Inspection on 02/08/07 for Tregonwell Lodge & Two Wells

This inspection was carried out on 2nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Tregonwell Lodge & Two Wells 18/08/06

Tregonwell Lodge & Two Wells 04/01/06

Tregonwell Lodge & Two Wells 24/08/05

Tregonwell Lodge & Two Wells 24/03/05

Tregonwell Lodge & Two Wells 07/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Tregonwell Lodge & Two Wells Salisbury Street Cranborne Dorset BH21 5PU Lead Inspector Heidi Banks Key Unannounced Inspection 2nd August 2007 11:55 Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregonwell Lodge & Two Wells Address Salisbury Street Cranborne Dorset BH21 5PU 01725 517458 01725 517918 cranborne@regard.co.uk 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) The Regard Partnership Ltd Mrs Violet Rosetta Alcock Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th August 2006 Brief Description of the Service: Tregonwell Lodge and Two Wells is owned by The Regard Partnership, which is a national organisation running care services around the country. The Regard Partnership took over ownership of the home in April 2003. Tregonwell Lodge and Two Wells provide accommodation for sixteen adults. The home provides care and support to people who have a learning disability. The current age range of service users living at the home is 19 to 46 years old. Tregonwell Lodge is a large country property in extensive grounds in the rural village of Cranborne in Dorset. Two Wells is a separate house situated next door to Tregonwell Lodge. Staff and service users can easily transfer between the two premises. The home is situated in the middle of the village and service users have easy access to the local shop, pub, post office and restaurant. The accommodation comprises of the main lodge, which has ten bedrooms, a communal lounge, kitchen, dining room, shared bathrooms and toilet facilities and a staff sleep-in room. In the courtyard is a further accommodation block, providing three bedrooms and one bathroom. Two Wells is a four bedroom property, providing accommodation to three service users including a lounge, dining room, conservatory, kitchen and a staff sleep-in room. The grounds of the two houses include extensive vegetable plantings, greenhouses, a courtyard with seating and workshop areas for computer training and arts and crafts. There is a paddock for a horse and an enclosure for ducks. There is a good-sized area for parking in the grounds. Current fees for the service range from £862 to £1550 per week which is inclusive of day services. Further information on fee levels and fair terms of contracts can be obtained from the website of the Office of Fair Trading; www.oft.gov.uk. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service. The inspection took place over approximately twelve hours on 2nd, 6th and 7th August 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last inspection of the service in August 2006. At the time of the inspection there were sixteen people living at Tregonwell Lodge and Two Wells. During the inspection we were able to take a tour of the home, meet ten of the people who use the service and observe some interaction between them and staff. Discussion took place with the Registered Manager, Mrs Violet Alcock, her Deputy Manager and several members of the staff team. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment was completed by Mrs Alcock and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care managers and health care professionals on behalf of the Commission. A total of twenty-six surveys were received and information from these sources is reflected throughout the report. A total of twenty-two standards were assessed at this inspection. What the service does well: The home has a very person-centred approach to care and empowers people who use the service to make decisions and choices about their lives. People’s needs are assessed before they move into the service to ensure that the home is able to meet their requirements. Support plans are drawn up with service users that reflect their needs and preferences with regards to their personal care, their lifestyle and activities. People are enabled to access their community on a regular basis and undertake work placements, college courses and leisure activities that are important to them. The home ensures that Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 6 people are supported to attend health care appointments as necessary and feedback from a general medical practitioner who has regular contact with service users at the home indicated that the home communicates well with them and demonstrates a clear understanding of people’s needs. Systems are in place to ensure service users are listened to and there is effective reporting of concerns to appropriate agencies where people may be at risk of harm. Service users told us that they liked their home. The manager informed us that there is an ongoing programme of refurbishment to improve and update the décor and furnishings throughout the two houses. Safe recruitment procedures are in place which helps ensure that people who use the service are protected from harm by the people who are employed to work with them. The home is committed to enabling care workers to undertake training towards nationally recognised qualifications to promote their competence in their role. The Registered Manager is experienced and is suitably qualified to undertake her role with competence. People who use the service are consulted about the running of the home and quality assurance systems are in place to ensure that feedback from relatives and health and social care professionals is obtained and used to plan the continued improvement of the service. Several positive comments were received from service users about living at the home; ‘I am happy here’; ‘I like living here’; ‘I would like to stay’. This was echoed by some relatives of service users; ‘I am grateful to The Regard Partnership for looking after X and providing X with a happy home.’ What has improved since the last inspection? The home has taken appropriate action to meet most of the recommendations made at the last inspection. Some aspects of medication practice have been reviewed to further safeguard service users. The home’s complaints procedure has been expanded to include the reporting of concerns and work is underway to produce a DVD of the complaints procedure to promote understanding within the service user group. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 7 The home’s maintenance plan indicated that consideration is being given to the general refurbishment of various areas of the home and since the last inspection, new furniture has been purchased for the communal areas. Fire drills are now carried out at various times of the day and management of the home demonstrated awareness that drills should be carried out when there are reduced staffing levels to ensure that evacuations can be safely managed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs and preferences are assessed before they move to the home to ensure that the home is able to meet their requirements and that there is a smooth transition. EVIDENCE: Since the last inspection of the service there has been one new admission to the home. Prior to the move to Tregonwell Lodge the individual had been living in another service run by The Regard Partnership in the village and had visited the home on a number of occasions. Care workers were also already familiar with the person’s needs. The service user had an Essential Lifestyle Plan in place and therefore there was a good amount of information available to care workers about their needs and wishes. The plan showed evidence of having been updated just prior to the move. The service user was spoken with during the inspection and presented as very positive about the move – they had wanted to move into the home and felt that it was more suitable for them. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a person-centred approach to their care where they are fully involved in making decisions and choices about their lives. EVIDENCE: A sample of support plans were inspected. These were written in a personcentred way using large font and giving clear information to the reader about people’s likes, dislikes and needs. In particular there was some good information available about people’s communication needs. For one service user who uses some non-verbal communication the way they communicate their needs had been clearly documented. For another service user it had been identified that they did not like sudden changes to their routine and therefore it was important that staff let them know in advance of any changes; ‘If there are changes I prefer to be spoken to in a gentle, soft steady voice Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 11 rather than a loud, aggressive voice…I don’t like people talking fast or not explaining things’. Most of the support plans for people living at Tregonwell Lodge were seen to be held in the office area which is situated in an outbuilding next to the home. It is suggested that, where practicable, the home looks to promote service users’ ownership of their own plans so that they are easily accessible to people in the home where support is delivered. One service user had an extensive Person-Centred Plan which they had developed themselves with staff support. This contained photographs and memoirs of the person’s life history, important relationships in their life, things they liked doing with their time and places they had visited. This was owned by the service user. The majority of service users responding to surveys told us that they always made decisions about what they did each day. All fourteen respondents told us that they could do what they wanted to do in the evening and at the weekend. Responses from some relatives of service users indicated that promoting people’s choice and decision-making is something the home does well; ‘Our relative has thrived on being given ‘choice’ socially and emotionally’. Goal-setting processes are in place for people who use the service. It is suggested that the goal-setting process is expanded in some cases. For example, ‘I hope to achieve more goals in swimming’ or ‘I would like to be able to attend more musical concerts’ could include more detail to identify how this will be achieved and by when. Residents’ meetings have recently been reintroduced in the home and are facilitated by staff. Minutes of these were seen, these showing that service users had been consulted about things they wanted to do and some ‘house rules’ had been discussed. As minutes of meetings are currently handwritten in a notebook and stored in the office of the home, it is suggested that the home looks into displaying minutes in an easy-read format in an accessible area of the home so that people can consult them as they wish. Discussion with the Registered Manager indicated that two service users are currently receiving support from an independent advocate on specific issues. The home acknowledges the need for independent advocacy in more areas of people’s lives but due to a general shortage of advocates it has