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Inspection on 26/07/07 for Tregenna House

Also see our care home review for Tregenna House for more information

This inspection was carried out on 26th July 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home 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 is improving the general appearance of the home and comfort for the residents. The registered providers strive to improve the facilities for the people using the service. The registered manager is competent and runs the home well. The people using the service and relatives said she is approachable and of a kind and caring nature. Staff said she promotes independence for the people using the service and she supports and empowers her staff. The management team endeavour to ensure that working practices are safe and an external consultant is employed to deal with mandatory training and audits. Training provision appears to be very good and staff said this is so. All laundry is dealt with on site and there are policies and procedures for infection control. To reduce the risk of infection liquid soap and paper towels are provided for staff along with alcohol hand cleansing gel, protective clothing such as plastic gloves and aprons are supplied and were seen being used.Care provided is to a very good standard and residents are only admitted following a full assessment to ensure the home can meet their needs. The people using the service and relatives said that care needs are met and they are very happy with the services provided by the home. They said the staff are patient, kind and very caring. Staff were observed to interact very well with the people using the service and the atmosphere is relaxed and friendly. Doctors and other healthcare professionals visit the home when required. Privacy was upheld for the people using the service, during the inspection and staff were observed knocking on doors before entering. Resident`s money is suitably dealt with and they can manage their own money according to their individual risk assessment and ability. Residents have an individual care plan and relevant risk assessments are undertaken. Medicines are stored safely and securely and only qualified nurses administer the medicines. Friends and family are welcome in the home and the people using the service can go out according to their wishes and ability. The visitor`s book shows the home receives a lot of visitors. A wide range of activities take place, organised by the activities co-ordinator, these include a lot of one to one sessions and outings for individuals to locations of their choice. There is a varied menu on offer, the people using the service, relatives and staff spoke highly of the cook and the food is good home cooking. There are two qualified nurses on duty at all times and sufficient care staff to look after for the people using the service. People said there are enough staff who are kind and always willing to help. Staff were observed to interact well with residents in a very kind, relaxed manner. Care staff are actively encouraged to undertake NVQ training and there are other training courses and study sessions on offer. The home has had no complaints but has received many thank you letters and cards that are kept in a file.

What has improved since the last inspection?

Five new bedrooms have been purpose built and provide an excellent service. They all have en suite facilities that include a wet room type shower. One bedroom is now used as a small lounge dining room that allows people to sit in a quieter room if they wish. Storage space has been improved with a room provided near the kitchen and a massive roof space area. This has meant that wheelchairs are no longer stored in the dining room and space has been allocated for a nurse`s station.Twenty hours per week are funded for taking people out into the community and on trips. The activities co-ordinator takes people out daily and residents said they enjoy this time. A health and safety consultant is employed and he now undertakes bulk training for staff over periods of five days, each member of staff attends a full day. The training entails, fire safety, infection control, food hygiene and health and safety. One of the team leaders provides the moving and handling training. There are two team leaders who will be undertaking on call duties, this will give them further empowerment and reduce the on call hours undertaken by the manager. This will improve further when a deputy manager is employed. It appears that all sections of the assessment form are now being completed fully. Care plans have generally been expanded to include all of the criteria listed under standard 3.3 and also reflect the findings of individual risk assessments. There is a separate risk assessment for the use of cot-sides with consent agreed and signed. Medicine training for all care staff is planned and will be provided by Boots chemist and a tutor from St Austell College. Medicine disposal records are now completed appropriately and the The royal pharmaceutical guidelines for care homes are available to staff. The home`s policies and procedures have been or are in the process of being reviewed. There is now a policy for staff supervision.

