Inspection on 10/11/08 for Tregona

This inspection was carried out on 10th November 2008.

CSCI found this care home to be providing an Excellent 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

Tregona 09/11/06

Tregona 05/01/06

Tregona 06/06/05

Tregona 09/12/04

Tregona 08/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tregona 3 Edith Road Maidenhead Berkshire SL6 5DY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Chapman     Date: 1 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Tregona 3 Edith Road Maidenhead Berkshire SL6 5DY 01628789433/62616 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Annie McDermott Type of registration: Number of places registered: Milbury Care Services Ltd care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Tregona provides care for three adults with learning disabilities, some of who may have associated physical disabilities. It is set in a residential area close to local amenities and the town centre. The home is a bungalow. There are a variety of aids and adaptations around the home to allow service users to be as independent as possible. All of the bedrooms are single and none of them have en-suite facilities. There are two communal toilets and one communal bathroom, this provides bathing and showering facilities. The Registered Manager has confirmed that the current fees charged are 1532.57 to 2061.50 pounds per week. There are additional charges for Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 3 Brief description of the care home any other services provided such as, hairdressing; toiletries; holidays and outings. The home has a Statement of Purpose and Service User Guide and the Registered Manager has advised that there is a copy of the most current Commission for Social Care Inspection report available in the home for viewing. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has since the 1 April 2006, developed the way it undertakes its inspection of care services. The last key inspection of the service was completed on 9th November 2006. This inspection of the service was an unannounced Key Inspection. The inspector arrived at the service at ten am and was in the service for five hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the owner or manager and any information that CSCI has received about the service since the last inspection. Care Homes for Adults (18-65 years) Page 6 of 29 The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector spoke with the manager and staff on duty. A tour of the premises was carried out and records relating to care, staffing and health and safety were sampled. Some observation of practice during the day showed how staff interpret service users non verbal communication in order to meet their needs. What the care home does well: What has improved since the last inspection? What they could do better: Two maintenance issues and the need for the review of one risk assessment and one health and safety check were identified. The manager confirmed that these would be adressed. The service needs to review whether they wish to change the registered name of the home from Tregona to 3 Edith Road the name that they and the company routinely call the home. Care Homes for Adults (18-65 years) Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information in formats they can understand to help service users and others decide if the home can meet their needs. Service users have the opportunity to visit the home to see what it is like before deciding to live there. A service agreement helps them know what the home has to offer and what their responsibilities are. Staff receive training to meet the individual needs of the service users. Evidence: The home has a Service Users Guide and Statement of Purpose that has been updated to meet the requirement from a previous report. It was seen that this has now been developed in pictorial format to meet the communication needs of the service users. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: There have been no recent admissions to the home. There is a pre admission assessment procedure in place to make sure that the home can meet the needs of a potential service user. The assessment covers a variety of needs including any religious, cultural, disability and health needs. There was evidence on files sampled that service users needs are regularly reviewed. The manager confirmed in the AQAA (Annual Quality Assurance Assessment) that introductory visits help the service user decide if the home is suitable. A key worker is allocated to facilitate these. In discussion with staff and from records sampled it was seen that staff receive specialised training to meet individual needs. From files sampled it was seen that service users or their representative have a copy of their service agreement. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have very clear and detailed care plans to support their needs in the way they prefer. They are supported to be as independent as possible and to take responsible assessed risks. Evidence: The care files of three service users were seen and show that there is a detailed care planning system in place. Records show that care plans are drawn up with the involvement of service users, family and advocates. Care plans include religious and cultural needs, behaviour management plans and service users likes and dislikes. Service users communication needs are very well documented. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Care plans are reviewed at least every six months with changing needs agreed and actioned. Daily diaries sampled show that care plans are carried out. There is a comprehensive risk assessment system in place and it was seen that each care plan has an accompanying risk assessment. The manager agreed to add further detail to individual bathing risk assessments to clearly show that the risks of scalding and drowning in the bath had been assessed. A requirement was made at the last inspection to make sure that there are guidelines in place to support a service user with complex health care needs. Records seen and discussion with the manager show that this has been met. In discussion with staff it was confirmed that they are aware of issues of confidentiality and that they receive information about confidentiality in their induction. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to have a stimulating lifestyle by engaging in a variety of activities and access to the community. Their visitors are made welcome and can join in some social events. Meals provided meet their health and dietary needs and could meet any religious and cultural needs. Evidence: Service users files sampled show that service users have individual activity plans and that they are supported to experience a wide range of leisure activities including attendance at day centre. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: During the inspection there was discussion with service users and staff about attendance at day centre and holidays that had been taken this year. Photograph albums are kept to remind service users of holidays and outings. During the inspection two service users were picked up by day services to go wheelchair Ice Skating. Service users have access to the homes vehicles and taxis are used when non drivers are on shift. Staffing levels are flexible to make sure that planned activities can go ahead. Staff confirmed that visitors are welcome and there are no set visiting times. Families are invited to arranged activities. Service users files show family contacts. Staff confirmed that meals provided at service users preferred times and to suit their dietary needs or cultural needs. One service user chose to eat lunch at a different time from the others. Menus show that a variety of appetising meals are on offer and that alternative choices are available. Food stocks were good and records showed that food is stored and cooked at safe temperatures. Two service users are on special diets for health reasons and there was evidence that any future religious or cultural dietary needs could be met. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user receive care in the way they prefer. Staff support them to access health care and the advice of relevant health and social care professionals. A robust medication procedure keeps them healthy and safe. The home knows their wishes about end of life care. Evidence: Service users preferred care, domestic and health routines are very well documented in care plans and guidelines. There is written and verbal evidence that relevant professionals have input to behavioural and health related guidelines. Health care needs are identified in the care plan and monitoring tools show that specific health needs are closely observed. A requirement that the home seek appropriate intervention about a health care need of a service user has been met. There was evidence on file of the input of the relevant health professional. Staff have information about the health care need but the manager agreed to source some training on this topic from a suitably qualified professional. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The medication system and procedure was sampled and shows that medication is securely stored and that staff are trained to give medication safely. Care plans include service users or their relatives wishes on end of life care and funeral arrangements. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and others know who to talk to if they have a concern. Staff are trained to recognise and deal with potential abuse and to report bad practice. Evidence: The Commission has not received any information about complaints made about the service and the home has not received any complaints. The complaints procedure is in pictorial format to meet service users communication needs. The procedure is made available to families and other stakeholders. The Commission has not received any information from other people about any safeguarding issues relating to the service. The home has made two safeguarding refferrals. Service users are provided with an accessible version of the safeguarding procedure. Staff are trained in how to recognise and deal with potential abuse. A Whistle blowing policy is in place. There is a system in place for the safeguarding of service users personal money. This was seen and found to be accurate. The manager said that as well as in house checks this is audited by a senior manager at monthly regulation 26 visits Care Homes for Adults (18-65 years) Page 19 of 29 Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean, comfortable and nicely decorated home. Suitably qualified professionals have been consulted and any aids needed to promote service users independence have been provided. Evidence: The home is a bungalow and all of the service users are able to access all of the rooms in the building. The home is well located to provide access to local transport and facilities. There are plans to redecorate communal areas and bathrooms. The paving slabs at front of property have been replaced and sensor lighting is being installed. The manager said that the kitchen is due for refurbishment. It was noted that the kitchen ceiling is covered in polystyrene tiles and the manager said she would make sure their removal was included in the refurbishment. Since the last inspection some new carpets and curtains have been purchased. It was noted that there were signs of damp on a bay window wall in a service users bedroom and that the gutter by the office window was overflowing. The manager said she would have these problems investigated and rectified. Service users have their own rooms with suitable furniture and fittings. Staff support Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: them to personalise them to their own taste, beliefs and culture. Rooms seen were warm, comfortable and homely. Service users have adaptations and equipment to maximise their independence. Relevant professionals are consulted to assess their needs and the appropriate equipment is then obtained. Specialist equipment suitable to their needs was seen in service users bedrooms. A previous requirement to provide a suitable shower chair has been met, a new shower chair has been purchased. Health and safety records show that the home makes sure that fire and safety requirements are adhered to. The manager informed the inspector that new hold open devices were being fitted to fire doors the following day. The garden was seen and is well kept and attractive. The home benefits from having a gardener who is employed on a regular basis. There is a laundry area separate from the kitchen and procedures are in place regarding the safe handling of soiled laundry. Staff confirmed that they are trained to maintain a safe and hygienic environment. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive care from a staff team who have been trained to meet their needs. A robust recruitment procedure makes sure that suitable staff are employed. Evidence: Pre inspection information showed that staff have job descriptions relating to their role and responsibilities and that are linked to achieving individual service users goals and aspirations. Staff spoken to during the inspection were clear about their duties and the needs of individual service users. They confirmed that they had received training to meet the specific needs of individual service users. Although they have received information about the mental health need of one service user staff said they would benefit from training from a suitably qualified professional. The manager agreed to progress this. Staff have an induction related to the Learning Disability Award Framework, there is a programme of NVQ (National Vocational Qualification) training underway and a full training programme to meet mandatory training and service users needs. Staff spoken with confirmed their training and NVQ qualifications. The manager confirmed that the new post of Regional Training and Development manager has improved access to staff training and that there are plans to increase NVQ training in the staff team. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: It was seen that staff deployment is flexible to meet service users needs. Extra staff are deployed to support service users activities and one service users has some contracted 1-1 hours. There is a supervision and appraisal system and staff confirmed that regular supervision and support is available. There is a recruitment procedure in place and staff files sampled show that this is carried out. Staff spoken with confirmed their recruitment process. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by experienced and qualified manager. The views of service users and others are sought to help develop the service. Up to date health and safety systems make sure the home is kept safe for service users. The service needs to review whether they wish to change the registered name of the home from Tregona to 3 Edith Road the name that they and the company call the home. Evidence: The home is well managed by an experienced and qualified manager. The manager works full time and is also registered for another home nearby, she divides her time between the two homes and staff teams. A discussion took place with the manager about the name of the registered service. The home is registered as Tregona but the home and organisation routinely refer to it as 3 Edith Road. This causes confusion when mail is received by the Commission because the system does not recognise the name of the home as 3 Edith Road. The manager has agreed to discuss this matter with her managers to see if they wish to Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: change the name of the registered service in line with their preferred name. If not then all correspondence should be sent under the registered name of Tregona. The Annual Quality Assurance Assessment (AQAA) submitted prior to the inspection was well filled in and showed how the home meets the regulations and standards. There is a company quality assurance system that includes an annual service review that seeks the views of the service users, families and others. There is an annual development plan with identified actions. Monthly service reviews, staff and service users meetings and individual reviews also seek the views of others. The pre inspection information shows that regular maintenance and servicing of equipment takes place. Health and safety records sampled show that regular checks to the fire safety system, food, fridge and freezer temperatures and hot water temperatures are carried out. It was seen that the water temperature record needs review to make sure that staff are fully aware of the correct procedure and the manager agreed to do this. Health and safety training is mandatory for all staff and risk assessments are in place to make sure that any environmental or individual risks are identified and reduced. It was seen that the manager has identified any potential health and safety risks and has made arrangements for them to be rectified, for example new fire door closures and a new kitchen fire door with a suitable exit mechanism. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 37 The service needs to review whether they wish to change the registered name of the home from Tregona to 3 Edith Road the name that they and the company routinely call the home. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!