only been possible to engage advocacy services with regards to specific issues. A sample of risk assessments was seen. These covered various aspects of daily living including personal care, cooking, using the washing machine and specific activities such as swimming. Road safety assessments are carried out on service users every six months which are signed by service users themselves, their key workers and a manager. Review of the risk assessments indicated that relevant potential hazards had been identified and measures in place to minimise risks had been documented. It was clear from the documentation that there is a focus on promoting people’s independence Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 12 where possible. For example, where one service user works in the village, they have been enabled to identify a safe route to walk to their workplace so that they can do so independently. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are enabled to participate in a range of activities in their home and community that supports their personal development and meets their individual needs and preferences. EVIDENCE: Inspection of records and discussion with people who use the service indicated that people are enabled to do a wide range of activities in their daily lives. In the daytime, people access a day service that is run by The Regard Partnership. This includes weaving sessions run in a nearby village by a qualified weaver which has resulted in people’s work being exhibited at a county arts and crafts show, drama, Tai Chi, swimming, woodwork, computer studies, horse-riding and music therapy. Some service users attend local colleges during term-time and some are actively engaged in work experience Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 14 placements, for example, at a local garden centre and children’s playgroup. One relative told us that this was something that the home did particularly well; ‘The care home does well in making sure that X gets the right and appropriate care and support with work-related issues’. Daily records showed that some people attend ‘Fit Club’ in the evenings which is held at a local leisure centre, and people have opportunities to go to the market, beach and forest at the weekend. The home has four vehicles that can be used to facilitate outings and the Registered Manager confirmed that the majority of staff are drivers which is important given that there is no public transport in the area. Activities that people like to do at home have been listed in support plans and daily records indicated that they are given regular opportunities to do these. Discussion with staff and service users indicated that they are very much part of their local village community and access the village shop and pub on a regular basis where they are familiar with their neighbours. Service users told us that they go on regular holidays in small groups. One person said that they had been part of a group who went to Corfu as they had wanted ‘to go somewhere hot’. Another group had gone to the Isle of Wight and another had made a trip to a holiday park. People spoken with indicated that they have contact with their families. At the time of the inspection, a number of service users were away from the home visiting relatives. Four of the eleven family members responding to the survey told us that the care home always helped their relative to keep in touch with them, four stating that this was ‘usually’ the case and three saying this ‘sometimes’ happened. Comments received varied considerably ‘Our relative doesn’t think to ‘phone us but would if prompted. They always facilitate our calls though’; ‘I do receive cards at various times of the year’; ‘My relative just needs assistance with use of the ‘phone….they contact me weekly’; ‘Despite writing each year in X’s diary, his close family never receive birthday cards etc.’. Another relative suggested that the home improves communication by sending a regular newsletter to family and friends of service users with contributions from staff and residents. Discussion with the Registered Manager indicated that the home is already sending out a newsletter twice a year. It was suggested that the manager, together with people who use the service, look at ways in which this could be expanded and contact with families can be promoted. Observation of people in their home showed that they have unrestricted access to all communal areas of the home and their own bedrooms at any time. Accommodation agreements on file indicate that service users are provided with a key to their bedroom door. This was confirmed by a service user who had recently been admitted to the home. Service users seen during the inspection had been able to choose where they wanted to spend their time and Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 15 there was evidence of positive, good-humoured interaction between care workers and service users with people’s independence being promoted at all times. One service user told us that there was some flexibility in routines, for example, they could eat in the lounge if they did not want to join others at the dining room table and indeed this was seen to be part of another person’s care plan. Observation also indicated that people are encouraged to participate in household tasks, for example, helping with cooking, laying the table and taking the bins out. Schedules are in place to list who will take responsibility for various tasks in the home. Menus in the home showed a range of meals being offered to people each week and where one person requires a gluten-free diet, suitable options were being provided. Care workers in the home were seen to be responsible for meal preparation. At ‘Two Wells’ there was evidence that where one service user wanted to have salad with her omelette and another wanted baked beans this had been facilitated. Care plans for service users indicated where people are able to prepare drinks for themselves and there was evidence of this happening in the home. People were observed to be able to help themselves to yoghurt or fruit from the kitchen after their main meal. