Inspection on 31/08/07 for Trafalgar Care Home

This inspection was carried out on 31st August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Trafalgar Care Home 28/08/08

Trafalgar Care Home 23/01/07

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 Amanda Porter Key Unannounced Inspection 31st August 2007 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 Trafalgar Care Home DS0000030316.V344153.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.V344153.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.V344153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2007 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 £461.60 - £529 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. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 31st August 2007 over a period of approximately five and a half hours. The purpose of the inspection was to review the requirements and recommendations made at the last inspection and assess all of the key standards. The Registered Manager, Mrs Patricia McIntyre, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The annual quality assurance assessment completed by the home. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. • Surveys completed by 4 relatives and 2 GPs. During the course of the inspection four residents, one visitor and three members of staff were spoken with and asked their views on the service provided at the home. Comments received included: “Staff are very good.” “I like working here.” “I am very happy with the care my relative receives.” “My relative is looked after very well. I have no complaints at all and am very pleased she moved to Trafalgar.” What the service does well: Trafalgar is well run by a competent manager and a competent and committed staff supports her. Residents and their families say that they are happy with the care provided and staff are caring and considerate. Residents receive a full assessment and assurances that their needs can be met. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 6 Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents like the food provided and enjoy the choices offered at each meal. The complaints procedure can reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff can easily follow. Financial procedures within the home ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at the home. What has improved since the last inspection? What they could do better: As a result of this inspection six requirements and two recommendations of good practice have been made. There are some shortfalls in recording within the care documentation and there needs to be a consistent approach to assessment and care planning so that staff are given specific details of the needs of each resident and how to care for them, realistic goals must be set and care given monitored effectively. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 7 To ensure that residents live in a pleasant environment any unpleasant smells need to be eliminated. The Registered Manager is working hard to achieve this. The number of staff on duty at night needs to be reviewed. At present the home only has two care staff on duty during the night. Some residents need two carers to attend to them and should another resident require assistance they will have to wait. The induction programme for new staff must include all the elements of the Skills for Care Common Induction Standards. This training would provide the home with skilled carers at all times. The Registered Manager must ensure that the home regularly audits all aspects of the services and facilities the home offers to the residents. This will support continuous improvement, ensuring that the service is run in the best interests of residents. 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.V344153.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 Trafalgar Care Home DS0000030316.V344153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure enables prospective residents, and/or those acting on their behalf, to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The files for three residents who had recently moved into the home were inspected. Prior to admission the home had been given a community care plan by the care manager for each resident making the placement to stay at Trafalgar. This information was used to draw up a care plan, which was made available to staff . Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 10 The manager confirmed in writing to the resident and/or chosen representative that needs could be met by the home. In response to the question in the survey “Do you and/or your friend or relative get enough information about the care home to help you make decisions?” 4 relatives said “Always”. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 11 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. The standard of care was adequate although the care documentation does not always ensure that staff have sufficient information upon which to base their care practice. The principles of respect, dignity and privacy were put into practise. The home has systems in place for managing residents’ medication to meet their healthcare needs. EVIDENCE: The care files for three residents were reviewed and contained some general risk assessments. Not all aspects of physical, psychological and social needs of Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 12 the resident were assessed or plans formulated as to how needs were to be met. For example: • Activities of daily living were not fully assessed. • Where social preferences were recorded this information was not used in a plan of care. • One resident with diabetes had no care plan to instruct staff how to meet these specific needs. • One resident had a pressure relieving mattress but no assessment of the risk of pressures sores for this person had been recorded. • Nutritional assessments were not undertaken. Generally the daily written statements in the care files lacked detail about what sort of day the resident has had, how they have been occupied and whether they were in a state of wellbeing. It was clear from discussions with staff that residents have access to the health services they need. There was evidence to show that residents get support from General Practitioners, community psychiatric nurses, district nurses, chiropodists, opticians and dentists. Arrangements are made for residents to attend hospital outpatient appointments as necessary. Records and stocks of medication in the home evidence good practice and medication is managed in accordance with legal requirements. Through observation of care practices and speaking with residents it was apparent that they were happy with the care they received and staff treated them with respect and were supportive and kind. One relative said, “Care is very good. If Mum needs a rest staff will put her on her bed. She is always clean. I am always kept informed – staff will ring me straight away.” In response to the survey question, “Do you feel that the care home meets the needs of your friend/relative?” 2 people said, “Always” and 2 said, “Usually”. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 13 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 new range of activities provided at Trafalgar Care Home gives residents the opportunity to participate in stimulating and motivating pastimes. Residents are able to have contact with family, friends and the local community if they wish and are able. Meals and mealtimes appear relaxed and are enjoyed by the residents. EVIDENCE: Since the last inspection the home has employed an activities organiser and all those spoken with were very pleased with the activities provided. Comments received included: “I am very please that we now have a lady four afternoons per week who engages the residents in various activities if they wish to take part.” “The activities person is very good. I don’t join in with every activity but those I do I enjoy.” Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 14 One resident spoken with said that he could do what he liked when he liked. He enjoyed pottering in the garden and could sit quietly reading when he wanted to. Visitors confirmed that they were made welcome and in response to the survey question, “Does the care home help your friend or relative to keep in touch with you?” 3 people said “Always”. Observation took place over one lunchtime and residents appeared to enjoy the food provided. Visitors confirmed that residents ate well and the food was good. The home offers a choice of food at any meal and staff are aware of residents’dietary preferences. One relative said, “The food is great and if someone doesn’t like something staff will offer to get them something else.” Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 15 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. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: The home has a clear complaints procedure available to everyone. One resident and one visitor spoken with during the inspection said that if they had any concerns they would feel confident about talking to the Registered Manager, knowing that she would listen to them. In response to the survey question, “Do you know how to make a complaint about the care provided by the home if you need to?” 4 people said, “Yes”. The home has a policy and procedure to respond to suspicion or evidence of abuse or neglect. Staff confirmed that they receive training on the protection of vulnerable adults. Through discussion it was apparent that they had a clear understanding of local procedures. Trafalgar Care Home DS0000030316.V344153.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. 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. The standard of the environment at Trafalgar Care Home is generally satisfactory providing residents with an attractive, homely and safe place to live. EVIDENCE: The home has a programme of routine maintenance. Records show the equipment and facilities with the home are regularly serviced. All communal areas inside and outside of the home are accessible to residents. The gardens were very attractive and had ample garden furniture for residents to sit out in the good weather. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 17 Most areas inside the home were clean and well presented. However there was a strong smell of stale urine in some areas. The Registered Manager explained that the home has a contract for routine carpet cleaning but the company concerned was running behind schedule. The laundry was well managed by the care staff and adequate supplies of clean linen were seen to be available. Trafalgar Care Home DS0000030316.V344153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Insufficient care staff are employed to meet the needs of residents at all times. Recruitment procedures are not robust enough to protect residents from the risk of unsuitable staff working at the home. Some training within the home is not sufficient to enable staff to meet the needs of all residents. EVIDENCE: Duty rotas showed that five care assistants were on duty in the morning, four in the afternoon and two at night. In addition the Registered Manager was on duty five days a week, and at night either she or her deputy were on call. There was a cook and domestic staff on duty every day. In the last report a requirement was made to review the night staff arrangements so that there are sufficient staff on duty to be able to meet the needs of the residents at all times and this has been repeated in this report. At this inspection the Registered Manager confirmed some residents need two care assistants to attend to them and this would mean that any other resident needing assistance would have to wait. The home has an ongoing training programme, which includes NVQ level 2 in care. The Registered Manager confirmed that at the time of inspection nearly Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 19 50 of care staff held this award and further candidates are working towards this award. Three staff recruitment files were reviewed and they contained most of the relevant information required. It was evident that the POVA first checks carried out were not always received before the member of staff commenced employment. Training files demonstrated that staff were receiving some induction training and this was confirmed with staff spoken with during the inspection. However this did not meet the performance criteria for Skills for Care. The Registered Manager said that she was in the process of sourcing a training package, which would meet this standard. Staff spoken with confirmed that they were encouraged to attend training. In response to the question “Do the care staff have the right skills and experience to look after people properly?” 1 person said, “Always” and 3 people said, “Usually”. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. EVIDENCE: The Registered Manager is experienced in caring for elderly people and is suitably qualified. Relatives and staff confirmed they found the management style at the home open and Mrs McIntyre was very approachable. Staff spoken with said that regular staff meetings are held and everyone’s views are listened to. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 21 The home has a quality assurance monitoring system, which seeks feedback from relatives and GP surgeries. The Registered Manager confirmed that action is taken as a result of their findings. The home needs a robust system of internal audits, which would highlight any shortcomings in the services provided at the home. This would enable the Registered Manager to rectify any shortfalls or weaknesses in a timely fashion. The home does hold some “pocket money” for any residents who request this. Clear records are kept of any monies held and how this is spent on behalf of the resident concerned. Records showed that staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 22 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 2 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 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The registered person must, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. (The plan must be based on a full assessment of needs and include all aspects of physical, psychological and social care. Records should also show whether goals set for the care are being met.) 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 registered person must ensure that at all time suitably competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users.(This must include sufficient night staff). DS0000030316.V344153.R01.S.doc Timescale for action 01/12/07 2. OP26 16(2)(k) 01/12/07 3. OP27 18(1)(a) 01/12/07 Trafalgar Care Home Version 5.2 Page 24 4. OP29 19(4) 5. OP30 18(1)(c) (i) 6. OP33 24(1) This requirement is made for the third time. The Registered Person must not allow a person who is employed to work at the care home unless the employer has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. (This must include obtaining a POVA first check before employment is commenced.) The Registered Person must ensure that the persons employed by the Registered Person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (The induction training must include the Skills for Care Common Induction Standards). The Registered Person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. (This must include a system of internal audits.) 01/12/07 01/12/07 01/12/07 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. Refer to Standard OP8 Good Practice Recommendations Nutritional screening should be undertaken on admission and subsequently on a periodic basis. Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI Trafalgar Care Home DS0000030316.V344153.R01.S.doc Version 5.2 Page 26 - 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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