risks and these details should be added. The plans would benefit from further information regarding residents’ religious, and social needs and their likes and dislikes in relation to social activities and reference to food. Discussions with staff members on duty and the observations made, confirmed that they were aware of individuals needs, and had a good knowledge of individual preferences- this level of detail needs to be included in the care plans. The staff stated that information is passed on verbally so that they are informed of any significant changes. Records and discussions with staff confirmed that health related professionals such as dentist, doctor, nurses and chiropodist visited the home regularly to meet peoples’ health care needs. The manager stated there were good working relationship with all the GP practices and the District Nurses who attend the residents. Medication records and procedures for the administration and safe storage of medicines were all satisfactory on the day of this inspection. A pharmacist representing the Primary Care Trust examined the administration and procedures for the safe handling of medication in the home and reported “all systems working well”(13/09/06). All liquids and creams had been dated and initialled by staff on opening. Nine staff have completed training in the safe handling of medication and a further two are booked. The manager and staff said they rarely have any resident requiring medication which needs to be kept in the fridge. However, it is recommended the home acquire a fridge, which can be dedicated for this use. The last entry in the controlled drugs register had not indicated the balance. This is extremely important and must be addressed immediately. A visitor praised the staff and comments indicated that they were satisfied with the care and accommodation provided. Observation and discussions with staff demonstrated that staff respected people’s privacy and dignity; they were seen knocking on resident’s bedroom doors, consulting them about their preferences at lunchtime and closing doors when providing personal care. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. 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. The home does not provide an appropriate programme of activities. Residents are offered choice regarding their daily lives. Meals provided offer variety and choice and any special diets are catered for. EVIDENCE: The home does not currently employ an activities coordinator; therefore care staff provide any social stimulation at the home. The manager stated different activities are offered in the afternoons but are not deemed very successful i.e. bingo is often played but difficult to organise with residents of varying abilities and interests. A “special buffet tea” also celebrates birthdays or special events and once a month there is a music session. Photographs of these events have been kept and provide a good aide memoir for the residents of events they have participated in. The file is currently kept in the office and staff may wish to Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 12 consider displaying some of the photographs for both residents and visitors to see. It is acknowledged an album would soon become “lost” and therefore the pictures would need to be framed for safety. The manager needs to consider how time can be allocated to make sure people are able to receive appropriate social activities. Records and peoples comments did not demonstrate that residents were receiving suitable stimulation. Care plans need to address the social needs of residents in sufficient detail especially in relation to people who have a communication problem and / or dementia. Staff gave examples of how choice was offered at the home, this included times for getting up and going to bed, meals provided and in general terms how they spent their day i.e. free to move to and from the communal areas and their bedrooms. Lunch on the day of the visit was well presented and nutritionally balanced. Discussions with the cook confirmed a good knowledge of the dietary needs of the residents and she confirmed that alternatives to the set menu were available. The kitchen is very small however, all food was stored appropriately and fridge and freezer temperatures were recorded daily. Meals can be taken in either dining room or in the privacy of the resident’s bedroom. Aids to help people eat their meals independently, such as plate guards, were being used. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory procedures for handling complaints. Residents are protected by the home’s procedures for handling allegations of adult abuse. EVIDENCE: The home has a complaints procedure, which tells residents and relatives how to make a complaint and how it will be handled. The manager informed the inspector that no complaints had been received since the last inspection. Training records showed that staff had attended a protection of vulnerable adults training session. The manager and deputy are booked to attend the next two day training event organised by health social care services. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents living at the home live in a comfortable environment. The home was clean but there was distinct and unpleasant odour in parts of the environment. EVIDENCE: Communal areas were clean and tidy and quite comfortable. The bedrooms seen during this visit were well maintained and furnished including personal mentoes and small items of furniture. Residents indicated they were happy with the facilities provided. Aids and adaptations are provided and satisfactory to meet the needs of the resident group. The manager confirmed that new equipment had been Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 15 purchased since the last inspection, i.e. a range of commodes and bathing aids. New bedding has recently been purchased and every bed has a bedspread. The laundry is small but adequate though requires staff to walk outside to access it, and the kitchen is also small and again staff are required to walk outside to access the freezer. The home was clean throughout out however there was a distinct odour in certain areas. The manager hopes to laminate one of the bedroom floors and bathroom floors where this odour is particularly strong. The company employs a person to undertake routine maintenance and there is a system in place to report all repairs identified. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are on duty in sufficient numbers and skill mix to ensure that the residents are cared for in a safe, caring and competent manner. Procedures for the recruitment of staff are robust and therefore offer protection for people living at the home. EVIDENCE: The manager is extra to the staffing numbers, but will cover staff shortfalls if required. The deputy or two care managers (senior staff) are on duty throughout the day. On the day of the visit four staff were on duty, plus the cook and cleaner to ensure the smooth running of the home. One senior staff covers the ground floor and one is delegated responsibility for the first floor. At the start of the shift they decide who will take the lead responsibility for the medication and these responsibilities are recorded on the handover sheet. Observations of the staff team indicated they worked positively with the residents and were patient and sensitive to their needs. Discussions with staff confirmed that they had a good knowledge of individuals needs, and staff expressed their commitment and enthusiasm towards ensuring residents had a good quality of care. Staff said they felt supported by their colleagues. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 17 Staff said there was enough staff on duty to care for people but not to take them out or really do many different social and recreational activities. The home has a satisfactory recruitment procedure. Files contained application forms, 2 satisfactory written references and CRB (Criminal Record Bureau) checks. However it is important that these procedures are fully completed even for staff already employed by the company and who then transfer from another work location to Trafalgar Care Home. The home has provided various training sessions since the last inspection including manual handling, basic food hygiene and protection of vulnerable adults. Staff records demonstrated that not all staff had attended basic training. Records showed that further training sessions had been planned and booked for the future. The manager confirmed that a total of 13 staff are studying or have completed NVQ at levels 2 and or 3. When all the staff have completed the training this will represent at least 50 of their work force. Two staff were successfully recruited in January 2007 and a third position is currently being advertised. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager successfully completed the Registered Manager’s Award in July 2006 and is steadily making improvements in the home. The home handles residents’ finances appropriately. Shortfall in staff appraisals and supervision could lead to residents’ needs not being met. The home has health and safety policies in place, which help to safe guard staff and residents. However, all staff must receive and complete regular fire safety training. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 19 EVIDENCE: Although the manager and deputy have introduced a staff supervision system records showed that not all the staff have received regular sessions. It is important regular sessions take place so that staff receive appropriate support and their training and development needs can be assessed. The management of residents’ finances were examined and this was satisfactory with individual transaction sheets in place and receipts obtained for all purchases made on behalf of individuals. The money held in safe keeping cross referenced to the balance on the transaction sheets. There is a range of policies and procedures regarding health and safety available to guide and instruct staff. There is also a programme in place to service and maintain the equipment in the home on a regular basis. Records indicated regular health and safety checks were routinely completed. However, staff have not received any fire training since January 2006. This requires immediate attention and all staff must complete regular fire safety training. Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 x 3 X X 2 Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 14 & 15 Requirement All care plans must be reviewed and updated to reflect changing needs and these entries must be signed. The controlled drugs (CD) administration record book must always indicate the balance of controlled drugs held in the home. All pipe work and radiators must be guarded or have guaranteed low temperature surfaces. Please note there are just 3 radiators still requiring covers. The home must be kept free from offensive odours. Please note staff were aware of this problem and continue to work hard to eradicate the odour. The night staffing arrangements for the home must be reviewed to ensure that sufficient staff are able to meet the needs of the residents at all times. All staff must receive regular fire safety training. Timescale for action 31/03/07 2. OP9 13 (2) 28/02/07 3. OP19 13 (4) (c) 31/03/07 4. OP26 16(2)(k) 31/03/07 5. OP27 18 (1) 31/03/07 6. OP38 23(4)(d) 28/02/07 Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 22 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 OP7 Good Practice Recommendations It is recommended that all care plans should make reference to the residents social and cultural needs and interests.. It is recommended that a dedicated fridge be purchased for the safe storage of medication requiring specific temperature control. Consideration needs to be given to refurbishing the bathrooms with are currently adequate but small for staff to manage those residents with mobility difficulties. The home would benefit from the recruitment of an activities organiser who could offer residents a variety of leisure and social experiences and stimulation. It is recommended the freezer be defrosted as soon as possible. Consideration needs to be given to the purchase of a second freezer. OP9 OP21 OP27 OP38 Trafalgar Care Home DS0000030316.V327523.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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