CARE HOMES FOR OLDER PEOPLE
Trefula House St Day Redruth Cornwall TR16 5ET Lead Inspector
Diana Penrose Unannounced Inspection 1st December 2005 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 Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 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. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Trefula House Address St Day Redruth Cornwall TR16 5ET 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) 01209 820215 01209 822499 Issuemarket Limited Miss Pamela May Davey Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability (37), Terminally ill (37) of places Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th June 2005 Brief Description of the Service: Trefula Nursing Home is situated on the outskirts of the village of St Day, near Redruth. It is in a quiet secluded area and has extensive views of the surrounding countryside. The home provides nursing and personal care for up to thirty-seven elderly people. The registration allows for people with a terminal illness or a physical disability. The home was first registered in 1992 and comprises of a two-storey house with an extension to the rear. Accommodation is provided in two distinct areas. There are hand washbasins in all bedrooms and adequate toilet and bathing facilities. Meals are prepared in a comparatively small kitchen on the ground floor and served in the dining rooms or lounges. Residents can choose to eat in their individual bedrooms if preferred. The home has extensive gardens that are well maintained. Access for residents is restricted in certain areas for safety reasons. There is a large car park at the front of the home. There is a flexible visiting policy and residents can see their visitors in private. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Trefula Nursing Home on the 01 December 2005 and spent five and three quarter hours at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to requirements identified in the last inspection report dated 15.06.05. In addition the inspector focused on the following key areas of care: assessment and care planning, medicines, leisure, adult protection, some of the environment, recruitment, training and Health and Safety. On the day of inspection 33 residents were living in the home and one was attending once a week for day-care. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered manager to gain their views on the services offered by Trefula. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
The home provides a warm, clean, homely environment that is well maintained and safe for residents, staff and visitors. The laundry facilities are good and appropriate hand washing facilities are provided for staff in all areas. Care provided is to a good standard and residents are only admitted following a full assessment to ensure the home can meet their needs. Residents said their care needs are met and they are happy living in the home. They said the staff are kind and caring. A visitor commented that the home is one of the best places he has been to, they look after the residents very well. Despite recurrent staffing difficulties at the home the Registered Manager ensures there are sufficient numbers and skill mix to meet the residents needs. She has implemented a robust recruitment policy and appropriate training is provided. There are two qualified nurses on duty at all times and sufficient care staff to look after the residents living in the home. Residents said there are enough staff and they are always willing to help. Staff were observed to interact well with residents in a very kind, relaxed manner. Residents have an individual detailed care plan and relevant risk assessments are undertaken. The plans are reviewed every month with the resident or their representative. Medicines are stored safely and securely and only qualified nurses administer the medicines. Friends and family are welcome in the home and residents can go out according to their wishes and ability. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
There were 3 requirements and 8 recommendations notified following this inspection. The home needs redecoration and new furnishings the areas that have received attention look much better. The service users guide and home’s brochure would benefit from being combined into one document Residents or their representatives should sign an agreement to allow the home to deal with their money. Medication records require attention and the medicines policy must be reviewed and updated. The home uses the Marsden Manual of Clinical procedures for performing last offices when someone dies, there should also be a policy in the home to inform staff on what else needs to be done in the event of a death in the home. The Registered Manager would benefit from being allocated a budget; she could then control the finances in the home more effectively. Alternative arrangements should be made for visitors to make drinks. They should not go into the kitchen for health, safety and infection control reasons. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 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 Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents are only admitted to the home following an assessment of their needs to ensure the home can provide adequate care. EVIDENCE: The Registered Manager said that she, or another nurse, visit prospective residents whenever possible to assess their needs prior to admission. She obtains assessments and relevant information from other healthcare professionals for example, Social Services, GP’s and hospital staff. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 and 10 Individual care plans are generated for each resident that inform and direct the staff in their care provision. There are systems and policies in place for dealing with residents medicines; some extra vigilance in record keeping and a review of the policy will help to ensure residents safety. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. EVIDENCE: Each resident has a care plan that includes health, social and personal care needs. Risk assessments include Waterlow scoring, nutrition, moving and handling, falls and Barthel scoring. The plans are very detailed and informative and are signed by the resident or their representative. They are reviewed monthly or when the need arises. Staff said they are very good care plans and the different sections make it easy to refer to. The daily logs refer to the care plan and notes are kept to a minimum. A monitored dosage system of medication is used in the home. New medicine trolleys have been provided by the pharmacy and are appreciated by the staff. The receipt of medicines must be recorded on the medication administration chart, dated and signed. Administration records are satisfactory. There is a photograph of the resident with their medication chart. Any handwritten medicine or instruction on the medication administration charts must be
Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 11 witnessed with two signatures recorded. The medicines policy requires reviewing and updating as discussed with the Registered Manager. There is a file for storing patient information leaflets (PIL). The arrangements for ensuring privacy and dignity are specified in the statement of purpose. Staff were observed to respect residents privacy during the inspection and residents said this is always so. Suitable screening is provided in shared rooms and residents are addressed by their preferred name. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 The home provides activities and entertainment and aims to offer a lifestyle that meets individual residents needs. Links with family, friends and the community are good and allow residents the opportunity to socialise. Residents are helped to maintain control over their lives and staff respect their individual preferences and choice. EVIDENCE: The home does not have an activities co-ordinator but care staff provide some activities for the residents. They play bingo, games and ball for example. Singers come in to entertain and trips out are organised. There are posters displaying the Christmas activities around the home and residents are aware of what is going on. Residents said they are looking forward to seeing the Christmas lights. There is a record of visitors to the home and there were visitors in the home during the inspection. Residents said they could receive visitors in private and at any time. Visitors spoken with said they are made welcome in the home and can call in when they like. Residents said the telephone arrangements in the home are good. Staff said that residents maintain control over their lives for as long as they are able. They are given choices in respect of food, clothes to wear and daily routines, for example. One resident said she goes out to church meetings when she likes. They all have their own possessions in their rooms. Residents said
Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 13 they could eat whatever they like at mealtimes and the food is very good. Staff address residents by their preferred name. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Arrangements are in place for the protection of residents safeguarding them from harm or abuse. EVIDENCE: The home has an adult protection policy that includes the Local Authority inter agency procedures, alerters guide and a draft copy of the national framework for safeguarding adults. It is recommended that a flow chart or simplified procedure be compiled for staff to reference easily. It needs to be clear as to who to report to and state that CSCI must be notified. There is a secure facility for the storage of money in the home. The Registered Manager said it has been difficult getting staff onto the adult protection training days as they are fully booked. She hopes to have staff attending in January 2006. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors however the home requires re-decoration and refurbishment. The home is clean and on the whole free from offensive odours making it a pleasant place to live in. EVIDENCE: The home is warm, comfortable and well maintained. Some refurbishment of bedrooms has taken place however this needs to be extended throughout the home to improve the standard. Some carpets and furniture need replacing as identified in the environmental audit. Residents have their own possessions with them and those spoken with are very happy with the accommodation provided. Hospital style beds are provided as required and screening is provided in double rooms. Staff have been provided with lockers for their personal belongings. The laundry facilities are suitable with two washers and three driers. The home deals with personal laundry; sheets and towels are contracted out. There are two sluices with washer/disinfectors in the home. Suitable hand washing
Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 16 facilities are provided for staff. Staff undertake infection control training as part of the NVQ syllabus. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Staffing levels meet the needs of residents and staff morale appears to be good. Recruitment procedures are robust and offer protection to the residents. The home provides appropriate training for staff to help them be more competent in their roles. EVIDENCE: The Registered Manager said the skill mix of staff was suitable for the residents living in the home. Four nurses have left recently and agency staff have been employed. The rota shows sufficient numbers of staff on duty. There are two nurses on duty during the day and one at night. There are on average 5 care staff in the mornings, 4 in the afternoons and 2 at night. Residents said there are enough staff and they work very hard. Staff were observed to interact well with residents, in a very kind, friendly manner The Registered Manager has a robust recruitment policy for the home and she ensures that appropriate checks are made prior to employing new staff. The records required by legislation are maintained. She is at present reviewing all the job descriptions. The Registered Manager said there are specific induction programmes for staff in each area; new staff are fully supervised for at least the first two weeks of employment. Each member of staff has an individual training plan and a training record card. There are basic training records of care instruction for care staff that are noteworthy. There is an employee handbook and an emergency procedure manual issued to all staff. Training is identified through the appraisal and supervision system, staff meetings and general conversation and observation. Parkinson’s Disease and continence training have been
Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 18 undertaken. There has been no dementia training as yet. Staff said they receive good training, several are on NVQ courses. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Appropriate training and safety checks are undertaken to ensure the health safety and welfare of residents and staff. EVIDENCE: The Registered Manager endeavours to ensure that systems are safe. An external consultant has been employed to assist with health and safety management and training. Statutory training takes place regularly, for example moving and handling fire, health and safety and food hygiene. All necessary service and equipment checks are undertaken regularly. Accidents are few and are recorded and reported appropriately; the Registered Manager also audits the accidents each month. COSHH data sheets are available to staff. Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 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 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 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 2 3 Standard OP9 OP9 OP9 Regulation 13 (2) 13 (2) (4) (c) 13(2) (4) (c) Requirement Timescale for action 31/03/06 The medicines policy must be reviewed and updated Medicines received must be 01/12/05 recorded on the MAR chart, dated and signed Transcribing onto the MAR charts 01/12/05 must be witnessed with two signatures recorded. 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 6 Refer to Standard OP1 OP11 OP15 OP18 OP19 OP34 Good Practice Recommendations The service users guide and homes brochure should be combined into one document There should be a policy for death and dying implemented It is strongly recommended that visitors have a separate facility to the residents for making drinks A flow chart or simplified adult protection procedure should be compiled for staff to reference easily The home needs further redecoration and refurbishment throughout The registered manager should be allocated a budget
DS0000009152.V268517.R01.S.doc Version 5.0 Page 22 Trefula House 7 8 OP35 OP34 Residents should sign an agreement for the home to deal with their money A copy of the accounts for the home should be sent to the CSCI Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trefula House DS0000009152.V268517.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
