Inspection on 05/07/07 for Tregarne

This inspection was carried out on 5th July 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tregarne 12/09/06

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 5th July 2007 11:00 Tregarne Hostel DS0000041927.V339052.R01.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.V339052.R01.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.V339052.R01.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 ****Post Vacant**** Care Home 16 Category(ies) of Learning disability (16), Physical disability (16), registration, with number Sensory impairment (16) of places Tregarne Hostel DS0000041927.V339052.R01.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 12th September 2006 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.V339052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection at Tregarne took place on the 5th July 2007 and was carried out as a key unannounced inspection. The inspection took place over the hours of 1100 to 1700. The acting manager was on duty and assisted the inspector during the course of the day. The acting manager has just completed his application to be the registered manager at the home. He presented well during the course of the inspection and “guests” commented positively on him. One of the guests was spoken to at the end of her day out and introductions and brief conversations took place with the majority of the guests on their return from their day care activities. Tregarne is providing short stay accommodation to guests with a complex range of needs, dependency levels and ages from 18 to 70. The service generally offers guests planned respite although there have recently been a large number of emergency admissions to the home as well as a number of longer stay placements. The home has recently been running at an occupancy level of no more that 10 due to plans by the County Council to look for a temporary environment for guests whilst the building is re-built. The plans for the new build of Tregarne are being discussed with the Commission for Social Care Inspection to ensure the application is processed in the best interests of the guests over what will be a difficult time. A completed Annual Quality Assurance Assessment form was received from the acting manager during the course of the inspection. The nightly range of fees for Tregarne is from £9.14 to £11.14. There have been 76 admissions to Tregarne over the last year. What the service does well: Some documentation at the home has been well designed and thought out with the needs of the guests in mind. This includes for example care planning, questionnaires and the complaints procedure. Pictures have been included in this documentation to ensure that it is guest friendly. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 6 This key inspection has identified that the delivery of care at the home is moving towards being much more client centred which is very positive. This is with credit to the acting manager. 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. The summary of this inspection report can be made available in other formats on request. Tregarne Hostel DS0000041927.V339052.R01.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.V339052.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All “guests” access the home by the Adult Social Care care management procedure that involves a social and financial assessment. Tregarne is not able to accept any new referrals at present due to the planned changes for the building. EVIDENCE: All potential guests to Tregarne access the resource 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 the Adult Social Care department and Tregarne. The occupancy level at Tregarne has been lower recently with no new guests (only existing) admitted to the home. This decision was made when plans were in hand to move the guests to another temporary accommodation whilst Tregarne was updated. These plans are still in place. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 9 It is noted that the home has had to deal with a lot of emergency admissions recently. With a planned admission a guest can visit the resource prior to admission which is then followed by a tea visit and then an over night stay if this is agreeable. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The guests’ 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 guest has a plan of care that is generated from the assessment received at referral. Copies of the referrals are held on the premises. Recent guests admitted to the home are already known to Tregarne and as such their documentation re referral is re-accessed. The care plans on the guests are detailed and client-centred focused. They are supported by good daily records that include a large amount of information as to how the guest 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 Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 11 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 been changed and when a social worker has been involved with a guest. It is noted that some of the guests admitted to Tregarne have complicated care needs. Guests are involved in care planning and confidential information is held appropriately. The acting manager has plans to provide a more inclusive environment at Tregarne with lots of choices available where possible. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning documentation evidences that the social care needs of the guests have been assessed and daily recording evidences how these needs are being met. The environment at Tregarne presents as very institutionalised which could detract from quality leisure time being spent at the home. EVIDENCE: Tregarne is a short stay facility and therefore all guests have established ongoing 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 guests are documented. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 13 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 guests appear to be very much part of the community. The home has it’s own recently newly purchased transport which is suitable for guests with a physical disability. On the day of the inspection the majority of the guests returned to Tregarne at 1630 from their activities. Most of the activities take place at Blantryre or Morley Tambley Lodge. The environment at Tregarne presents as institutionalised which could detract from quality leisure time being spent at the home. It is noted though that the acting manager has made a number of improvements to the environment internally and externally. In the grounds of the home there is now a vegetable patch which has been dug over and is looked after by the guests. In addition animals are in the grounds to include an aviary and rabbits and guinea pigs. Seats have been provided in the grounds for the guests to watch and hold the animals. This is apparently very successful. Internally in the home information in pictures is displayed to inform what the meals for the day are going to be and what activities are due to take place in the evening. Activities at Tregarne include craft opportunities, gardening and planting, barbecues, sensory room, computer suite and film nights. The main meal of the day at Tregarne is eaten in the evening. The menu at the home rotates over a four week period. During the day most of the guests attend local day care facilities in the nearby area and therefore have their main meal when they return to the home in the evening. The staff join the guests having their meals. The main meal of the day on the day of the inspection was cottage pie, fresh carrots and cabbage. An alternative choice is always available to the guest when they do not wish to have the main meal on the menu. The home caters for a variety of diets as required and a vegetarian meal option is always available. The acting manager has plans to improve and enhance guest involvement in the preparation of food in the downstairs area of Tregarne. It is noted that there are some gaps in the records of meals provided which should be addressed. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 guests’ preferences in regard to the delivery of personal support. As Tregarne is a short stay facility the guests’ 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 the health care needs of the guests during their stay. Cornwall County Council are presently in the process of updating the medication policy and procedures for their homes. Consequently, at this time the current medication document is very old (04) and therefore out of date. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 15 As soon as the policy and procedure is available it is important that all staff who have medication administration duties read this document. The storage of medication at Tregarne was found to be satisfactory as was the record keeping. It is noted that some staff require updated medication training and this is due to take place soon. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Guests and their representatives are provided with information on how to complain in their service user guide documentation. Adult protection policies and procedures are in place and training to staff has commenced and is ongoing to ensure the safety and well being of the guests at all times. EVIDENCE: Each guest is provided with information of the complaints procedure in the service user guide. The complaints information is very detailed, informative and user friendly. The home has received seven complaints over the last year all of which have been fully logged and investigated. Cornwall County Council has recently updated and improved it’s adult protection policy and procedure. It is noted that there is no reference to the Commission For Social Care Inspection within this documentation and requirements under Regulation 37 reporting. Adult protection training has taken place to the majority of the staff with dates for the remaining staff to receive this training. The statutory requirement date for this training has therefore been extended. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 17 Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment at Tregarne does not meet any of the environmental 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 guests who have high physical care needs. Due to this fact there are parts of the building that cannot be accessed by those guests. To access the lower ground area of the home (with facilities for more independence) requires the use of (steep) stairs as there is no alternative way of getting there. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 19 Communal areas are basic, toilets and bathrooms are dated. Attention has been given to paintwork and cleanliness but the bedrooms again are very basic at the home. Tregarne presents as shabby and institutionalised. The laundry is provided with industrial machines. Protective clothing is available to the staff and used by the staff. The heating system is controlled centrally which is unsatisfactory. The grounds at the home are pleasant and spacious. Parking is available in the grounds but this can be limited at times. Plans for the new build of Tregarne are available to look at the home. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team at Tregarne is a stable team offering continuity to the guests. Recruitment procedures are satisfactory. Training is ongoing but more is required to meet the requirements of legislation. Supervision of the staff team is taking place. EVIDENCE: The home has a stable staff team with very few changes of staff. Recruitment procedures were found to be satisfactory on the day of the inspection. During the peak time activity at the home there are care staff, ancillary staff, driver and management on duty. As the guests attend their day care activities these staffing levels are reduced. The home does use agency staff but tries to ensure that the same agency staff are used for continuity to the guests. It is noted that staff sickness levels at Tregarne are high. More staff training is required re medication administration, adult protection, health and safety training and moving and handling. These training requirements have been identified by the acing manager. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 21 Staff receive support in the form of documented supervision to allow them to undertake their jobs. The acting manager supervises all the staff and supervision is taking place every other month for each individual. The acting manager has worked hard in this area to meet the requirements of legislation. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager presented as very capable on the day of the inspection and has already made improvements to the day to day quality of life for the guests at Tregarne. EVIDENCE: The acting manager presented very well on the day of the inspection. It is apparent that he has a good vision for the future of Tregarne and is fully aware where there are problems, in particular the poor environment. He has applied to be the registered manager with the Commission for Social Care Inspection. He is undertaking studies to obtain his registered managers award. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 23 The monthly “Regulation 26” reports are provided to the CSCI by the responsible individual as required by legislation. All the guests are fully involved in a regular quality audit/monitoring of the home. The findings from the 2006 guest/carer survey have been acted upon by the manager to the benefit of the guests. Maintenance, fire and health and safety checks are maintained and updated. More staff are to receive health and safety training. Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 24 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 x 5 x 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 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 25 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 YA23 Regulation 18(1) Timescale for action To ensure that staff receive adult 30/09/07 protection training as a priority. (This was included in the previous inspection report(s) with a timescale of 31/03/06 and then 31/12/06 and 31/07/07). 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. Refer to Standard Good Practice Recommendations Tregarne Hostel DS0000041927.V339052.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V339052.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!