CARE HOME ADULTS 18-65 Trefusis 38 Trefusis Road Redruth Cornwall TR15 2JH
Lead Inspector Lowenna Harty Announced 04 April 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Trefusis Version 1.10 Page 3 SERVICE INFORMATION
Name of service Trefusis Address 38 Trefusis Road Redruth Cornwall TR15 2JH 01209 219333 01326 371099 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) Spectrum Louise Margaret Warrell Care Home 3 Category(ies) of Learning Disability (3) registration, with number of places Trefusis Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07/10/04 Brief Description of the Service: Trefusis is a care home providing accommodation and personal care for up to 3 adults with a learning disability. The home is run by Spectrum, an organisation that provides specialist care in small units to adults who have autistic spectrum conditions. The aim is to provide service users with a homely environment in a local community setting and to enalbe them to live as normal a life as is possible. Spectrum employs a manager and team of staff to provide care and support for the service users living in the home. Senior managers from outside of the home are available to provide additional specialist input as and when it is required. The house is a detached, two-storey building set in its own grounds. Access is suitable for the three service users living there. The home is situated within easy reach of the town of Redruth with good access to transport and all the facilities of the town. The home has transport and drivers. Service users are provided with individual furnished bedrooms and a shared bathroom. The home has a combined kitchen and dining room, separate office and two lounges, one of which doubles as a staff sleeping in facility. The home has a spacious garden that is well maintained. There is a lockable office on the first floor of the building. Trefusis Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme on April 4 2005 starting at 9.15 am. The inspector was at the home for four and three quarter hours. The manager completed a preinspection questionnaire prior to the inspection and the inspector undertook the following activities whilst at the home 1. Inspection of records, including assessment information and care plans 2. Discussion with the manager of the home on how it operates on a day-today basis 3. Inspection of the building 4. Interview with a member of staff 5. Individual interviews with each of the three service users, who all chose to have the home’s manager present. 6. Observation of the daily life of the home. The home does not currently have a registered manager although the person in charge of the home has applied to the Commission to be registered and their application is currently being determined. What the service does well:
The service users in the home have lived there for several years and are well settled at Trefusis The house is comfortable and homely, with a large garden at the rear of the building. It is in the town of Redruth and the town centre is within easy walking distance. There are good public transport routes and the home has a car to provide transport for service users. The service users enjoy a wide range of activities inside and outside of the home, including attendance at the local college, voluntary work, social events and sporting activities. They are encouraged to keep in touch with their families and meet with people from outside of the home. One service user has recently had a birthday and enjoyed having a party in the home, to which they invited 15 guests. All of the service users said that they enjoyed most of the activities provided for them at the home. Service users go shopping for the household food; take it in turns to choose the main evening meal and prepare and serve their own food with help from staff. They make their own breakfasts and lunches and can use the kitchen whenever they wish during the daytime. They all said that they are satisfied with the food provided to them. They are encouraged to eat healthily and always have access to fresh fruit and healthy snacks. Service users are encouraged to be independent in their personal care and take pride in looking smart and fashionably dressed. They enjoy going out shopping for their personal effects and clothes.
