Inspection on 01/03/06 for Tregarland Care Home

This inspection was carried out on 1st March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tregarland Care Home 08/10/08

Tregarland Care Home 03/10/06

Tregarland Care Home 09/08/05

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Tregarland Care Home 51 Whitchurch Road Tavistock Devon PL19 9BD Lead Inspector Graham Thomas Unannounced Inspection 1st March 2006 09:30 Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 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 Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 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 Adults 18-65. 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. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tregarland Care Home Address 51 Whitchurch Road Tavistock Devon PL19 9BD 01752 310603 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) Tregarland Limited Mrs Caroline Maria Hay Care Home 20 Category(ies) of Learning disability (20), Physical disability (20) registration, with number of places Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Caroline Hay must complete the Registered Managers Award and NVQ 4 in Care by 31st March 2006 9th August 2005 Date of last inspection Brief Description of the Service: Tregarland provides residential care for 20 people with a learning disability, who may have additional physical disabilities. The home consists of a pair of semi-detached houses called individually Tregarland North and Tregarland South. Each house operates as a completely separate unit, each with its own staff and communal areas including kitchens and laundries.Tregarland North has level access on the ground floor with wheelchair access through the rear entrance. In both houses there are two ground floor bedrooms. The other eight bedrooms in each house are spread over the first and second floors. There is a large garden to the front of the houses. The home is within walking distance of Tavistock town centre. A mini bus with a tail lift is available to support the mobility of the service users. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to monitor progress in respect of previous requirements and recommendations and meet with service users. During the inspection, the Inspector spoke individually with ten service users and met with others in small groups. Three staff were interviewed and discussions were held with the Registered Manager. Various records were sampled including care plans, staff records, health and safety documents and records relating to the administration of medicines. A tour of the building was conducted. What the service does well: What has improved since the last inspection? 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. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 6 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 Outcomes Statutory Requirements Identified During the Inspection Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 7 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 the following standard(s): 2 Service users’ needs and aspirations are adequately identified by the home’s assessment process EVIDENCE: Individual care plans of all service users are being reviewed and assessments of need are being revised. Prospective service users have their needs assessed prior to admission. Files showed that pre-admission assessment material is gathered from referring authorities. Since the last inspection, clearer links have been established between the assessment and care planning processes. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 6 and 7 Service users’ individual needs and aspirations are better supported by a care planning system which is improving significantly. EVIDENCE: Each service user has an individual plan of care. These set out, in detail, individual needs in respect of personal and health care, family and social contact, physical and psychological needs. These showed evidence of regular review with service users’ involvement wherever possible. References to a 52 week system of review have been removed in accordance with a recommendation made at the last inspection. Since the last inspection, these have been modified to meet requirements and recommendations made at that inspection. Care plans now show more clearly a cycle of assessment, planning, action and review. Additionally, links to the key working role are being developed, placing service users’ needs and aspirations at the heart of staff supervision and development. Information is being gathered to record the life stories of individual service users for inclusion in the plans. Restrictions on usual freedoms are now clearly identified in the plans though it is recommended that more specific detail should be included. Individual guidance on challenging behaviour has been reviewed in accordance with a previous Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 9 requirement. Further development is recommended to reinforce, wherever possible, service users’ “ownership” of their own plan. It is recommended that newly acquired staff skills in Total Communication should be used to create user friendly forms of the main points of the plans for service users to retain. Minutes of regular service users’ meetings were seen in which every service user was encouraged to contribute. Individual service users discussed decisions they were making about opportunities for working and making decisions about their lives. At the time of the inspection service users were in enthusiastic discussion with staff about the redecoration of their rooms and choices they were making about this. One service user has an individual advocate. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 11 and 13 Service users are generally very well supported to maintain and their social, leisure and occupational interests. EVIDENCE: Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 11 Tregarland accommodates service users with a wide range of abilities. Plans for weekly activities are produced for each service user. Opportunities are offered to participate in the activities of daily living such as meal preparation, shopping and cleaning. Service users have the opportunity to attend self-advocacy groups and are also involved in regular service user meetings which are recorded. Some service users are able to use local facilities independently and the home offers as much freedom as possible based on assessed risk. Individual service users discussed various activities in which they were involved. One service user with a particular interest in computers talked about a course he was attending. Others spoke of voluntary work placements concerned with conservation. Two service users are involved in a job-share arrangement at a local pub. Other activities included pottery and attendance at the local day centre. One key worker discussed attendance at a local informal special interest group with small groups of service users. Opportunities are promoted to participate in the life of the local community. This includes shopping trips, the use of the local swimming pool, cafes, the cinema and pub. Support is provided in the form of transport in a minibus for which no additional charge is imposed. This helps service users to preserve their individual funds for spending as they wish. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 20 Protection of service users in relation to the administration of medicines is much improved since the last inspection and is now adequate. EVIDENCE: Requirements and recommendations in respect of medication systems were reviewed. The policies and procedures have been reviewed as required. Original prescriptions are now held on file for reference if repeat prescriptions are required. A data sheet on individual service users is held with the original prescriptions. Where medication details are hand written on the Medicines Administration Records, these are now fully recorded. Medicines records now include a full name and the name by which the service user is usually known. Details of the use of variable dosage medicines and the circumstance under which they are to be used are now recorded. Evidence was seen of double checking of the “Tregarland Medication Control” sheets. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 23 The protection of service users from abuse has been improved and reinforced since the last inspection and is now adequate. EVIDENCE: Since the last inspection staff have received training in challenging behaviour, autistic spectrum disorders, total communication, physical interventions and the protection of vulnerable adults from abuse. Incidents which have adversely affected the welfare of service users have been routinely reported to the Commission as required by regulation. Individual service users felt they were able to discuss any concerns with staff. Staff files showed that all the required pre-employment checks are made including references, criminal records checks and checks against the national register for the Protection of Vulnerable Adults (POVA) Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 24, 25, 26, 28 Tregarland continues to provide service users with an exceptionally spacious, clean, comfortable and particularly well-maintained home EVIDENCE: Findings in respect of the above standards remain similar to previous inspections. The quality of the living environment within both units, which make up the home, was found to be excellent. A maintenance and repair record is kept in each unit. No significant faults were found anywhere in the buildings and there was ample evidence of continual refurbishment and upgrading. At the time of this inspection, service users were talking enthusiastically about their choices for room redecoration. The quality of the environment demonstrates the success of the home’s maintenance and repairs system. The home has a maintenance and renewal plan. Tregarland is a very spacious and light building. All of the rooms both communal and individual are of a good size. The home is well furnished and decorated to a high standard. The quality of the living space, combined with the real division of the home into two separate units, creates a homely and welcoming environment. Tregarland North has been adapted with internal ramps on the ground floor and there is flat access at the rear of this unit. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 15 The bedrooms in both Tregarland North and South were found to be airy and spacious to the degree which make them suitable for the pursuit of individual activities and interests as well as entertaining guests privately. They are all individually decorated and furnished to a high standard, each reflecting the occupant’s tastes and preferences. On the ground floor in Tregarland North, bedrooms are of a suitable size to accommodate wheelchair users. Tregarland North and South each have a large and comfortable dining room with sufficient space for service users and staff to eat together. These communal rooms are decorated and furnished to a high standard. There is a no-smoking policy in operation in the home. These arrangements are made clear before admission. Each house has two large sleeping in rooms for staff and a small office. On inspection the home was found to be clean and free from offensive odours. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35 and 36 Service users benefit from the improvements made in clarifying staff roles and responsibilities as well as improved training for staff. EVIDENCE: Staff are provided with contracts and job descriptions at the start of their employment. Copies of the General Social Care Council codes of conduct and practice are available for reference. In discussion, the staff were generally supportive of the main aims of the home. Since the last inspection work has been undertaken to clarify and develop the role of key workers and link this role to the care planning process. This has been achieved by linking care planning to the supervision and development of staff. Each staff member has an individual training profile. More external training is being undertaken linked to identified shortfalls in the service and service users’ needs. The Registered Manager has researched additional funding streams for staff training to support award bearing and other courses. The numbers of staff trained at NVQ level 2 or above meets current national targets. The home provides care and support for a number of service users who have mental health needs in addition to a learning disability. It is therefore recommended that staff should attend mental health awareness training. Staff and service user interactions seen during the inspection were respectful, relaxed and supportive. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 17 Staff supervision records were sampled. Regular supervision was evident from the records. These now show a clearer link between care planning, key working and the identification of staff training needs. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Service users can be confident that their views underpin the development of the home. EVIDENCE: The home’s quality assurance system continues to develop. The Registered Manager stated that a parents’ survey had been sent out and that a service users’ survey was to be discussed at a forthcoming residents’ meeting. There are regular formal meetings both for service users and their families which are recorded. Informal opportunities for feedback are also available. This information needs to be formally summarised and integrated into the annual development plan for the home. The Registered Manager hoped that an annual development plan could be produced by May 2006. Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 19 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. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 X 28 3 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 3 12 X 13 4 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 x X X 3 X X X X Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 20 No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA6 YA6 YA35 Good Practice Recommendations Restrictions on individual freedoms identified in the care plans should provide more specific detail Service users’ “ownership” of their own plans should be promoted by providing a user-friendly version of the main points for individuals to retain Staff should receive awareness training in mental health issues for people with a learning disability Tregarland Care Home DS0000064169.V269071.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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