What the care home could do better:

Staff who review the care plans must record the date and sign when they have been reviewed. There are issues around medicines that must be addressed; the registered manager stated that she was tackling these at the last inspection. Nurses must also ensure that the issues are addressed for the safety of the people using the service and compliance with regulations. Liquid medicines labelled for individuals are being administered to other residents who are prescribed the same medicine. Medicines prescribed for an individual belong to that person and must not be shared. Handwritten instructions on medicine administration charts must be witnessed and signed by two people to reduce the risk of errors. The medicines fridge temperature must be recorded regularly; the records show that it is only done now and again. Medicine pots must be washed and dried according to infection control guidelines. Activities undertaken by the people using the service are recorded in the daily records, the registered manager said that she would implement a sheetspecifically for recording social activity and each resident would have one in their file. This will make it easier to see what each person is doing. It is recommended that interview records be kept on file to ensure that interviews are fair and non discriminatory. Induction records should be kept in the home so that they can be checked signed as necessary. It is again recommended that the registered manager compile a training matrix whereby she can easily assess and audit staff attendance to ensure they attend according to the law. The registered manager should complete the Registered Managers Award within the next six months, as she must have a management qualification. All meetings should be recorded and residents meetings would be beneficial, the manager hopes to start these again. Audits are undertaken for several subjects, these need to be recorded to show issues are being addressed and continual improvement is taking place. Cleaning rotas need to be in place and adhered to in the kitchen, with records maintained. This was not happening during the inspection as the manager had taken the food safety manual to her home.

CARE HOMES FOR OLDER PEOPLE Tregenna House Pendarves Road Camborne Cornwall TR14 7QG Lead Inspector Diana Penrose Key Unannounced Inspection 26th July 2007 09:30 X10015.doc Version 1.40 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 Tregenna House DS0000009261.V341940.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 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 DS0000009261.V341940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregenna House Address Pendarves Road Camborne Cornwall TR14 7QG 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) 01209 713040 01209 715356 enquiries@tregennahousenursinghome.co.uk Issuemarket Limited Miss Amanda Johnstone Care Home 44 Category(ies) of Dementia (44), Mental disorder, excluding registration, with number learning disability or dementia (44) of places Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) to a maximum of 44 Mental disorder (Code MD) to a maximum of 44 Identified service users only, currently in residence, category OP nursing. The maximum number of service users who can be accommodated is 44. 2. 3. Date of last inspection Brief Description of the Service: Tregenna House is a large two storey Victorian property with a modern single storey extension, that at the back. The extension has recently been extended further to incorporate five new bedrooms with excellent en suite facilities, including wet room showers. Storage space has also been considerably improved. 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, which is being designed specifically for people with dementia. A large area of garden at the side of the home has been improved with vegetable and herb beds included. The home provides nursing and residential care for up to forty-four elderly people with a mental disorder or dementia. Accommodation is over two floors; the ground floor provides accommodation for 28 residents. There is a large lounge with a dining area at one end and another small lounge / diner inside the front door. The kitchen is on the ground floor with a hatchway opening into the main dining area. The first floor, Bluebell Wing, provides accommodation for 16 residents with more limited mobility. There are two lounges upstairs with dining facilities incorporated. Meals are transported from downstairs but there is a kitchenette for making snacks and drinks. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 5 Suitably qualified nurses and care assistants provide nursing and personal care within a very relaxed, friendly atmosphere. Information about the home is available in the form of a residents’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £487 to £650 per week, those receiving extra one to one care pay up to £1500.00 per week, this information was supplied to the Commission by the registered manager during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. An Inspector visited Tregenna Nursing Home on the 26 July 2007 and spent eight and a half hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that the needs of the people using the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that people’s placements in the home result in good outcomes for them. It was also to gain an update on the progress of compliance to the requirements identified in the last inspection report dated 04 July 2006. All of the key standards were inspected. On the day of the inspection forty-four people were residing in the home. The methods used to undertake the inspection were to meet with people using the service, the registered manager, staff and visitors to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. The registered provider has complied with most of the requirements set at the last inspection. Residents expressed satisfaction with the care and services provided at the home and were treated with kindness and respect. Overall the home is providing a good quality of care to the residents placed there. 