Trefusis Version 1.10 Page 6 All of the service users said that they feel safe in the home and would be able to talk to somebody if they were unhappy about their care. Most of the staff working at the home either have or are working towards obtaining formal vocational training qualifications and benefit from training provided by Spectrum to support the specialist needs of the service users. This helps the service users to live as independently as possible in the local community. What has improved since the last inspection? What they could do better:
The home’s policies, procedures and staff training with regard to management of service users’ medication needs to be improved. Spectrum has been issued with statutory requirements to complete work on this, which is currently in progress. The home’s written policies, procedures with regard to the protection of service users from harm and abuse need to be updated and staff should be provided with access to multi-agency training in this respect. Spectrum has been issued with recommendations to complete work on this, which is currently in progress. Some improvements are needed to the home’s environment. A statutory requirement has been issued to Spectrum to get rid of the smell of damp in one of the bedrooms, which was very noticeable at this inspection, as well as
Trefusis Version 1.10 Page 7 some mould around the edge of the bath. A further requirement has been issued that there are up-to-date records of staff training in fire safety. There are recommendations for paper towels to be supplied to visitors and staff in the bathrooms and for service users to be provided with access to training in basic food safety, for hygiene reasons. Two requirements were issued in respect of staffing. One of these has been re-notified from several previous occasions and relates to information that Spectrum must keep in the home by law. Better evidence that staff have been given basic training in key areas of health and safety and first aid is also needed, particularly for those staff left alone in charge of the home at night. Recommendations include the introduction of a staff appraisal scheme, a training plan for the staff team and access to infection control training for staff. At the time of the inspection the service users made some specific requests, which the person in charge of the agreed to implement immediately. The inspector will review progress in this respect at the next inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trefusis Version 1.10 Page 8 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Trefusis Version 1.10 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 2 The home has a clearly written statement of purpose and service users’ guide that meets with the national minimum standards and regulations. Service users currently in the home were assessed prior to their admission to the home to ensure that their needs could be met there. EVIDENCE: The home’s current statement of purpose and service users’ guide have been updated and now include all the information required by regulation, including information on the staff currently employed to work in the home, their qualifications and experience. No new service users have been admitted to the home for several years and current service users’ care plans indicate there are no current or expected vacancies. Interviews with the service users indicated that those currently resident in the home are very familiar with the services provided to them there. There is initial assessment information that relates to each of the service users in the home. Trefusis Version 1.10 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 Service users have detailed written care plans and are familiar with their contents. They are supported by detailed written risk assessments, to which they have provided written agreement. EVIDENCE: Service user’s written care plans meet the national minimum standards and are reviewed with them at least once every six months. Their care plans are read and explained to them before they sign them. Service users have some literacy skills and are able to directly contribute to their personal records. In addition, key aspects of their care plans are translated into formats that they can access directly on a day-to-day basis. External professional representatives are invited to attend care-planning meetings and reviews. The care plan format is thorough, person-focused and goals orientated. The home’s statement of purpose and service users’ records indicate that they are able to access independent advocates if they wish and all have contact with their families outside of the home. Service users have detailed written risk assessments, which they have signed their agreement to. These provide for situations in which it may be necessary to place certain restrictions on service users for their own protection or that of other people. They are subject to regular review and are updated as necessary.
Trefusis Version 1.10 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15 & 17 Service users enjoy a wide range of activities in and out of the home in accordance with their assessed needs, preferences and written care plans. They are encouraged to maintain contact with their families and develop relationships with others in accordance with their risk assessments and abilities. They are encouraged to maximise their skills with regard to preparing meals and enjoy a healthy diet. EVIDENCE: Service users enjoy a broad range of activities in accordance with the home’s statement of purpose and their individual needs and preferences, in and out of the home. The person in charge of the home said their daily activities are planned individually on a weekly basis and gave examples of how she has assisted them to further develop their daily activities outside of the home. Service users attend local colleges, leisure facilities and/or voluntary work placements. One receives therapeutic earnings for the voluntary work they do at a local animal centre. Staff also organise social functions and take service users to pubs, restaurants, places of interest in the local community and local shops. They help service users to maintain family links and develop friendships and relationships in accordance with their individual risk assessments.
Trefusis Version 1.10 Page 12 Spectrum’s senior managers provide skilled, external support in this respect, where necessary. Service users are encouraged to eat healthily. They are involved in all aspects of food preparation and are encouraged to develop their skills and independence in this respect. They go shopping for household food, take turns in choosing main evening meals and prepare their breakfasts and lunches for themselves. They are able to access the kitchen at all times and have a ready supply of healthy snacks, including fresh fruit. Dietary advice is sought from external professional sources as necessary and service users’ weight is monitored. Trefusis Version 1.10 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Service users’ personal support needs are fully met in accordance with their written care plans and individual needs. Service users do not retain, administer or control their own medication on the basis of their individual risk assessments. Policies, procedures and staff training in relation to the medicines management by the home are inadequate to fully protect service users from medication errors. EVIDENCE: Service users are mainly independent with regard to their personal care, hygiene and grooming, although staff are available to provide them with support as necessary. Their individual care plans and risk assessments fully account for their personal support needs and they are encouraged to maintain their independence and choice with regard to their personal appearance and clothing. All appeared smartly and fashionably dressed and take pride in their appearances. They are able to choose when they get up in the mornings and go to bed at night, depending on their daily activity plans. Spectrum’s medication policies and procedures are currently part of a major review of all the organisation’s policies, procedures and training. None of the staff has completed safe handling of medicines training and the home’s written policies and procedures need to be updated and improved to reflect current best practice.
