CARE HOMES FOR OLDER PEOPLE
Trefula House St Day Redruth Cornwall TR16 5ET Lead Inspector
Diana Martin Announced 15 June 2005 09:30 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 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 D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Trefula House Address St Day Redruth Cornwall TR16 5ET 01209 820215 01209 822499 enquiries@tregennahousenursinghome.co.uk Issuemarket Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Pamela 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 D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11/01/05 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 comparatively small kitchen on the ground floor and served in the dining rooms or lounges. Service users can choose to eat in their individual bedrooms if preferred. The home has extensive gardens that are well maintained. Access for service users 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 service users can see their visitors in private. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Trefula on the June 2005 and spent the day at the home. This was an announced visit. On the day of inspection 31 residents were resident in the home. The inspector met with 7 residents and 4 representatives, a number of staff and the Registered Manager to gain their views on the service that Trefula provides. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well:
Information is given to prospective residents and their families prior to admission to the home. They can visit the home to meet staff and residents and stay for a meal if they wish. The Registered Manager visits prospective residents to assess their care needs to ensure that an appropriate service can be offered. All residents are issued with a contract of residency that they agree and sign. Each resident has a care plan that includes health, social and personal care needs. The documents are very detailed and include relevant risk assessments for example for pressure sores, continence and falls. The resident or their representative are explained the plan of care and asked to sign as agreeing to it. Residents spoken with said their health needs were met and they had access to their GP or other health professionals when required. Equipment for pressure relief and moving and handling is available in the home. The home works closely with GPs and specialist nurses to ensure quality care is given. Residents said their privacy is respected at all times and this was observed during the inspection. There is a nutritious menu with choices available. Residents spoke highly of the food and one commented that the homemade pasties are very good. Staff were giving appropriate assistance where required. Special occasions are celebrated. There is a suitable complaints procedure in place that both staff and residents were aware of. Complaints are recorded with the action taken and the final outcome. There have been no complaints since the last inspection. The home provides a warm, comfortable environment that is well maintained. A refurbishment programme is in progress. Residents have their own possessions with them and those spoken with are very happy with the accommodation provided. Residents said there are enough staff working in the home and that they are very caring and kind. Staff were seen to interact well with the residents and appeared happy in their work. Staff said that there have been improvements
Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 6 since more permanent staff have been employed and less agency staff employed. 51 of care staff have an NVQ in care and others are on courses. This meets the recommendations of the National Minimum Standards. There is a robust recruitment process based o equal opportunities. Overseas employees have integrated well and residents feel they are settling in and are very hardworking. The Registered Manager is a qualified first level nurse who is competent to run the home. Staff said the home runs well and that the manager is very approachable. Meetings take place regularly with records maintained, meetings include, residents, care staff, ancillary staff and nurses. Staff and residents said they could air their views at any time. Staff are appropriately supervised and care staff receive formal supervision six times a year. The management endeavour to ensure that working practices are safe. Statutory training takes place and the health and safety risk assessments have been done. Equipment is serviced regularly and the necessary fire checks take place. Accidents are very few and are recorded and reported appropriately. What has improved since the last inspection?
The statement of purpose has been reviewed and updated. Residents, or their representatives have been consulted in the planning and review of their individual service plan. Individual training sheets have been developed and records are maintained for all staff. The Pharmacist supplies information leaflets with all medicines and these are kept in a file for staff reference. They are available to residents should they wish to refer to them. The medicine policy has been updated and made available to staff. Medicine charts were in order and signed appropriately. The complaints procedure includes the reporting of complaints, at any time to the Commission for Social Care Inspection. The homes policies and procedures have been reviewed and The Royal Marsden book of clinical procedures adopted. The Registered Manager has commenced the Registered Managers Award, which is an NVQ level 4 management qualification. Care staff receive formal recorded supervision bi-monthly, during these sessions they can discuss issues, problems and training needs, for example. The registered provider is visiting the home monthly and providing a report for the Registered Manager and the Commission. During her visits she talks to staff and residents and tours the building. There has been an audit in respect of refurbishment and health and safety in the building. An action plan is to be compiled to implement improvements. The Registered Manager stated that residents are now involved in the choice of décor and furnishings in the home. Screens have been provided and a window obscured to respect residents privacy.
Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 7 Lockable storage space has been provided for staff and the site for the changing facilities has been identified. A survey of residents preferences in respect of activities has been undertaken so that the home can provide meaningful activities and entertainment. 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. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3 and 5 Prospective residents are given information prior to moving into the home enabling them to make a fully informed choice about where to live. Each resident is issued with a contract and relevant information about the facilities so they know exactly what is or is not provided. No resident moves in without their needs being assessed and assured that the home can meet their needs. Prospective residents are invited to visit the home on a trial basis prior to moving in, enabling them to make an informed decision. EVIDENCE: The statement of purpose and service users guide have been reviewed and updated. Each resident is issued with a relevant contract, either the home’s or Social Services. A copy of the homes’ contract is included in the statement of purpose and issued to all residents. The Registered Manager visits prospective residents whenever possible to assess their needs prior to admission. She also obtains any other assessments or information from Social Services and the hospital staff for example. Prospective residents and their relatives are welcome to visit the home and
Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 10 stay for a meal. The first month of their stay is a trial period and there is a months notice period included in the contracts. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 and 11 Individual care plans are generated for each resident that inform and direct the staff in their care provision. Residents have access to health care services as necessary to ensure their assessed needs are met. Systems are in place to ensure that residents are respected and their privacy is upheld at all times. Residents are assured that at the time of their death they will be treated with care, sensitivity and respect; the addition of a policy to guide staff would enhance this. 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 staff said they are getting used to them now, if fully completed initially there is less writing involved. The resident or their representative had signed most of the plans inspected. The plans are reviewed monthly and audited every three months. Residents spoken with said their health needs were met and they had access to their GP or other health professionals when required. The home owned pressure relieving equipment and there was some supplied by the NHS. The Registered Manager said the specialist community nurses get involved as necessary. There was equipment for moving and handling purposes.
Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 12 The arrangements for ensuring privacy and dignity were specified in the statement of purpose. Staff were observed to respect residents privacy during the inspection. Suitable screening is provided in shared rooms and residents are addressed by their preferred name. The Registered Manager said that resident’s family and friends could visit or stay, at the time of a death, according to the individuals’ wishes. General Practitioners, District Nurses and specialist therapists visit when required. One nurse has attended a 3-day palliative care course. The home refers to the Marsden Manual for the last offices procedure. It is recommended that the home have a dying and death policy to direct the staff on what to do in the event of a death in the home. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Dietary needs of service users are well catered for with a varied selection of food available that meets their taste and preference. EVIDENCE: Nutritional needs are assessed and special diets catered for. There are choices on the menu and further alternatives available on request. Service users can eat in the dining areas, lounge or in their bedroom. Appropriate assistance is given when required. Special occasions are celebrated and there was a list of service users birthdays in the kitchen. The cook has achieved the Intermediate Food Hygiene Certificate. There was a facility for making hot drinks in the kitchen, this was utilised by staff and visitors, although staff have a kettle in their staff room. It is strongly recommended that a separate facility be used away from the kitchen. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 standard(s) 16 and 17 There is a suitable complaints procedure in place that ensures complaints are listened to and acted upon. Resident’s legal rights are protected and they are able to vote in elections. EVIDENCE: There is a suitable complaints procedure in place, both staff and residents were aware of this. There is a system for the recording of complaints and the action taken. There have been no complaints since the last inspection. Residents said they could vote if they wished and used the postal system. Advocacy services could be arranged through Age Concern, Care Aware and Help the Aged. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 standard(s) 19 The home and grounds are well maintained, creating a safe environment for residents, staff and visitors. EVIDENCE: The home is warm, comfortable and well maintained. A refurbishment programme is in progress. 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. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 Staffing levels meet the needs of residents and staff morale is good. Residents are in safe hands and benefit from the care staff achieving NVQ qualifications. There is a robust recruitment procedure in place that safeguards the residents living in the home. EVIDENCE: The Registered Manager said the skill mix of staff was suitable for the residents living in the home. The rota showed that there were sufficient numbers of staff on duty. There are two nurses on duty during the day and one at night, and there are waking night staff. There are on average 5 care staff in the mornings, 4 in the afternoons and 2 at night. Staff said the staffing is good in the home now that there are more permanent staff. Residents said there were enough staff and that they work hard. Staff were observed to interact well with residents and in a very kind, friendly manner. 51 of care staff are qualified to at least NVQ level 2 and all new care staff are enrolled onto the NVQ level 2 course if they have not already done it. Induction is in line with the TOPSS guidance. There is a thorough recruitment policy in place based on equal opportunities. Personnel records contain all the required documents. Some overseas workers have been employed and are integrating fairly well with staff and residents. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 35,36 and 38 The home is well managed with good leadership and direction for staff that promotes consistent quality care. The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place. Suitable accounting procedures are adopted that ensure that the residents are safeguarded. Service users money is managed well but residents’ financial interests would be safeguarded if guidance for staff and further controls were in place. Staff are appropriately supervised and supported in their work. EVIDENCE: The Registered Manager is a qualified first level nurse who keeps herself up to date with current issues in respect of her client group. She is currently studying for the Registered Managers’ Award and is very competent to run the home. The views of residents and relatives are not sought annually at present but it is the Registered Managers intention to do so. There are questionnaires for
Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 18 visitors to complete if they wish, by the signing in book. Monthly residents meetings are held with minutes kept, these show that action is taken and individual choice is respected. Staff meetings are also held and minutes kept. Staff said they were free to air their views at any time. Accidents in the home are audited regularly and the care plans are audited. The accounts for the home are kept at the office in Camborne, a copy will be sent to the CSCI. Petty cash is kept in the home with records and receipts maintained. It is recommended that the Registered Manager has a budget allocated for the home. There must be a policy for the safekeeping of service users money and residents should sign to agree to the home dealing with their money. The Registered Manager deals with some service users pocket money. A record is kept of all transactions and receipts are kept for purchases. Money is stored securely although it is pooled as a float. The Registered Manager said money could be obtained by the following day if a larger sum is required. Resident’s money is held in a pooled bank account with individual records kept for each resident, the office in Camborne controls this. Resident’s money must not be pooled in one account and residents or their representatives must receive regular statements of their account. Staff are supervised appropriately and a system is in place to formally supervise care staff 6 times a year, records are maintained. Annual staff appraisals take place. Safe systems are in place; an external consultant has been employed to assist with health and safety risk management. Statutory training takes place regularly, for example fire, health and safety, food hygiene and infection control. Moving and handling training is in hand. All necessary service and equipment checks are undertaken regularly. Accidents are very few and are recorded and reported appropriately. Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 x 3 2 3 3 x 3 Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? 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 8 Regulation 12(1)(a)( b) 13(6) 12(1) (a) Requirement Opportunities for appropriate exercise and physical activities must be established (previous timescale of 01/03/05 not met) The adult protection policy must be reviewed and updated in line with the Local Authority procedure, it must include the reporting of incidents to the Commission for Social Care Inspection (previous timescale of 28/03/05 not met) An action plan for improvement must be compiled from the environmental audit Service users money must not be pooled in one account. Service users or their representatives must receive regular statements of their account. Records for staff and service users must be stored safely and respect confidentiality There must be adequate changing facilities for staff Timescale for action 05/09/05 2. 18 29/08/05 3. 4. 19 35 13 (4) (a) (c) 23 (2)(b) (d) 12(1)13(6 )20 05/09/05 05/09/05 5. 6. 7. 37 38 17 (1) (b) 23(3)(a) 01/08/05 01/12/05 Trefula House D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 21 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. 7. Refer to Standard 11 15 34 1 29 35 34 Good Practice Recommendations There should be a policy for death and dying implemented It is strongly recommended that visitors and staff have a separate facility to the service users for making drinks The registered Manager should be allocated a budget The service users guide and home’s brochure should be combined into one document The pre-employment health questionnaire should be more comprehensive 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 D52-D04 S9152 Trefula House V184143 150605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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
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