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 is improving the general appearance of the home and comfort for the residents. The registered providers strive to improve the facilities for the people using the service. The registered manager is competent and runs the home well. The people using the service and relatives said she is approachable and of a kind and caring nature. Staff said she promotes independence for the people using the service and she supports and empowers her staff. The management team endeavour to ensure that working practices are safe and an external consultant is employed to deal with mandatory training and audits. Training provision appears to be very good and staff said this is so. All laundry is dealt with on site and there are policies and procedures for infection control. To reduce the risk of infection liquid soap and paper towels are provided for staff along with alcohol hand cleansing gel, protective clothing such as plastic gloves and aprons are supplied and were seen being used. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 7 Care provided is to a very good standard and residents are only admitted following a full assessment to ensure the home can meet their needs. The people using the service and relatives said that care needs are met and they are very happy with the services provided by the home. They said the staff are patient, kind and very caring. Staff were observed to interact very well with the people using the service and the atmosphere is relaxed and friendly. Doctors and other healthcare professionals visit the home when required. Privacy was upheld for the people using the service, during the inspection and staff were observed knocking on doors before entering. Resident’s money is suitably dealt with and they can manage their own money according to their individual risk assessment and ability. Residents have an individual care plan and relevant risk assessments are undertaken. Medicines are stored safely and securely and only qualified nurses administer the medicines. Friends and family are welcome in the home and the people using the service can go out according to their wishes and ability. The visitor’s book shows the home receives a lot of visitors. A wide range of activities take place, organised by the activities co-ordinator, these include a lot of one to one sessions and outings for individuals to locations of their choice. There is a varied menu on offer, the people using the service, relatives and staff spoke highly of the cook and the food is good home cooking. There are two qualified nurses on duty at all times and sufficient care staff to look after for the people using the service. People said there are enough staff who are kind and always willing to help. Staff were observed to interact well with residents in a very kind, relaxed manner. Care staff are actively encouraged to undertake NVQ training and there are other training courses and study sessions on offer. The home has had no complaints but has received many thank you letters and cards that are kept in a file. What has improved since the last inspection? Five new bedrooms have been purpose built and provide an excellent service. They all have en suite facilities that include a wet room type shower. One bedroom is now used as a small lounge dining room that allows people to sit in a quieter room if they wish. Storage space has been improved with a room provided near the kitchen and a massive roof space area. This has meant that wheelchairs are no longer stored in the dining room and space has been allocated for a nurse’s station. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 8 Twenty hours per week are funded for taking people out into the community and on trips. The activities co-ordinator takes people out daily and residents said they enjoy this time. A health and safety consultant is employed and he now undertakes bulk training for staff over periods of five days, each member of staff attends a full day. The training entails, fire safety, infection control, food hygiene and health and safety. One of the team leaders provides the moving and handling training. There are two team leaders who will be undertaking on call duties, this will give them further empowerment and reduce the on call hours undertaken by the manager. This will improve further when a deputy manager is employed. It appears that all sections of the assessment form are now being completed fully. Care plans have generally been expanded to include all of the criteria listed under standard 3.3 and also reflect the findings of individual risk assessments. There is a separate risk assessment for the use of cot-sides with consent agreed and signed. Medicine training for all care staff is planned and will be provided by Boots chemist and a tutor from St Austell College. Medicine disposal records are now completed appropriately and the The royal pharmaceutical guidelines for care homes are available to staff. The home’s policies and procedures have been or are in the process of being reviewed. There is now a policy for staff supervision. What they could do better: Staff who review the care plans must record the date and sign when they have been reviewed. There are issues around medicines that must be addressed; the registered manager stated that she was tackling these at the last inspection. Nurses must also ensure that the issues are addressed for the safety of the people using the service and compliance with regulations. Liquid medicines labelled for individuals are being administered to other residents who are prescribed the same medicine. Medicines prescribed for an individual belong to that person and must not be shared. Handwritten instructions on medicine administration charts must be witnessed and signed by two people to reduce the risk of errors. The medicines fridge temperature must be recorded regularly; the records show that it is only done now and again. Medicine pots must be washed and dried according to infection control guidelines. Activities undertaken by the people using the service are recorded in the daily records, the registered manager said that she would implement a sheet Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 