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s independence is promoted in all aspects of their care and they are enabled to access specialist health care services as required to meet their individual needs. EVIDENCE: The level of information in people’s support plans about their personal care needs was seen to be generally very comprehensive with reference to likes, dislikes and people’s ability to be independent; ‘I can run my own bath. I can wash myself and wash my hair. I can brush my teeth morning and night. I need to be prompted to wash my hands and fingernails when preparing food. I like to use body spray.’ For another service user there was some useful information about how they will communicate their need to go to bed or ask for something to eat or drink and how staff should respond to this. The role of the key worker is central to personal support at the home. Service users spoken with told us that they have key worker time every week. Inspection of records showed that there are specific functions that the key Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 17 worker should fulfil in their role which include supporting service users with their laundry, room cleaning, personal shopping and banking, updating support plans and risk assessments and completing weight charts with the service user. Service users told us that they also used their key worker time to go out on a one-to-one basis to a place of their choice and that this was important to them. Key workers are also responsible for keeping a record of how the time is used and those seen showed evidence that time was being used for the specific functions specified by the manager. Of the eleven relatives responding to the survey, five indicated that the home always gave the support or care to their relative that they would expect, four indicated that this was usually the case and two stated that this sometimes happened. One relative commented that they did not feel their relative always got enough help with cleaning their room. Another stated that they felt there were shortfalls in some aspects of personal care that their relative received. It was identified by some relatives that changes in staff and key worker allocation might contribute to this lack of consistency and that this was a potential area for improvement. Discussion with staff indicated that new arrangements are being implemented whereby each service user will be allocated two key workers to promote continuity of care and ensure that if one member of staff is on leave there is a second key worker available to ensure that they benefit from key worker time every week. Inspection of a sample of records showed that service users are registered with a local health care practice and are supported to attend appointments with health care professionals as necessary including their general practitioner, dentist, practice nurse and chiropodist. From notifications made to the Commission by the home there is evidence that prompt action has been taken to consult with a medical practitioner where there are concerns about people’s physical or emotional health. Where, at a service user’s review, a representative from the funding authority had made a recommendation around a Health Action Plan there was evidence that the home had asked the person’s general practitioner to make a referral to the Community Learning Disability Team. The home is liaising with the funding authority regarding the progress of this. It is suggested that the home puts together a Health Action Plan with every service user to ensure that their needs are clearly identified and a structured format is in place to monitor that these are being met. Some positive comments were received from relatives about the care received by people who use the service; ‘They keep X safe, happy and healthy’; ‘They offer a stable environment…X seems very happy; ‘I think the care home does exceedingly well and cannot think how they could improve their care and support’; ‘Our relative is very well cared for’. Ten out of eleven relatives also indicated in surveys that they were either always or usually kept up-to date with important issues affecting their relative; ‘We are kept up to date with important and less important issues’; ‘Sometimes they have been unable to contact us right away but bring us up to date when they get us’. One relative Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 18 indicated that they were never kept informed of visits to the doctor, dentist or chiropodist. Discussion with the Registered Manager at the inspection showed that she is very conscious of service users’ rights to confidentiality and the home strives to give people choice about what information is discussed with third parties and what they wish to keep confidential. A comment card received from a general medical practitioner who has contact with people who live at the home indicated that the home communicates clearly and works in partnership with them, that staff demonstrate a clear understanding of the care needs of service users and that they are