Inspection on 17/01/08 for Tregolls Manor

This inspection was carried out on 17th January 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Tregolls Manor 10/08/06

Tregolls Manor 07/02/06

Tregolls Manor 02/08/05

Tregolls Manor 07/10/04

Tregolls Manor 22/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Tregolls Manor Tregolls Road Truro Cornwall TR1 1XQ Lead Inspector Diana Penrose Unannounced Inspection 17th January 2008 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 Tregolls Manor DS0000009142.V357658.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. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregolls Manor Address Tregolls Road Truro Cornwall TR1 1XQ 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) 01872 223330 01872 225412 tregolls.manor@btconnect.com Tregolls Manor Homes Limited Mrs Rosemary Ann Evans Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2006 Brief Description of the Service: Tregolls Manor is a detached property set off one of the main routes out of Truro and occupies an elevated position. There is level access to the home from the car park and there are accessible paths for ambulant residents to the rear of the building. The accommodation and facilities occupy three floors and a lift for eight persons accesses all three floors. The home is well maintained and furnished to a high decorative standard. The patio and garden areas are well maintained, sheltered and offer privacy. The home provides care and accommodation for up to twenty-five residents with low dependency needs and who are over 65 years of age. 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 £650 to £875 per week. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. An Inspector visited Tregolls Manor Care Home on the 17th January 2008 and spent eight and three quarter hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that residents’ placements in the home result in good outcomes for them. All of the key standards were inspected. On the days of inspection 25 residents were living in the home, two of these were receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, relatives, staff and the management to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. The registered manager has completed an Annual Quality Assurance Assessment and the information provided has also been used to inform this inspection. This report summarises the findings of this inspection Residents expressed satisfaction with the care and services provided at the home and said they are treated with kindness and respect. What the service does well: Tregolls manor is a well established and well managed home that has a relaxed and friendly atmosphere. The home provides a very comfortable well-furnished environment that is clean and safe for residents, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. The grounds are tidy, safe and attractive with sufficient seating. There is a laundry on site and residents are satisfied with the service provided. Residents say they are happy living in the home, they say the staff are very kind and caring. There is a low turnover of staff, which benefits the residents. Residents say their independence is respected and they can choose how to live their lives. Resident’s healthcare needs are met and suitable equipment is provided for moving and handling purposes and for the prevention of pressure sores. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 6 There is a suitable policy in place for the administration, storage and disposal of medicines. Each resident has a lockable cabinet in their room. Recruitment procedures are robust and staff training is good. All care staff are encouraged to undertake NVQ qualifications. The management endeavour to ensure that working practices are safe and statutory training takes place regularly along with relevant equipment and service checks. Maintenance issues are addressed promptly. What has improved since the last inspection? What they could do better: Handwritten instructions on the medicine administration record charts must be signed by the person writing the instruction and by a witness. This was a requirement in the last inspection report. This is still not always being done and was discussed with the deputy manager who said he would address the issue. A recommendation has been made in this report. When medicinal creams are administered they should be signed for on the MAR charts. The deputy manager said he would address this as well. A resident’s committee or regular resident’s meetings could help to ensure that views are heard and that the home is run according to the resident’s wishes. Staffing should be assessed to ensure that staff have time to spend time with residents. A review of social activities is needed. Please contact the provider for advice of actions taken in response to this Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 7 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. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 8 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 Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 9 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): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide appropriate care. Contracts are given to all residents to inform them of the services provided. EVIDENCE: Signed contracts were seen on files for both permanent and respite residents. Completed assessment documents were inspected and found to be detailed, completed appropriately, dated and signed. Residents said the registered manager visited them and spoke to their relatives prior to admission. The home does not provide intermediate care. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 10 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. Residents said their healthcare needs are met and they have care plans to ensure that staff know how to care for them. There is a good medicines system in place. EVIDENCE: Two resident’s files were inspected; each contained an individual care plan, various risk assessments, pre-admission assessment details and other relevant care information. The care plans have improved since the last inspection and some planning for social, emotional and religious needs has been included. Residents sign to agree their individual care plan and they are reviewed on a monthly basis. The daily records are informative. Doctors and other healthcare professionals visit residents as appropriate and records are kept. Staff said there is sufficient equipment for moving and handling and pressure relief in the home. Residents said their healthcare needs are met. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 11 The home has a suitable medicines policy and system in place for the administration of medicines. All care staff have been trained in the safe handling of medicines. Storage is safe and secure in each resident’s room or bathroom. A monitored dose system is used. The transcribing of medicines or changes on the medication administration record (MAR) charts are not always signed by two members of staff, this was a requirement of the last inspection. When medicinal creams are administered they should be signed for on the MAR charts. The deputy manager said he would address these issues with the care staff. There are suitable arrangements for ensuring that resident’s privacy and dignity are respected. Residents have their own telephone line to their room. Resident’s said their privacy was respected and this was observed during the inspection. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 12 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. Outings and activities are on offer, visitors are welcomed and residents are encouraged to live a life of their preference. EVIDENCE: A monthly calendar of events is given to each resident and displayed in the home. These are mainly trips out, a limousine and a mini bus suitable for the disabled, are available for these outings. Other activities such as bingo and quizzes are provided, mainly on a Wednesday, and organised by one of the care staff. There is no activities co-ordinator. The deputy manager stated that residents are asked at lunchtime what they would like to do. Board games are available to residents and stored in the pink lounge. Religious services are held in the home one resident said she goes out to church. Several residents spoken with said there is not a lot going on in the home and it can be boring. A review of the activities provided is needed. Some said they do not go on trips because they are in a wheelchair however they said they could still go if they wanted to. The drinks parties seem to be enjoyed and residents said that Christmas was lovely in the home. All residents spoken with said they could do as they please and most chose to stay in their Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 13 rooms rather than go to the lounges. A group of residents were sitting in an area on the first floor having coffee and chatting. Comments include “It’s very boring, not like at home”, “I stay in my room but I’m happy”, “I go to the lounge but there’s no one there” and “I enjoy going out in the big car”. Residents said they choose when they get up and go to bed. They choose what clothes to wear and how they spend their day. They 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. Residents can control their own finances and administer their own medication according to their wishes and individual risk assessment. They have their own possessions and furniture around them. There are choices on the menu and the daily routines are flexible. One resident said “Staff respect my wishes and they do everything for me, I am very spoilt”. Meals are served in a spacious dining room that aims to provide a comfortable and social dining experience. There are white tablecloths and napkins and fresh flowers on each table. Residents can eat in their bedroom if they prefer. One resident said there is no flexibility as to which table she could sit at as everyone has established his or her own place. The management said residents could move around as they wish and could ask the staff if they wanted to move. The menu is displayed and has plenty of choices; residents said they could still have something different if they wished. Special menus are provided for occasions like Mothers Day, St Pirrans day and so on. There is a good supply of fresh local produce and cakes are homemade. Each resident is provided with a fresh supply of bottled water each day. Comments include “The food is excellent”, “the deputy manager cooks a wonderful roast dinner and he gives us plenty of veg” and “we have whatever we want”. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 14 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. There are suitable policies in place for complaints and adult protection; all staff need to receive appropriate training to make sure that residents are safeguarded. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been 2 very minor concerns raised to the home since the last inspection. These have been recorded in the Regulation 26 reports to the Commission but not recorded in the complaint records. The home has an adult protection policy with a copy of the local inter agency procedures included and ‘No Secrets’ information is on the staff notice board. There is a whistle-blowing policy. The manager said that staff receive in house training on abuse with the use of a training video and abuse is included in the NVQ training for care staff. She also said that mental capacity act training is on offer. Staff said they had received abuse training, one said she had attended an external course. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 15 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 is clean with no unpleasant odours and the building and grounds are well maintained. EVIDENCE: The home is very clean, warm and comfortable. It is decorated, furnished and maintained to a high standard. There are chandeliers and period furniture in keeping with the age of the building. There are plenty of cosy areas to sit and relax and more residents were seen in these areas than at the last inspection. The grounds are tidy and safe. The rear garden is accessible to residents and there are areas for walking and sitting outside. Most rooms have en-suite facilities. Some residents said they chose their room on admission to the home, two people said they had moved when another room became available. Residents said they are happy with their rooms and they have their own possessions around them. Assisted bathing facilities are provided. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 16 There are no unpleasant odours in the home and all areas are clean. The laundry is suitable for the size of home. All laundry is undertaken in house, dry cleaning is sent out to Cornish Linen Services. The washing products used are designed to eliminate bacteria such as MRSA. There are infection control policies in place and protective clothing is in use. It is recommended that a sluice with a washer disinfector be provided for the disinfecting of commode pots and urinals. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 17 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. Recruitment procedures are robust. Residents feel that staff are kind and caring but said there are insufficient numbers because they are always very busy. EVIDENCE: There are on average 4 care staff on duty in the mornings, 3 in the afternoons and 2 at night. A senior carer is on duty at all times. Residents thought that more staff were required as there are several poorly people who need two carers to tend to them regularly. They said that staff are kind and caring but they have no time to stop and chat, as they are always busy. Some said they come in do what they have to and then go. Staff were observed to be working steadily during the inspection and there was not a lot of interaction with residents. Staff spoken with felt there were enough staff on duty. The comments were fed back to the deputy manager who said he would look at the staffing arrangements. 58 of care staff have achieved the NVQ level 2 in care, or above, 31 are enrolled on the course. Three of the care staff are qualified nurses. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 18 Three staff files showed that all relevant checks undertaken. One file lacked interview records and a photograph of the staff member. All new staff are issued with terms and conditions of employment, and a job description. The home has an equal opportunities policy. There is an induction programme in place that includes the Skills for Care criteria. Training needs are identified during the annual appraisal system and records of needs are kept on file. Records of training undertaken are also maintained. The deputy manager stated that diabetes and continence training is provided annually and that infection control training is soon to be introduced annually. Staff said they had received moving and handling and fire training. Palliative care training and communication skills training had been undertaken by some staff externally. Staff said that some training is provided but they pay for some external courses. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 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 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 management team are competent and run the home well. Quality assurance and health and safety systems are in place for continual improvement of the service and the safety of residents, staff and visitors. EVIDENCE: The registered manager is a Registered Nurse who is competent and experienced in running the home. Since her surgery in 2006 her hours of work have become more flexible. The deputy manager is very capable of running the home in her absence and they appear to work well as a team. Both have completed the Registered Managers’ Award. Residents said the management of the home is good and they have no problems. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 20 The home has achieved the Investors in People Award. Quality assurance questionnaires are distributed annually to service users and the views of relatives and visitors are sought. The results of the annual survey are reported in the statement of purpose. The deputy manager said a member of the management team discusses issues with the residents and resolves any problems very quickly. Staff meetings take place every 6 weeks and minutes show that staff can air their views and issues are addressed. Residents meetings do not take place although this maybe explored. There is an audit that takes place in the kitchen but no other audits. The home has a policy not to hold money or valuables for residents. All residents have a lockable facility in their rooms and can be taken to the bank if they wish. Residents control their own money or have a relative or representative to control it. They are invoiced for any shopping or hairdressing and so on and receipts are kept. There is satisfactory evidence that health and safety precautions are in place. The accident records were inspected and nothing untoward found, most accidents ware unwitnessed. Machinery and equipment service checks are undertaken regularly. Certificates show that these are up to date. Statutory training takes place and there is a matrix to show who has attended and when. Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP26 Good Practice Recommendations Transcribing onto MAR charts should always be witnessed and signed by two people A sluice with a washer disinfector should be provided for infection control purposes Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Tregolls Manor DS0000009142.V357658.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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