CARE HOMES FOR OLDER PEOPLE
Tregenna House Pendarves Road Camborne Cornwall TR14 7QG Lead Inspector
Diana Martin Announced 12 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Tregenna House Address Pendarves Road Camborne Cornwall TR14 7QG 01209 713040 01209 715356 enquiries@tregennahousenursinghome.co.uk Issuemarket Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Amanda Johnstone Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number Mental Disorder, excluding learning disability or of places demential - over 65 years of age (40) Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: To include up to 19 named service users category OP nursing, outside of the new registration categories Date of last inspection 16/11/04 Brief Description of the Service: Tregenna House is a large two storey Victorian property with a modern single storey extension at the back. The building is situated in large grounds close to the town of Camborne. There is parking to the front of the home and an enclosed garden to the rear.The home provides nursing and residential care for up to thirty-nine elderly residents with a mental disorder or dementia. The ground floor provides accommodation for 23 residents. There is a large lounge with a dining area at one end. The Registered Providers hope to build a conservatory and move the dining area as it is in the walk through from the old building to the extension. The kitchen is on the ground floor with a hatchway opening into the dining area. The first floor, ‘Bluebell Wing’, provides accommodation for 16 residents with more limited mobility. There is a large enclosed garden at the back of the home, which the Registered Providers hope to design so that it is suitable for those residents with a dementia. Suitably qualified nurses and care assistants provide nursing and personal care within a relaxed friendly atmosphere. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Tregenna House on the 12 May 2005 and spent all day at the home. This was an announced visit. On the day of inspection 39 residents were living in the home. The inspector met with 7 service users, 2 visitors, a number of staff and the Registered Manager to gain their views on the service that Tregenna provides. In addition the inspector examined records, policies and procedures, toured the building and observed staff going about their work. This report summarises the findings of this inspection. What the service does well:
The home provides a warm, clean, homely environment that is well maintained and safe for residents, staff and visitors. There is an ongoing programme of redecoration and refurbishment, which has improved the general appearance of the home; several carpets and curtains have been replaced since the last inspection. A housekeeper has been employed to ensure the home is clean and pleasing at all times. Personal clothing is washed on site but bed linen and towels are sent out to the laundry. To reduce the risk of infection liquid soap and paper towels are provided for staff along with protective clothing such as plastic gloves and aprons. The home’s statement of purpose and resident’s guide help prospective residents and their families have an informed choice as to whether the home is suitable for their needs. A relative stated that the information provided by the home, both written and oral, was excellent. The care provided is to a high standard and residents are only admitted following a full assessment to ensure the home can meet their needs. Residents said their care needs are met and they are happy living in the home. They said the staff are kind and very caring. Visitors said they are impressed by the professional approach of all staff in the home. Residents have an individual care plan that is drawn up with them or their representative; it is reviewed monthly and is accessible to the resident on request. Health specialists are involved when necessary and the home has equipment for the prevention of pressure sores and for staff to move residents safely. Staff are trained in the use of this equipment. There is an appropriate medicines policy and systems in place for the storage, administration and disposal of medicines. Only qualified nurses administer the medicines and a pharmacist visits the home regularly. The home has an activities co-ordinator. Although there was no activities programme residents and staff said that activities take place in the home and records were kept. There were activities going on during the inspection. Friends and family are welcome in the home and residents can go out according to their wishes and ability. Several residents had visitors during the inspection.
Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 6 Residents said the food was good and that drinks and snacks are available between meals. Although the menu is a set one there are alternatives available every day. There is a dining space but some residents choose to eat in their own room. There are two qualified nurses on duty at all times and sufficient care staff to look after for the residents living in the home. Residents said there are sufficient staff and they are always willing to help. Staff were observed to interact well with residents in a very kind, relaxed manner. The Registered Manager is a Registered Mental Nurse, she has enrolled on the NVQ level 4 Management course and keeps herself up to date with health care issues relating to the residents she cares for. She supervises the staff and both staff and residents said they could air their views at any time. What has improved since the last inspection?