satisfied with the overall care provided to service users. Medication practices at Tregonwell Lodge were reviewed at this inspection. Medication is stored in a cupboard in the dining room and is supplied by a local pharmacy in monitored dosage systems. Inspection of a sample of Medication Administration Record (MAR) charts indicated that they had been signed appropriately which suggests that medication has been given as prescribed. A photograph of each service user is attached to their MAR chart to aid with identification when medication is administered. The Registered Manager confirmed that where homely remedies were needed by a service user, the home would seek the advice of the pharmacy who would add the additional medication onto the MAR chart. Documentation to support that the home undertakes regular audits of medication practices has been forwarded to the Commission. In-house training is given to care workers when they commence in post and records kept to evidence this. Review of a sample of staff training records showed that three out of eight care workers had gone on to do accredited training in medication administration and further training had been booked in association with a local college for other staff who had not yet undertaken this training. It is recommended that the home continues to promote the uptake of accredited training for all staff in this area of care. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that service users are enabled to express their views and ensure that they are protected from harm. EVIDENCE: The majority of service users responding to the survey indicated that care workers always listened to them and acted on what they said, the remaining people stating that they felt this was usually or sometimes the case. Two people gave examples of situations where they had wanted to change something about their care and had been enabled to do so. Service users also told us that if they were unhappy they would talk to Violet (the Registered Manager), their key worker, or staff on duty. The home has a complaints procedure, a copy of which is on display in the hallway of Tregonwell Lodge. This is in symbols format. The manager reported that service users who are members of the home’s ‘Film Club’ are currently working on making a DVD of various policies and procedures, including the home’s complaints procedure, in order to promote accessibility. Inspection of the home’s complaints record showed that there had been one complaint made since the last inspection. This was from a service user who had been supported by his key worker in writing a letter of complaint. A format for recording complaints and concerns is in place and had been completed in this instance by the manager to identify the action taken to Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 20 respond to the issues raised. The manager had responded to the complaint in writing. Correspondence relating to the complaint had been kept on file, this indicating that the manager had responded to the complaint within two days. All eleven relatives responding to the survey indicated that they were aware of the home’s complaints procedure. The Annual Quality Assurance Assessment document supplied by the home indicated that they have a policy on safeguarding adults and whistle blowing. There was evidence on staff recruitment files seen that care workers had been introduced to these policies on commencement of their employment although in some cases it was suggested that documentation to evidence this could be clearer. The training records for eight care workers were seen, this indicating that five people had undertaken further training in abuse awareness. It is recommended that the home finds ways of promoting the uptake of this training to ensure that all staff have up-to-date knowledge of adult protection procedures. Since the last inspection the home has made appropriate referrals to the local authority where people who use the service have been identified as being at risk of harm. The Commission has been notified by the home of concerns that have arisen. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Tregonwell Lodge and Two Wells provide a homely, safe and comfortable place for people to live in. EVIDENCE: The home comprises two character properties in spacious grounds on the edge of a rural village. Service users spoken with during the inspection indicated that they liked living at the home and this was echoed by a number of relatives who commented in surveys that their family members were happy there. One relative told us that whenever they visited the home there was always a pleasant atmosphere and that they had noticed their family member has her own space when required. Another commented that the home ‘provides a safe, friendly, comfortable home environment’. Since the last inspection the home has purchased new sofas and coffee tables for each lounge. One relative indicated in a survey that they felt that some Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 22 service users’ bedrooms would benefit from redecoration. The Registered Manager showed us a maintenance plan for the home which includes, as a priority, the redecoration of five people’s bedrooms and the lounge and dining room in both houses. Three bedrooms were seen during the inspection, each of them being in good decorative order and showing evidence of personalisation by the service user themselves. The Registered Manager informed us that planning permission is being obtained to convert the garage at ‘Two Wells’ into a bedroom with bathroom en-suite facility for one service user who would benefit from ground floor accommodation. The home employs a part-time cleaner and at the time of the inspection the home environment presented as clean. The Annual Quality Assurance Assessment (AQAA) supplied by the home indicates that there is an infection control policy in place in the home. It also states that infection control is an area covered in the health and safety training undertaken by staff. Review of a sample of eight training records showed that six had undertaken this training. The home has acknowledged in their AQAA that promoting staff access to infection control training is an area that they could improve on. The home is arranging for a sluice to be plumbed into the laundry room to improve procedures when dealing with soiled items. Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home recruits people safely and demonstrates a commitment to promoting the professional development of staff through NVQ training. Increased uptake of specialist training is needed for all staff to be able to fully meet the individual needs of service users. EVIDENCE: A structured induction programme is in place for new staff when they commence employment in the home. Documentation seen showed that this included an orientation to policies and procedures in the home and a ‘Skills for Care’ induction pack. It was not always clear from records seen how people had been assessed with regards to each outcome area and therefore it is suggested that the home makes sure that this is clearly documented. Out of a total of twenty-four care workers, two staff have a National Vocational Qualification (NVQ) at Level 4, five have a NVQ 3 and ten have a NVQ at Level Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 24 2. The remaining seven care workers are in the process of enrolling to start an award later this year. It is suggested that the home ensures that appropriate certificates to evidence people’s qualifications are kept on file. Staff recruitment records for Tregonwell Lodge are held at The Regard Partnership’s Head Office with the agreement of the Commission. These are audited on behalf of the Commission by a Provider Relationship Manager, the last audit taking place in February 2007. The service’s recruitment procedures ensures that suitable checks are carried out on care workers before they commence employment including enhanced disclosures from the Criminal Records Bureau and written references. Where recommendations were made by the Provider Relationship Manager there was evidence that the organisation has responded by reviewing their procedures accordingly. The Registered Manager discussed the home’s role in ensuring the safe recruitment of staff and confirmed that care workers do not start in post until all necessary checks have been completed. The Regard Partnership offers a range of internal training courses to its staff and certificates on file indicated that training by external providers is also accessed for specialist areas. Three members of staff spoken with reported that the training they received was good and they felt their professional development was supported by the manager. Care workers’ training records showed that in the past year some people have attended training in epilepsy, physical intervention, communication awareness, challenging behaviour and supervision skills. However, this was not the case for all staff and it is recommended that the home looks to promote the uptake of training across the whole staff team to ensure that everyone has the knowledge and skills they need to work with the service user group. The home has developed a training audit process so that gaps in people’s training can be easily identified. Four our of eleven relatives responding to the survey indicated that they felt care staff always have the right skills and experience to look after people properly, with the remaining seven relatives stating this was usually or sometimes the case. Comments received from some relatives of people who use the service indicated that they felt staff’s knowledge and competence is variable; ‘The quality of staff immediately concerned with X’s care varies somewhat and this is reflected in how they care’; ‘Some are more skilled than others…there are frequent changes’; ‘Not sure about agency and young staff…Our relative’s key worker is experienced’. One relative commented that they felt experienced care workers should be paid more as ‘low pay attracts young, unskilled workers and experienced staff move on for better pay.’ Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a competent manager and is run in the best interests of its residents. However, shortfalls around the uptake of mandatory training by staff continue to exist which potentially puts people at risk. EVIDENCE: Violet Alcock is the Registered Manager of the home. She has completed her NVQ Level 4 and Registered Manager’s Award and is in the process of completing her Diploma in Management. She has worked in a management role within residential care for seven years, three of which have been at Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 26 Tregonwell Lodge and Two Wells. There are clear lines of accountability in the home from the Registered Manager, to the Deputy, Senior Support Workers and the care team. Feedback on the management of the home from care workers was positive; ‘Violet is the right person for the job’ and this was echoed by a relative who stated in a survey that the ‘Home Manager is excellent’. The manager is supported by a team of people based at The Regard Partnership’s Head Office in Surrey who have some