9 specifically for recording social activity and each resident would have one in their file. This will make it easier to see what each person is doing. It is recommended that interview records be kept on file to ensure that interviews are fair and non discriminatory. Induction records should be kept in the home so that they can be checked signed as necessary. It is again recommended that the registered manager compile a training matrix whereby she can easily assess and audit staff attendance to ensure they attend according to the law. The registered manager should complete the Registered Managers Award within the next six months, as she must have a management qualification. All meetings should be recorded and residents meetings would be beneficial, the manager hopes to start these again. Audits are undertaken for several subjects, these need to be recorded to show issues are being addressed and continual improvement is taking place. Cleaning rotas need to be in place and adhered to in the kitchen, with records maintained. This was not happening during the inspection as the manager had taken the food safety manual to her home. 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. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 10 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 Outcomes Statutory Requirements Identified During the Inspection Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered persons have a suitable assessment procedure. There is suitable evidence that people who use the service have been assessed appropriately before admission is arranged. Suitable assessment procedures ensure the registered persons only accommodates people who the provider can suitably meet their needs. EVIDENCE: Evidence was provided in the form of documentation, records and discussion with the registered manager. The files of some people who use the service were inspected. Their needs were assessed prior to admission to the home and recorded on specific forms. The forms inspected were fully completed and signed by the nurse undertaking the assessment. The form should also state who is involved in the assessment and Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 12 where the information was obtained. Information is received from hospital staff and this was evident. One woman said the registered manager visited her husband prior to admission and did an assessment that she was involved in. She said she was able to visit the home prior to deciding if it was right for her husband. The home does not provide intermediate care. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have a generally satisfactory care plan for which there is evidence of regular review, although staff need to sign the reviews. Suitable care plans help to ensure people who use the service receive the care they need in a consistent manner. Residents have access to health care services as necessary to ensure their assessed needs are met. There are systems and policies in place for dealing with resident’s medicines; some extra vigilance will help to ensure residents safety. People who use the service said they felt staff worked with them in a manner, which respected their privacy and dignity, and this was also evident from the inspectors’ observations. EVIDENCE: Evidence was provided in the form of documentation, records, observation, and talking with the people using the service, relatives, staff and the registered manager. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 14 The people who use the service have a written care plan. The registered manager said she tries to involve the person or their representative as much as she can and the resident or their representative had signed the plans inspected. Some of the plans were reviewed on a monthly basis; not all were signed by the person doing the review. They have improved since the last inspection to more fully inform and direct the care staff on the care to be provided. Relevant risk assessments are included and these are generally reflected in the care plans. The Liverpool Care Pathway has been implemented and the home is undertaking the gold standard framework. Both nursing and care staff write the daily records and these are informative. A key-worker system is in place and seems to work well. Residents said their needs are met and relatives and staff said the standard of care provided is good. Care practice observed was to a satisfactory standard. Doctors and other healthcare professionals visit as appropriate and records are kept. One relative spoke of her husband’s admission to hospital and that it was handled well by the home. The home has suitable equipment for moving and handling and pressure relief. People needing a hoist have an individual sling that is washed regularly. The pressure setting of air mattresses is recorded. There are records in people’s files to show that healthcare professionals from the community are involved in their care, for example the speech and language therapist and the tissue viability specialist nurse. A monitored dosage system of medication is used in the home. No residents administer their own medicines. Records for the receipt, administration and disposal of medicines were satisfactory. There is a photograph of each resident with his or her medication administration chart. Any handwritten medicine or instruction on the medication administration charts must be witnessed with two signatures recorded. Care staff do not administer medicines, however it is recommended that basic training be provided, especially on induction, the manager said this is in hand. She stated that this happens informally but needs to be recorded. The medicines policy had been updated. Patient information leaflets (PIL) and medicine books are available for reference. Medicines prescribed for an individual resident must not be administered to anyone else; lactulose syrup was again being shared between several people. The registered manager said she would look into this again as she knew it was not good practice and so did the nurses. The medicines fridge temperature must be recorded regularly; the records show that it is only done now and again. The manager and a nurse said the medicine pots are washed in the kitchen but some were seen drying in the clinical room on a towel. This is not best practice and must be addressed. The medicine disposal tubs contained ‘sharps’ as well as medicines; the manager said she would also address this with the nursing staff. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 15 Residents’ privacy was observed to be upheld during the inspection and staff knocked on doors before entering. Relatives and people using the service said that staff are respectful and uphold residents’ privacy. Shared rooms are provided with appropriate screens. Systems are in place to deter residents wandering into other resident’s rooms; for example some residents have a gate across their doorway that suits them. Some bedroom doors are locked whilst the person is in the lounge. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a wide range of activities and one to one time that aims to offer a lifestyle to meet individual residents’ needs. Links with family, friends and the community are very good and allow residents the opportunity to socialise. Residents are helped to maintain control over their lives and staff respect their individual preferences and choice. Dietary needs of residents are well catered for with a varied selection of food available that aims to meet their taste and preference. EVIDENCE: Evidence was provided in the form of records, observation, and interviews with residents, staff and the registered manager. There is a relaxed attitude to activities in the home and people can choose whether or not to join in. There is no activities programme, the manager said activities are decided on a daily basis and staff are guided by the people using the service. Records are maintained within the individual’s daily records so it is difficult to see what has been taking place and the frequency. The registered manager said that she would implement a sheet specifically for recording social Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 17 activity and each resident would have one in his or her file. Activities include bingo, puzzles, reminiscence, films and gardening; there is now a greenhouse for resident’s use. Some people were playing bingo during the inspection. Entertainers and musicians visit the home and the people using the service said they enjoy their visits. People move freely around the home and a great deal of one to one interaction with staff was observed. There are opportunities to go out on trips or to the local shops. The activities co-ordinator took two residents out shopping and they bought a small bookcase that they were going to assemble together. The manager requested that he take another resident out when the rain stopped. Everyone spoken with said the activities coordinator is excellent and he was observed to interact well with residents, relatives and staff. Residents said there is always something to do if you want it and staff have time to sit and chat. People using the service said they choose when they get up and go to bed. One woman said “we get up when we want really” and breakfast was observed to go on throughout the morning. Residents said they receive visitors when they wish and can receive them in private, the visitor’s book showed that several people visit the home each day. Relatives said there are no restrictions on visiting times and they are always made very welcome by the staff. Staff said residents are encouraged to live the lives they wish. There is a four-week set menu but the cook said she does not strictly adhere to this the daily menu is recorded in a diary. There is a board in the dining room and the cook wrote the lunchtime menu on this. She said she knows what people like and residents can have an alternative if they wish, she asks residents what they would like every day. She said it is all home cooking. Everyone spoken with praised the cook and spoke really highly of the food. Fresh fruit and vegetables were seen and homemade cakes were provided at teatime. Special occasions are celebrated and birthday cakes are provided. The people using the service enjoyed their breakfast and their lunch during the inspection. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. Arrangements are in place for the protection of residents safeguarding them from harm or abuse. EVIDENCE: Evidence was provided in the form of documentation and discussion with staff and the registered manager. There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been no complaints since the last inspection. There are many thank you letters and cards and these are kept. Relatives said they could approach staff or the manager if they had a problem. The home has a whistleblowing policy that refers to the ‘No Secrets’ document. The home also has a copy of the Local Authority inter agency procedures, alerters guide and a draft copy of the national framework for safeguarding adults. It was recommended at the last inspection that a flow chart or simplified procedure be compiled for staff to reference easily, this has yet to be completed. It needs to be clear on who to report to and state that CSCI must be notified. There is a secure facility for the storage of money in the home. Staff have been attending adult protection training either with the department Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 19 of adult social care or in house. There has been one adult protection issue recently which is being investigated by the department of adult social care. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and grounds are accessible and well maintained providing a safe environment for the people using the service, staff and visitors. The recent building work has improved the communal areas and storage space and the new bedrooms are of an excellent standard. The home is clean and free from offensive odours making it a pleasant place to live in. EVIDENCE: Evidence was provided in the form of a tour of the building, talking with the people using the service, staff and registered manager. The home is decorated and furnished to a good standard. It is clean, homely and comfortable. Some bedroom carpets have been replaced with waterproof flooring to improve the control of odours. The five new purpose built bedrooms Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 21 are now in use, they are very spacious and each has wet room en suite facilities. There is a very large storage facility incorporated in the extension, which was desperately needed. Unfortunately separate changing facilities for catering staff have not been addressed within the recent building work and must be considered. Individual bedrooms are personalised with pictures and belongings. People using the service said they are very happy in their surroundings. One bedroom is now used as a small lounge dining room and this was being utilised. An area of the other dining area is now utilised as a nurse’s station and is appreciated by nursing and care staff. The grounds are tidy and accessible to the people using the service. Vegetable and herb beds are incorporated in an area to one side of the home and there is a greenhouse for residents use. The enclosed garden at the back has been levelled and landscaped ready to be designed specifically for residents with dementia. The management hope to provide pet rabbits and an aviary for the people using the service. All laundry is done in house there are two washers and two driers. There are three sluices with washer disinfectors. Hand-washing facilities are appropriate and alcohol hand cleansing gel is in use. Staff were observed wearing disposable gloves and aprons. Records show that staff have attended infection control training. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels meet the needs of the people using the service and staff morale is good, although cover for periods of sickness was causing concern. People using the service are in safe hands and benefit from the 59 of care staff trained to at least NVQ level 2 in care. Recruitment procedures are robust and offer protection to the people using the service. The home provides appropriate training for staff to help them be more competent in their roles although the record keeping needs improvement to show that all staff are receiving training according to the law. Equal opportunities issues regarding recruitment and work practices seem satisfactory. EVIDENCE: Evidence was provided in the form of documentation, records, observation, and interviews with residents, relatives, staff and registered manager. The rota showed there are suitable numbers of care staff employed. There is a nurse on duty, on each floor at all times and the night staff stay awake at night. On average there are three care staff upstairs and six downstairs in the mornings, two upstairs and five downstairs in the afternoons and one upstairs and two downstairs at night. There are also staff that come in from 19:00 – 22:00 or 23:00 to help people get ready for bed. The manager said that staff Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 23 help between units as needed. The manager said there are sufficient ancillary staff employed. The manager said more staff have been employed but there have been huge problems recently with sickness. She said that sometimes the agencies are unable to supply staff at short notice but resident’s care has not been compromised. All staff spoken with said the staffing levels are very good in the home although sickness can cause a lot of problems. Staff are loyal and work overtime to cover absence, agency staff are also employed. The people using the service said that staff are very caring and there seem to be enough around. Relatives spoke very highly of staff and comments include “they are all lovely I have no complaints and “I can’t fault any of them”. Staff were observed to interact very well with residents in a kind, relaxed manner. Care practice observed was appropriate and safe. Several male care staff are employed and this is working very well. The home is approved to take nursing students and has had one placement. At the moment there are two students doing an apprenticeship they are at college doing NVQ level 2 in care. The registered manager has a good approach to ensuring staff have a National Vocational Qualification in care. 59 of staff have an NVQ either at level 2 or 3 and copies of NVQ certificates are kept on file. Other staff are undertaking NVQ training. There is a robust recruitment procedure. Three staff files were inspected and included all of the checks required by legislation. Copies of training certificates are kept on file; these must include nurse qualification certificates and was discussed with the registered manager. It is recommended that interview records be kept on file to ensure that interviews are fair and non discriminatory. New recruits on duty said they did not have their induction papers with them so these could not be inspected. The records should be kept in the home; the manager explained this to one member of staff. The induction programme used complies with the skills for care guidance. The registered manager’s approach to staff training is good. The registered manager said that staff receive statutory training as required. A health and safety consultant is employed and he now undertakes bulk training for staff over periods of five days, each member of staff attends a full day. The training entails, fire safety, infection control, food hygiene and health and safety. One of the team leaders provides the moving and handling training. The records make it difficult to assess that training is up to date. Some invoices were seen that show numbers of staff who have attended various courses and there is evidence that in house training takes place. It is again recommended that the registered manager compile a training matrix whereby she can easily assess and audit staff attendance to ensure they attend according to the law. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 24 Staff said the training provision is very good, comments include “we have plenty of training” and “We have loads of training and are encouraged to go on courses. Our manager empowers staff to get on and take extra responsibility”. The registered manager said there are now twelve first-aiders in the home. She said twenty-four staff are doing a distance learning dementia awareness course. A trainer from St Austell College assists the home with training requirements. Some new training is taking place with staff regarding selfawareness, prejudices, life experiences and so on and training in respect of the mental capacity act is scheduled. Nurses receive updates as relevant for example the caring for patients with syringe drivers and intravenous infusions. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 25 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 people using the service and they benefit from the Quality Assurance systems in place although written evidence of audits undertaken is needed. There is a suitable system in the home for dealing with residents’ money that ensures that the people using the service’s financial interests are safeguarded. Appropriate training and safety checks are undertaken to ensure the health safety and welfare of the people using the service, visitors and staff. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 26 EVIDENCE: Evidence was provided in the form of documentation, records, observation, and interviews with residents, staff and the registered manager. The registered manager is competent and experienced to run the home. She is a qualified mental nurse and is continuing with the Registered Managers’ Award course, progression is slow and she is waiting for the college to provide another assessor. She ought to complete the course within six months. She said she keeps herself up to date on current issues by reading relevant magazines, surfing the internet, attending mandatory training and relevant courses. She has attended a recent update on the use of syringe drivers. Staff and residents said the registered manager runs the home very well, is very approachable and treats everyone fairly. Staff appreciate her participation as part of the team and said she works extremely hard. One said she promotes independence for the residents and they can do what they want another said she gives staff specific roles “we are not just carers”. Residents and relatives said they could talk to her easily and would feel comfortable approaching her if they needed to complain for any reason. The home has a quality assurance process in place. This includes an annual survey to ascertain the views of the people using the service and their representatives. A matrix is compiled from the results and an action plan put in place. Accidents are audited and complaints would be if they had any. Other audits include a weekly hazard check, pressure sores and wounds, chemicals (done by housekeepers) and medicines. Some of these are not recorded but the manager said she would devise a system to do this. Staff meetings are held and staff are encouraged to air their views, minutes of meetings show this, however not all meetings have minutes. There are no resident or relatives meetings at the moment but the registered manager hopes to start these again. One of the Directors visits the home monthly and writes a report in accordance with Regulation 26. These need not be sent to the Commission but must be stored in the home. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 27 There is a suitable policy for the management of residents’ money. The home holds money for most residents and one of the company directors is appointee for three residents and deals with their money appropriately. One person manages her own money. Residents’ money is held in a non-interest bank account separate to the business account. Some money is stored securely in a safe in the form of petty cash and receipts are kept for all money removed from the safe. Appropriate electronic records are maintained of all transactions, the accounts are printed each month for the resident or their representative. Receipts are kept for purchases and for money received on behalf of residents. There are two signatures on the sheets when the accounts are checked. There is a procedure for staff to follow when the administration staff are not in the home this includes availability of petty cash. The home has a health and safety policy. An external consultant undertakes the health and safety audits and fire risk assessments. An action plan is in place and he provides necessary training for staff. As mentioned under the staffing section, a matrix is recommended to show that this training is undertaken by all staff according to the law. Service and equipment checks are undertaken with records maintained. Fire safety records are kept and staff receive instruction at each weekly fire drill. Accidents are recorded and reported appropriately. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 28 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 29/10/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. For example: • Any handwritten information on MAR charts must be witnessed with two signatures recorded. Medicines prescribed for an individual resident must not be administered to anyone else. Medicine pots must be washed and dried according to infection control guidelines. The medicines fridge temperature must be monitored and recorded regularly Medicines must be appropriately disposed of Requirement • • • • Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 30 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 4 5 Refer to Standard OP3 OP7 OP18 OP29 OP30 Good Practice Recommendations The initial assessment form should indicate who is involved in the assessment. All care paperwork used should be fully completed dated and signed, including care plan reviews A flow chart or simplified adult protection procedure should be compiled for staff to reference easily Interview records should be kept in the staff files The registered manager should compile a training matrix whereby she can easily assess and audit staff attendance to ensure they attend according to the law. Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon 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 Tregenna House DS0000009261.V341940.R01.S.doc Version 5.2 Page 32 - 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. 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