The environment continues to improve, new carpets and curtains have been provided in several rooms. The curtain screens in shared rooms have been replaced and look much better. Staff said the improvements are wonderful for the residents but it also makes a much more pleasant environment to work in. The employment of a housekeeper makes sure the home is clean and welcoming with finishing touches such as net curtains and flowers. Individual residents have been risk assessed as to the appropriateness of providing a key to their room. This has been documented and held with their care plan. Staff supervision arrangements have improved and annual appraisals have been undertaken for most staff. A number of the homes policies and procedures have been reviewed and updated. Relatives have been asked to compile life histories for individual residents; this provides very useful information for staff enabling them to care for residents in a manner that respects their lifestyle. Staffing numbers and skill mix have been improved by robust recruitment and training of staff. The less mobile residents are now upstairs which means that those who like to walk around can do so more freely and safely. The staffing has been adjusted to cope with these changes. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 7 What they could do better:
The home will benefit when the remaining policies and procedures have been reviewed and updated. The home must implement a safekeeping policy and procedure that guides and informs staff on the safekeeping of residents money and valuables, staff must be made aware of this policy. There should be a form for the resident or their representative to sign to agree to the home handling their money. All care plans should be reviewed regularly and signed by the staff member involved. The handwriting of medicines onto the medicine administration charts must be witnessed with two signatures recorded. The medicine fridge temperature should be recorded regularly with the records maintained available for inspection. Medicines prescribed for a specific resident must not be administered to other residents; this is in particular reference to bottles of liquid medication. It is recommended that there be a blood glucose monitoring machine for each diabetic resident and that there be a system in place for the cleaning of these with records kept. This will reduce the risk of infection and help the machines work effectively. It is recommended that a book of attendance be implemented for residents joining in the activities in the home. This will show more easily how many attend and how effective the programme is. The Adult Protection policy must be reviewed and updated as previously required. Doors marked “keep locked” must be locked at all times, two cupboard doors were unlocked during the inspection. There need to be individual hoist slings for residents with records kept of the laundering arrangements. Hand-washing facilities for staff were good but the use of alcohol gel would be a further safeguard to reduce the risk of cross infection. Some pedal bins around the home were not working and need replacing and a new chair is needed for the bath hoist in the extension for infection control purposes. The home would benefit from the provision of a second tumble drier. The pre-employment health questionnaire should be more comprehensive; this has been looked into and will be sorted soon. The Registered Manager should have an annual appraisal to discuss and address her role, her professional development and training needs. There should be a policy in place for the supervision of staff. Please contact the provider for advice of actions taken in response to this
Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Prospective residents are given information prior to moving into the home enabling them to make a fully informed choice about where to live. No resident moves in without their needs being assessed and that the home can meet their needs. EVIDENCE: The Registered Manager said the statement of purpose was due to be reviewed, as it required updating. A copy must be sent to the Commission on completion. There was a suitable residents guide in place. The Registered Manager said both documents are given to prospective residents. There is a form for initial enquiries. Prospective residents are visited prior to admission when a full assessment of their needs is undertaken. The Registered Manager said she always ensures the Social Services assessment is received prior to making a final decision as to whether the home is suitable for a resident. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 Each resident has an individual care plan setting out their health, personal and social care needs; these are detailed to guide and direct the staff providing care. Residents have access to health care services as necessary to ensure their assessed needs are met. There are suitable policies in place for dealing with resident’s medicines, however the recording procedures need some minor improvement to safeguard residents from the risk of harm. EVIDENCE: All residents had a written care plan; the resident or their representative had signed most of the ones inspected. The care files were detailed and included the initial assessments, the care plans, risk assessments, GP visit records and daily records. Not all of the plans had been reviewed regularly or signed by the staff member involved. Residents spoken with said their health needs were met and they had access to their GP or other health professionals as required. The home owned pressure relieving equipment and there was some supplied by the NHS. The tissue viability nurse specialist visited regularly. Although individual records regarding wound care were maintained a record must be kept of the incidence of pressure sores. There was equipment for moving and handling purposes and
Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 12 there were two moving and handling trainers in the home. Physiotherapists visited the home but Occupational Therapists were not easy to arrange. A monitored dosage system of medication is used and the medicine round was observed to be satisfactory. Records were well maintained for receipt, administration and disposal of medicines. The transcribing of medicines onto the MAR charts must be witnessed with two signatures recorded. The medicine fridge temperature records could not be found, these should be available for inspection. Medicines prescribed for a specific resident must not be administered to other residents; a more suitable system is needed for medicines such as Lactulose. There was a copy of the ‘The Royal Pharmaceutical guidelines for the administration of medicines in care homes’. The homes medicine policy should include the use of oxygen. A pharmacist visits the home regularly and gives advice to the staff. It is recommended that there be a blood glucose monitoring machine for each diabetic resident and that there be a system in place for the cleaning of these with records kept. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Residents could enjoy a lifestyle to suit their preferences; their social, recreational and religious needs were catered for. The home ensures that residents have ample opportunity to maintain contact with their family and friends as they wish. Resident’s dietary needs are well catered for with a selection of meals on offer and records are kept. EVIDENCE: The home has an activities co-ordinator. Although there was no activities programme residents and staff said that activities take place in the home. One member of staff was making buns with a resident during the inspection. Residents said they could choose not to join in with activities if they wished. Records were maintained in the daily records; a book of attendance is recommended for easy reference. Residents said they were able to maintain contact with family and friends as they wished by visits or telephone. Several residents had visitors during the inspection. Some said they go out with their family. There is a record kept of visitors to the home. There was a set menu spanning 4 weeks, alternatives were available and recorded. Residents said the food was good and that drinks and snacks are available between meals. One resident said she had a meal of her choice that
Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 14 was not on the menu. Residents could eat in the dining room or their bedroom if they wished. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Arrangements are in place to protect residents from possible risk of harm or abuse, improvements to the policy must take place to ensure these are robust. EVIDENCE: The home had an adult protection policy that referred to the ‘No Secrets’ document. The home also had a copy of the Local Authority procedures. The homes policy is still required to be reviewed and updated in line with the Local Authority procedures. There was a secure facility for the storage of money in the home. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,23,25 and 26 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. The decoration and furnishings are to a good standard creating a comfortable home. Residents have access to communal areas that are spacious and safe and their rooms are suitable for their needs. The home was clean and free from offensive odours; further controls could be in place to improve infection control. EVIDENCE: The home was well maintained, decorated and furnished to a good standard. It was clean, homely and comfortable; a housekeeper had been employed since the last inspection and improvements had been made. Some carpets had been renewed and net curtains had been provided to most windows, new screening curtains have been provided in shared rooms and are a huge improvement. New chairs and lockers had been provided in the staff room. The grounds were tidy and reasonably accessible; it is still hoped to improve the enclosed garden with particular design features to benefit residents with a dementia.
Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 17 Residents said they were very happy in their surroundings. There had been no changes in the room sizes. Radiators were guarded and window restrictors were in place. Doors marked “keep locked” must be locked at all times. There was a large lounge on the ground floor with a dining room incorporated. On the first floor there are two sitting rooms with dining tables and chairs included. The home is mainly non-smoking, one resident smoked under supervision in the lounge once a week. The laundry facilities were suitable; however the home would benefit from the purchase of another tumble drier. The Registered Manager said the home was looking to expand the laundry facility. There need to be individual hoist slings for residents with records kept of the laundering arrangements. Hand-washing facilities for staff were good but the use of alcohol gel would be a further safeguard to reduce the risk of cross infection. Some pedal bins around the home were not working and a new chair was needed for the bath hoist in the extension for infection control purposes. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels meet the needs of residents and staff morale is good. EVIDENCE: The Registered Manager said the skill mix of staff was suitable for the residents living in the home. The rota showed that there were sufficient numbers of staff on duty. There was a nurse on duty, on each floor at all times and there were waking night staff. Staff said the staffing was good in the home. Residents said there were enough staff and that they were very hard working and caring. Staff were observed to interact well with residents and in a very kind, relaxed manner. Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 and 36 The Registered Manager is a person of good character and fit to run the home. The home is run in the best interest of the residents and they benefit from the Quality Assurance systems in place. Staff are appropriately supervised and supported in their work. EVIDENCE: The Registered Manager is a Registered Mental Nurse who has enrolled on the NVQ level 4 in Management course. She keeps herself up to date by attending courses, reading journals and networking with other healthcare professionals. The views of residents and relatives are sought annually and the last survey was positive. Staff meetings are held and minutes kept. Staff said they were free to air their views at any time. Accidents in the home are audited regularly. Staff are supervised appropriately and a system had started to formally supervise care staff 6 times a year. There should be a policy in place for staff supervision. Annual staff appraisals were in progress. It is recommended that the Registered Manager also have an appraisal annually.
Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 x x 3 x 3 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x 3 x x 3 x x Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 21 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. 2. 3. Standard 1 8 9 Regulation 4 (2) 17(1)(a) Sch 3 (3)(n) 13(2)(4)( c) 13(2)(4)( c) Requirement A copy of the updated statement of purpose must be sent to the Commission A record must be kept of the incidence of pressure sores The transcribing of medicines onto the MAR charts must be witnessed with two signatures recorded Medicines prescribed for a specific resident must not be administered to other residents; a more suitable system is needed for medicines such as Lactulose The adult protection policy must be reviewed and updated in line with the Local Authority procedure, it must include the reporting of incidents to the Commission for Social Care Inspection(timescale of 10/01/05 not met) Doors marked “keep locked” must be locked at all times. The home’s policies and procedures must be reviewed and updated (timescale of 14/03/05 not met) Timescale for action 02/08/05 04/07/05 12/05/05 4. 9 04/07/05 5. 18 13(6)12(1 ) (a) 02/08/05 6. 7. 19 38 13(4) 23(4) 12,13 12/05/05 03/10/05 Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 22 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 9 9 9 Good Practice Recommendations The drug fridge temperature recordings should be available for inspection The homes medicine policy should include the use of oxygen. There should be a blood glucose monitoring machine for each resident requiring monitoring and a system should be in place for the cleaning of these, with records kept. A record of residents attending activities should be maintained There should be individual hoist slings for residents with records kept of the laundering arrangements The use of alcohol gel is recommended as a further safeguard to reduce the risk of cross infection The bath hoist chair in the downstair extesnion should be replaced Pedal bins that do not work should be replaced A second tumble drier should be provided. The pre-employment health questionnaire should be more comprehensive There should be a policy in place for staff supervision. The Registered Manager should have an appraisal annually 4. 5. 6. 7. 8. 9. 10. 11. 12. 12 26 26 26 26 26 29 36 36 Tregenna House D52-D04 S9261 Tregenna House V215851 120505 Stage 4.doc Version 1.30 Page 23 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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