responsibility for human resources, finance, quality assurance and training. The home has maintained good communication with the Commission throughout the past year, notifying us in writing when issues of concern have arisen and supplying information promptly when this is requested. Service users’ records showed that they are consulted on a regular basis about their satisfaction with the care they receive. This is done through a ‘Residents’ Questionnaire’ which is completed by the service user with their key worker on a monthly basis. This covers people’s satisfaction with the support offered to them with activities and personal care, their home environment, their key worker and staffing levels. It is suggested that the home looks to engage external advocates with this process to ensure that people are enabled to express their views independently of staff. Surveys are also distributed to staff, service users’ relatives and health and social care professionals on a regular basis to obtain feedback about the service. At the last inspection evidence was seen that, where an issue had been highlighted that relatives did not always know how to complain about the service, a copy of the procedure had been distributed to all relatives. The home has told us in their Annual Quality Assurance Assessment that their annual development plan and business plan has been updated. Discussion took place with the Registered Manager about some aspects of the plan including the ongoing refurbishment of the home. A sample of health and safety records was inspected. The home has a fire risk assessment in place. The Registered Manager reported that staff training in fire safety is held every three months but the minimum requirement is for care workers to receive this training every six months. Records seen for eight care workers indicated that six had received the training in the past six months. One (a ‘bank’ worker) was last recorded as having done the training in June 2006 and another (a permanent worker) was last recorded as receiving the training in December 2006. Records for First Aid training, Food Hygiene training, Health and Safety training and Moving and Handling training showed gaps where a minority of staff had not completed the training. Discussion with the Registered Manager indicated that training is arranged for staff on a regular basis but for various reasons some staff had not been able to attend. The manager has agreed to undertake Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 27 a review of training provision to ensure that people undertake their mandatory updates when these are due and that staff who are new to the service receive their mandatory training at the commencement of their employment. At the time of the inspection further training had been arranged in these areas for September. The Registered Manager confirmed that rotas were arranged to ensure that there is a qualified ‘First Aider’ available to service users on every shift. Records showed that fire drills are held on a regular basis and take place at various times of the day. Details of the people participating in each drill and the time taken to evacuate the home had been recorded. Records are kept to indicate that initial fire training had been provided to new staff. There is a framework for undertaking weekly health and safety checks in the home including checks on fire doors, fridge / freezer temperature records, hot water temperatures and the environment. Some gaps in the documentation were noted. These were discussed with the Deputy Manager of the home who confirmed that checks had now been resumed. The home is visited twice a year by the Health and Safety Officer employed at the organisation’s Head Office who undertakes a review of procedures. Evidence of inspections of gas safety, electrical installations and maintenance of the oil burner was on file, all having taken place in the past year. Tregonwell Lodge & Two Wells DS0000034481.V347116.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X X 2 X Tregonwell Lodge & Two Wells DS0000034481.V347116.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 YA42 Regulation 23 Requirement All mandatory training must be completed within the required timescales. This includes training in Manual Handling, Health and Safety and Fire Prevention. Please note this refers to only a minority of staff who have not attended when training sessions have been running. This requirement is repeated from the last two inspections of the service as the previous timescales of 31/01/06 and 31/10/06 have not been met. Timescale for action 01/12/07 Tregonwell Lodge & Two Wells DS0000034481.V347116.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. Refer to Standard YA18 Good Practice Recommendations The home should continue to review the delivery of personal support in the home to promote as much consistency and continuity of care as possible for people who use the service. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. All staff with responsibility for administering medication to service users should undertake accredited training. This recommendation is repeated from the last inspection of the service. 3. 4. YA23 YA35 All staff working within the home should undertake formal training in abuse awareness to update their knowledge of adult protection procedures. The home should continue to promote training for all staff that reflects the individual needs of service users. 2. YA20 Tregonwell Lodge & Two Wells DS0000034481.V347116.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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