Trefusis Version 1.10 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 There are systems in place to ensure that service users are protected from abuse, neglect and self-harm. Policies, procedures and staff training that underpin protection of service users from abuse, neglect and self-harm would benefit from amendment and improvement, however. EVIDENCE: Spectrum is currently in the process or reviewing and amending all its policies and procedures and undertaking a major review of staff training. In the meantime the person in charge of the home has applied for staff to attend local multi-agency training provided by Cornwall County Council. She has also obtained copies of the policies and procedures for the protection of vulnerable adults from abuse from the service users’ placing authorities. There is a copy of Spectrum’s current procedures for the protection of vulnerable adults from abuse in the home. Staff are familiar with actions that they are expected to take in this respect. All of the service users said they feel safe in the home would be able to make a complaint if necessary. Service users have regular contact with a range of professionals and relatives from outside of the home and Spectrum’s senior managers are in frequent attendance at the home. The home’s policies and procedures in respect of service users’ personal finances still need to be updated, but the person in charge of the home stated that work is in progress in this respect. In the meantime, service users are encouraged to manage some aspects of their personal finances and they all have individual bank accounts. There are records and receipts of all transactions where staff are involved in handling service users’ money, which are regularly audited at Spectrum’s head office Trefusis Version 1.10 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Service users live in a comfortable, homely environment that is mainly safe, clean and hygienic, although some improvements are needed. There have been some improvements to the décor recently. EVIDENCE: The home was clean and tidythroughout. The house is comfortable, homely,well furnished and attractively decorated. All communal parts are fully accessible to the service users. It is well situated for accessing the town centre and public transport. Service users enjoy the privacy of their own rooms and are able to have keys if they wish. The fire safety risk assessment has now been completed and there are records of fire drills and equipment safety checks completed on a regular basis. Records of staff fire stafety training need to be kept fully up-to-date though. There was some evidence of damp in the bathroom and one of the bedrooms. Whilst anti-bacterial soap is provided in all the bathrooms and service users have their own towels for drying their hands, it would be advisable to provide paper towels for staff and visitors using the bathrooms and staff should be provided with training in infection control. Because of their extensive use of the kitchen, service users should be given basic food hygiene training.
Trefusis Version 1.10 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 & 36 Spectrum employs enough qualified staff to support service users. There is some evidence that service users are supported and protected by the home’s recruitment policy and practices although this needs further improvement. Staff continue to lack training in key areas, which are essential for service users’ safety and well being. They are generally well supervised, although they are not provided with annual appraisals as yet. EVIDENCE: Spectrum employs five Three are qualified to NVQ level 2 or above and one is f completing their training to achieve this. There was written evidence in the home that staff have undergone enhanced CRB checks and Spectrum has taken up two references prior to their starting work in the home. There was a lack of full evidence, however that recruitment of staff is fair, safe and effective, in the form of completed application forms and interview records. There were no copies of full employment histories for staff employed since 24 July 2004 with written explanations for any gaps in their employment. Individual records of staff training have improved but there is still no whole team training and development plan. Some staff lack training in key areas, Such as fire safety, health and safety, emergency aid, basic food hygiene, safe handling of medicines, multi-agency training in the protection of vulnerable adults from abuse and infection control. Whilst staff are provided with regular individual 1:1 supervision with records kept and there are regular team and house meetings, Spectrum has still not implemented an appraisal scheme in
Trefusis Version 1.10 Page 17 this home. The person in charge of the home said Spectrum is improving computerised record systems to ensure that records required by regulation are accessible for inspection purposes and there is currently a review of staff training in progress to ensure that all staff receive the basic training they need to comply with current legislation and guidance. A staff member said they feel well supported by skilled mangers and have had good access to training and knowledge in the specialist techniques used by Spectrum to support service users with very complex needs to maximise their abilities for independent living in the community. Trefusis Version 1.10 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40, 41 & 42 Service users’ rights and best interests are mainly, but not fully safeguarded by the home’s current policies and procedures. Most records needed to protect their welfare are clear and well written although some, required by regulation still need to be kept in the home. Whilst the home is generally kept safe, there are concerns with regard to essential staff training that have already been highlighted in this report. EVIDENCE: Spectrum is currently undertaking a major review of all its written policies and procedures. In the meantime, staff have ready access to clearly written policies and procedures. Service users are aware of key policies that directly affect them, such as fire safety procedures and how they can make a complaint. Key policies that should be prioritised have been identified in this report and include management of medicines and Protection of Vulnerable adults from abuse. Most records required by law are kept in the home. There are safe and secure storage facilities in lockable filing cabinets in an office that is kept locked when not in use. Service users help maintain their personal records.
