Inspection on 21/10/08 for Tramways Corner

This inspection was carried out on 21st October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tramways Corner 15/09/09

Tramways Corner 13/05/08

Tramways Corner 08/08/07

Tramways Corner 19/07/06

Tramways Corner 03/11/05

Tramways Corner 17/05/05

Tramways Corner 25/01/05

Tramways Corner 11/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tramways Corner Tramways Corner 39 Trebarwith Crescent Newquay Cornwall TR7 1DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Tramways Corner 39 Trebarwith Crescent Tramways Corner Newquay Cornwall TR7 1DX 01637872049 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Catherine Fogarty,Mrs Mary V Musselwhite Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service users to include up to 8 adults with a learning disability (LD) of whom 1 may also have a physical disability. Total number of service users not to exceed a maximum of 8 Date of last inspection Brief description of the care home Tramways Corner is an end terrace property very close to the town centre of Newquay. Behind the property there is parking for two cars. Additional car parking is available in a near by pay at the metre car park. There is a courtyard to the back of the house accessed through the kitchen. In the courtyard there is seating, pots of plants and a barbecue. Accommodation is provided on three floors (there is no stair lift facility) to upstairs bedrooms. On the ground floor there is a large lounge/diner and a kitchen that also has dining space. The laundry is domestic in type but is separate to the kitchen. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 8 Brief description of the care home The home provides accommodation and personal care for up to 8 residents with a learning disability. Fees range from 300 to 450 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on the 21st October 2008. The inspection included: discussion with staff, a tour of the premises, examination of relevant documentation, and the inspector met with 1 of the people that live there. We also looked at the responses from surveys received from the people that use the service and others, which were sent out prior to the inspection. The residents have lived at Tramways for a number of years and the registered providers and staff have a good understanding of their care needs. The overall rating is Care Homes for Adults (18-65 years) Page 6 of 28 primarily the result of the homes significant efforts and improvement since the last inspection, specifically in management systems and record keeping. Of 10 requirements made at the last inspection, only one remains. It is anticipated that further improvement will result once the registered provider has completed the registered managers award training, and the ratio of NVQ trained staff increases. Overall, the registered providers have made significant effort and improvements since the last inspection, which deserves recognition and bodes well for the future. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Relevant information for residents is available, though alternative formats may be of benefit. The registered providers endeavour to ensure that prospective residents will fit in with the existing residents, and obtain pre-admission assessment information to aid this. Evidence: The homes Statement of Purpose and Service User Guide have been reviewed since the last inspection. As discussed at the time of the inspection, there is a tendency for brevity (e.g. one paragraph for complaints that does not fully explain the process or provide the contact details for the Department of Adult Social Care). Tramways has an established group of people living there. The most recent person to move in to the home visited on three occasions before the decision was made to progress the admission. The resident met with the existing people that lived at the home. Pre-admission assessment information was obtained. There have not been any new admissions to the home since the last inspection. One person has moved on to Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: alternative accommodation, and there are currently 7 people living at Tramways Corner. Placements are initially agreed on a first month trial basis, and the home maintains good contact with referring agencies, family and representatives. The registered provider is aware of the importance of a successful placement for the existing residents as well as the new person coming to the home. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents, who are mostly involved to the best of their capabilities in decision-making and self-determination. Evidence: Care plans have been completely rewritten since the last inspection to provide accurate up-to-date information. Those examined provide individual specific information such as dietary needs, medical conditions, and ensure continuity of care. The individuals needs and preferences are evident in the plan of care. There is evidence of review and the involvement of the resident, where possible. The staff were knowledgeable of individuals needs and capabilities. The home maintains good links with one local day care service used by all but one of the people that live at Tramways Corner. There are risk assessments, which have also been rewritten since the last inspection, Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: but more could be still be done to show that issues are not dealt with in isolation (the decision made by Tramways staff alone), and that alternative solutions have been considered (e.g. door locks: rather than the option simply being having or not having a standard lock on residents doors, consideration should be given to alternative locks that allow privacy, but also emergency access by staff). The registered provider was not available at this inspection, so it was not possible to look at the finances of the people that live there. The registered provider is aware of the need to ensure that residents can manage their own finances, or have a representative do so for them, and at the last inspection the registered providers undertook to make arrangements for money to be paid direct to the individual. The staff member on duty at the time of the inspection was unsure of the arrangements, but felt that the registered providers had made appropriate arrangements. The staff member on duty said they would ask the registered provider to confirm the arrangements in place. This will be followed-up at the next inspection. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to have social relationships with family and friends, and lead active lives outside of the home. Risk-assessments help to identify where residents rights and responsibilities need to be respected. The menu demonstrates choice being available, with healthy eating encouraged. Evidence: One resident works at a nearby garden centre, and another organises their own lifestyle. The remaining residents attend external facilities at varying frequencies during the week. All have a family member available, though contact varies. The home have been supportive in finding work placements for residents and also in assisting one resident to move on to alternative accommodation. Some of the residents access the local facilities, and a trip to the shops was planned for one resident on the day of the inspection. The registered providers have liaised effectively with local businesses to Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: support residents. Weekends are free-time and residents relax with each other or with friends and family. Relationships with family and friends are encouraged. The home has worked closely with relatives and the Department for Adult Social Care to facilitate one residents move to alternative accommodation. Daily records evidence when the residents have had visitors. The people living at the home can receive their visitors in private in their room, or in the lounge. Residents can also telephone their family and friends or visit them at any time. Some of the residents go home at the weekend. Some go out unaccompanied, although it is expected that they inform staff where they are going and when they will return. Residents are free to decide if they want to be sociable or if they would prefer to spend time alone in their room. Residents assist with household tasks to varying degrees. The residents fall within a 20-year age group, and their activities and lifestyle are in keeping with this. The registered provider is aware of possible diversity issues presented by differing age groups. The staff were seen to interact appropriately with residents. Residents have unrestricted access to the home and small rear garden. Bedrooms are not lockable, and more could be done to explore the options available to ensure privacy and individual wishes are respected. The residents preferred form of address are known and used. There is a weekly menu, and the people that live at Tramways are involved in determining the meals for the week ahead. The registered provider has the food order delivered weekly. Some meals are provided at the activities undertaken during the week. Care plans do identify specialised diets. There is a record of food provided, which also shows the choices made by the people that live there. The home is following the Safer Food Better Business guidelines. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sensitive and flexible personal support. Residents do receive access to all the healthcare facilities available. Residents are protected by the homes medicine practices. Evidence: There is one member of staff on duty at any time, though there is evidence of additional staff being available as necessary. The staff member on duty at the time of the inspection felt confident that additional staff would be provided if the need arose. Times for getting up and going to bed are now reflected in the individual care plans and daily entries. All residents are receiving access to the health care facilities they are entitled to (e.g. dental checks, eye tests). Guidance and support regarding personal hygiene is provided, and residents are assisted to choose their own clothes and appearance. The home liaises with other health professionals as needed. The staff have undertaken medicine training via a local college. None of the residents self-medicate. Medicines are stored in a room that was very hot at the last inspection, Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: but the room was comfortably cool on this occasion. Medicines that require cool storage are placed with refrigerated foodstuffs. The home has a copy of pharmaceutical guidelines. Medicine Administration Records are handwritten, and show two signatures to indicate that the entries are correct. The homes medication policy and procedure was seen to be satisfactory apart from not including the procedure for the return or disposal of medicines. The home now has a fax facility, which is used to confirm instructions from prescribing doctors. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure, which has been explained to the residents. Staff have received relevant training, and residents are protected from abuse. Evidence: There is a brief, but current complaints procedure. As discussed, the complaints procedure would benefit from review and expansion, to include how to complain if the registered provider is not available and the contact details for the Department of Adult Social Care. The staff member confirmed that this has been explained to residents. The complaints procedure does state that a response will be made within 28 days. An alternative format may be useful for residents. There has been no complaint made since the last inspection. All the staff have attended training on safeguarding and the Mental Capacity Act. There is an adult protection procedure, including whistleblowing, and the staff member on duty at the time of the inspection understood the process to follow. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, homely environment, which is clean and hygienic. Evidence: Tramway provides a homely environment with comfortable communal accommodation. The home is not suitable for wheelchairs as bedrooms are accessed by stairs with no stair lift or shaft lift facility, but the registered providers are aware of this and take this into account when assessing prospective residents. Bedrooms are available on the first and second floor. Each bedroom is individual and has been personalised. Six bedrooms are single with one double bedroom. Furniture and soft furnishings are satisfactory. Shared toilets and bathing facilities are available on each floor of the home. Bedroom doors do not have locks fitted. Regular maintenance and testing of the premises is undertaken. There have been no changes to the environment since the last inspection, other than the removal of the bar area in the lounge. The home was found to be clean on the day of the inspection. The laundry is small and domestic in nature, but sufficient for the residents current care needs. The communal dining and lounge areas are spacious and comfortable. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: There is a nurse call system, but this is not used at the moment. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider is doing more to encourage and promote staff training. The home adheres to a robust employment procedure. Staffing levels are flexible, and there is now capacity to respond to fluctuating care needs. Evidence: Only two members of staff have achieved the equivalent of NVQ Level 2 in care, but another will be commencing shortly. Although a requirement in respect of NVQ training has been made (as at the previous inspection), it is recognised that improvements have been made and staff illness has postponed some planned NVQ training. Staff comments in the surveys returned confirm that a variety of training is available and provided. One new member of staff was seen to be undertaking a National Training Organisation compliant induction programme at the last inspection, and there have not been any new staff employed since then. The registered provider has made suitable arrangements for staff to receive training in areas such as the mental capacity act, manual handling and 1st Aid. There is one member of staff on duty at any time, though there is now evidence of Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: additional staff being available as necessary. The staff member on duty at the time of the inspection felt confident that additional staff would be provided if the need arose. Personnel files were not inspected at this time as there have been no new staff employed since the last inspection. The registered provider is aware of the need to adhere to a robust employment procedure in order to protect the people that live at Tramways Corner. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a small home, which is managed by the day-to-day involvement of one of the registered providers. The registered provider has yet to complete the training for the registered managers award. The views of residents and others have been sought. Residents benefit from a homely environment and a stable staff team. Relevant safety checks and maintenance is carried out. Evidence: The registered providers progress in undertaking the Registered Managers Award has not changed since the last three inspections, and it is hoped that the successful completion of this training is not too far off. Completion of this qualification will meet this standard. Either one of the registered providers has day-to-day involvement in the home. The management approach is relaxed, but since the last inspection the staff and people that live in the home have benefited from a more pro-active approach to training, records, and managerial systems. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: The staff member on duty said that a good number of quality assurance questionnaires have been returned, though these were not available at the time of the inspection. As discussed at the time of the inspection, a summary of the findings, and any action taken as a result should be published (possibly made available to residents and others via the homes Service User Guide). Staff comments confirm the availability and provision of ongoing training, including: fire, manual handling, mental capacity act, and 1st Aid. The registered providers ensure that there is regular maintenance and safety checks of the equipment and premises. There is appropriate insurance in place. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 32 18 The registered provider must 01/11/2009 make arrangements to ensure that at least 50 of the staff have NVQ Level 2 in care or equivalent qualification. Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 32 18 The registered provider 22/05/2009 must make arrangements to ensure that at least 50 of the staff have NVQ Level 2 in care or equivalent qualification. To ensure the consistency and quality of care delivered. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered provider should review and amend the information provided for residents or their representatives, with consideration given to alternative formats and expansion of the information (e.g. complaints procedure). The registered provider should ensure that risk issues are not dealt with in isolation (the decision made by Tramways staff alone), and that alternative solutions have been considered (e.g. door locks: rather than the option simply being having or not having a standard lock on residents doors, consideration should be given to alternative locks that allow privacy, but also emergency access by staff). The registered provider should review the risk-assessments 2 9 3 16 Care Homes for Adults (18-65 years) Page 26 of 28 in place to ensure that decisions are not made in isolation, and alternative solutions are considered (e.g. door locks) 4 20 The registered provider should review the homes medicine procedure to include the return and/or disposal of medicines. The registered provider should expand on the information provided in the complaints procedure and consider the benefits of alternative formats for residents. The registered provider should complete the training for the registered managers award. The registered provider should analyse the responses from the quality assurance questionnaires, take appropriate action as needed, and publish a summary of the findings. 5 22 6 7 37 39 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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