Inspection on 12/09/06 for Tregarne

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tregarne 05/07/07

Tregarne 19/12/05

Tregarne 16/08/05

Tregarne 22/03/05

Tregarne 14/09/04

Tregarne 23/03/04

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 19/06/2009.

CARE HOME ADULTS 18-65 Tregarne Hostel North Street St Austell Cornwall PL25 5QE Lead Inspector Elaine Bruce Key Unannounced Inspection 12th September 2006 08:30 Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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 Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregarne Hostel Address North Street St Austell Cornwall PL25 5QE 01726 72429 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) philip@cornwall.gov.uk Cornwall County Council Mrs Elisabeth-Anne Philp Care Home 16 Category(ies) of Learning disability (16), Physical disability (16), registration, with number Sensory impairment (16) of places Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service Users to include 16 adults with a Physical Disability (PD) Service Users to include 16 adults with a sensory impairment (SI) Service Users to include 16 adults with a learning disability (LD) Total number of service users not to exceed a maximum of 16. Date of last inspection 19th December 2005 Brief Description of the Service: Tregarne is a split level detached property within walking distance of St Austell town centre. The home is a social services establishment that provides short stay care for up to sixteen service users with a learning disability. The accommodation is located on the ground and first floors. Each floor is self contained and therefore has the ability to function independently. One floor of the home has been adapted to meet the needs of service users with a physical disability. The home has the benefit of a fully equipped sensory room and a small computer suite. The property has pleasant spacious gardens to three sides and a parking area. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 12th September 2006 and was a key unannounced inspection. The inspection took place over 6 hours. The registered manager was on duty and assisted the inspector during the course of the day. She presented well in coping with the unannounced inspection and the demands of her day to day job. Three of the service users were spoken to briefly at the commencement of the inspection whilst they waited for their transport to take them to their various day care activities. Tregarne is providing short stay accommodation to service users with a complex range of needs, dependency levels and ages from 18 to 70 years. The home generally offers service users planned respite although one of the service users is presently staying at the home longer term until a more suitable resource is found for him. The home has recently been running at an occupancy level of no more than 10 due to plans by the County Council to look for a temporary environment for service users whilst the environment was improved. These plans are on hold at this time. What the service does well: What has improved since the last inspection? Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 6 The stability of the management arrangements at Tregarne has improved since the last inspection. The registered manager had been covering duties and responsibilities for her line manager who had been on long term sickness. She has now returned to the home in her full time post as registered manager. 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. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 7 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 Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 8 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): 2,3,4 and 5 The quality outcome judgement of these standards is adequate. All service users access the home by the care management process that involves a social care and financial assessment. Improvements have recently been made to the contract of care document that is provided to each service user. EVIDENCE: All service users access the home by the care management assessment process that involves a social care and financial assessment. The assessment is requested at the time of referral and is then discussed at a pre admission “panel meeting” with senior staff of Adult Social Care and Tregarne. The occupancy level at Tregarne has been lower recently with no new service users (only existing) admitted to the home. This decision was made when plans were in hand to move the service users to another temporary accommodation whilst Tregarne was updated. These plans are on hold at this time. Each service user is provided with an individual written contract or statement of terms and conditions re their placement. This documentation has recently been improved to make it more service user friendly. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 9 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): 6,7,8,9 and 10 The quality outcome judgement of these standards is good. The service users’ health, personal and social care needs are evidenced as being met in care planning documentation. The daily records that support the care plans are good. EVIDENCE: Each service user has a plan of care that is generated from the assessment received at referral. Copies of these referrals are held in the file although it is noted that this documentation is sometimes difficult for the home to access. The service users that have recently been admitted to the home have already been known to Tregarne. Consequently, there is already documentation held that is accessed again. The care plans are detailed and very service user focused. They are supported by good daily records that include a large amount of information as to how the service user is spending their time at the home. Risk assessment information is included in the care planning documentation. The home operates a key worker system which gives the responsibility of care planning to that staff member. There is evidence in place that all the documentation is regularly reviewed weekly. The documentation also evidences when the care plan has Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 10 been changed and when a social worker has been involved with a service user. It is noted that some of the service users admitted to Tregarne have complicated care needs. Service users are involved in care planning and confidential information is held appropriately. Case tracking took place with the service users who were spoken to at the beginning of the inspection prior to them attending their day care resource. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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 the following standard(s): 11,12,13,14,15,16 and 17 The quality outcome judgement of these standards is adequate. Care planning documentation evidences that the social care needs of the service users have been assessed and daily recording evidences how these needs are being met. The environment at Tregarne presents as shabby and institutionalised which could detract from quality leisure time being spent at the home. EVIDENCE: Tregarne is generally a short stay facility and therefore all service users have established on-going family or carer links. The home operates an open door visiting policy and everyone is asked to sign the visitors’ book on arrival to the home. All visits to the service users are documented. Care planning identifies where a particular service user enjoys an activity which can be for example shopping, bowling and going to the pub. The daily records evidence when this activity has taken place and the service users appear to be very much part of the community. The home has it’s own transport to access these resources. The transport is suitable for service users with physical disabilities. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 12 The environment at Tregarne presents as shabby and institutionalised which could detract from quality leisure time being spent at the home. The main meal of the day at Tregarne is eaten in the evening. The menu at the home rotates over a three week period. During the day most of the service users are attending local day care facilities. The staff join the service users when having their meals. An alternative choice is always available to the service users should they not wish to have the main meal on the menu. The home caters for a variety of diets as required. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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 the following standard(s): 18,19 and 20 The quality outcome judgement of these standards is adequate. Health care needs are identified in care planning and multi-disciplinary professionals are requested to meet these needs if required. Medication administration arrangements are satisfactory. EVIDENCE: The assessment process identifies the service users preferences in regard to the delivery of personal support. As Tregarne is a short stay facility the service user’s permanent carers retain the overall responsibility for service users physical and emotional health. If required community nursing services and general practitioner services are available to meet health care needs during the service users stay. Documentation is available in care planning in the form of an agreement for the administration of medication. As recommended in the inspection report of the 19th December 2005 the medication policy and procedure has been individualised to Tregarne. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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 the following standard(s): 22 and 23 The outcome judgement of these standards is poor. Service users are provided with information on how to complain in their service user guide documentation. Adult protection policy and procedures must be provided with the correct information and staff must be fully trained in this important area. EVIDENCE: Each service user is provided with information of the complaints policy and procedure in the service user guide. The home have not received any complaints since the last inspection. Cornwall County Council has a large adult protection policy and procedure. It is noted that there are some errors in this documentation which were discussed at the time of the inspection with the manager. Adult protection training has commenced for some staff and more training is planned. This was included in the inspection report of the 19th December 2005 as a statutory requirement. The timescale for compliance is not met and it is included again in this inspection report. It is very important that all staff are trained in adult protection and that procedures for the protection of investigation work are also fully understood. It was a concern to the CSCI that on the day of the inspection a meeting was taking place that should have involved the CSCI. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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 the following standard(s): 24,25,26,27,28,29 and 30 The quality outcome judgement of these standards is poor. The environment at Tregarne does not meet any of The National Minimum Standards. EVIDENCE: It is the understanding of the CSCI that Tregarne was originally built to accommodate more able service users. The home now has a range of complex service user needs and ages. Due to this fact there are parts of the building that cannot be accessed by those service users with more complex needs. Communal areas are basic: some furniture is shabby and worn and curtains are of poor quality. To access the lower ground floor area of the home (with facilities for more independence) requires the use of (steep) stairs as there is no alternative way of getting there. Consequently this whole area of the home is out of use for some service users. Toilets and bathrooms are dated and again shabby. One shower has difficult access and one of the bathrooms has a very dated screen to provide privacy. One toilet is sited immediately off the dining room which is unsatisfactory. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 16 Bedrooms are very basic and in some cases in desperate need of general decoration and improvement. Bedroom furnishings are also in need of attention/replacement. It is noted that maintenance records appear to be up to date for equipment within the home. The laundry is provided with industrial machines but again attention is needed immediately to decoration and maintenance. The home was noted to be clean on the day of the inspection. Protective clothing is available and used by staff. The sensory room is well used and meets the needs of the service users. The heating system at Tregarne is very unsatisfactory to include blow heaters which are controlled centrally. There are pleasant grounds at the home which are used by the service users. Parking is available in the grounds but this can be limited at times. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 17 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): 31,32,33,34,35 and 36 The quality outcome of these standards is adequate. The staff team at Tregarne is a stable team offering continuity to the service users. Regular supervision to all staff should take place as required by The National Minimum Standards. It is noted that there are some gaps in the frequency of this. More training is required to meet the requirements of legislation. EVIDENCE: The home has a stable staff team with very few changes of staff. Recruitment procedures were found to be satisfactory to include criminal records bureau checks. During the peak time activity at the home (morning) there are care staff, ancillary staff, driver and management on duty. As the service users attend their day care activities these staffing levels are reduced. The levels are once again increased for evenings and week-end activity. Staff receive support in the form of documented supervision to allow them to undertake their jobs. The manager supervises the assistant officers and ancillary staff. The officers supervise the care staff. It is noted that there has been some supervision lapse at this level. As already identified more staff require training in adult protection and there are plans in hand for this to happen. It is noted that there has been less training at the home recently generally for all staff. There are plans for Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 18 moving and handling training to be updated and more staff are required to be trained in first aid. Evidence is required that night staff have received fire drill training. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 19 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): 37,38 and 39 The quality outcome of these standards is adequate. The registered manager is competent in running Tregarne. It is unfortunate that the poor environment makes this job extremely difficult. The CSCI will welcome information on the future plans for Tregarne. EVIDENCE: The registered manager is experienced, has achieved her registered managers award qualification and all the assistant managers have undertaken management training. The Regulation 26 reports are provided to the CSCI by the responsible individual as required by legislation. Very good documentation has been developed to ensure the full involvement of the service users in quality assurance and monitoring which is due to take place. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 20 The home has a large amount of policies and procedures in place. It is noted that some of these have not recently been reviewed by the County Council and attention will be given to these at the next inspection. Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 21 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x x x Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 Page 22 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 YA23 Regulation 18(1) Timescale for action To ensure that staff receive adult 31/12/06 protection training as a priority. (This was included in the previous inspection report with a timescale of 31/03/06). Requirement 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 YA24 Good Practice Recommendations To provide to the CSCI an improvement plan for the premises with dates for completion and priory of work to be undertaken. To provide training to staff as required which includes first aid training to ensure there is a staff member on duty at all times who has this training. To regularly provide supervision to all staff at the home. 2. YA35 3. YA36 Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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 Tregarne Hostel DS0000041927.V303577.R03.S.doc Version 5.2 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. 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