Trefusis Version 1.10 Page 19 Some records with regard to staffing are not retained in the home, as previously highlighted in this report. Issues in relation to health and safety, particularly in respect of staff training in key areas such as emergency aid and fire safety have been highlighted above. SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23
ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 2 Standard No
Trefusis Standard No 31 32
Version 1.10 Score x 2
Page 20 11 12 13 14 15 16 17 x 3 x x 3 x 3 33 34 35 36 x 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x x 2 2 2 x Trefusis Version 1.10 Page 21 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 20 & 40 Regulation 12(2) Requirement The home’s written policies and procedures in respect of medication must enable service users to decide to manage all or some aspects of their medication for themselves and provide suitable guidance for staff in this respect. (Previous timescale of 30 November 2004 not met) The registered provider must make arrangements for the recording, handling, safekeeping,safe administration and disposal of medicines into the home including 1. A full review of the homes written policies and procedures to comply with the Royal Pharamceutical Society Guidelines, June 2003 and current best practice and 2. Provision of training for all staff handling medicines in the safe handling of medicines. The source of the damp in the homes bathroom and one service users bedroom must be identified and the cause erradicated. There must be written envidence that all staff have been provided
Version 1.10 Timescale for action 01 June 2005 2. 20, 35 & 40 13(2) 01 June 2005 3. 30 & 42 12(2)(b) 01 June 2005 4. 24 & 42 23(4)(d) 01 June 2005
Page 22 Trefusis 5. 32, 34 & 41 12(1)(a) 19(1)(a) 19(5)(b) 6. 32, 34 & 41 19(1)(b) 17(2) 7. 35 & 42 12(1)(a) 13(4) 18(c)(i) with training in fire safety maintained in the home. Evidence that new staff have the attitudes, characteristics, skills and experience as listed in National Minimum Standard 32.2 and 32.3 must be kept in the home. (Previous Timescales of 30 November 2005 and 01 November 2004 not met) Records required by regulation in relation to staffing including copies of application forms and interview records must be available in the home at all times. ( Previous timescale of 30 November 2004 not met There must be clear and accesible evidence in the home that all staff have undergone training in health and safety, basic food hygiene and first aid. Staff left in charge of the home must have completed emergency aid training. 01 June 2005 01 June 2005 01 June 2005 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 23 & 35 Good Practice Recommendations Staff should be provided with access to multi-agency training for the protection of vulnerable adults and the home should obtain a copy of the locally produced “No Secrets” video for reference The home’s policies and procedures in respect of the protection of vulnerable adults should be updated with regard to introduction of the POVA register. Paper towels should be provided in the toilets and bathrooms Service users should be provided with access to training in basic food hygiene. The registered provider should introduce a staff appraisal scheme.
Version 1.10 Page 23 2. 3. 4. 5. 23 & 40 30 & 42 30 & 42 36 Trefusis 6. 7. 8. 35 & 42 35 36 Staff should be provided with training in infection control. A whole team training and development plan should be drawn up for the home to provide a clear indication of training undertaken and training needed. A whole team training and development plan should be drawn up for the home to provide a clear indication of training undertaken and training needed. Trefusis Version 1.10 Page 24 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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