Inspection on 04/01/06 for Tregonwell Lodge & Two Wells

This inspection was carried out on 4th January 2006.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tregonwell Lodge & Two Wells 02/08/07

Tregonwell Lodge & Two Wells 18/08/06

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 Marion Hurley Unannounced Inspection 4th January 2006 09:30 Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 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.V274396.R01.S.doc Version 5.1 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.V274396.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tregonwell Lodge & Two Wells Address Salisbury Street Cranborne Dorset BH21 5PU 01725 517458 01725 517918 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 Limited Mrs Violet Rosetta Alcock Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2005 Brief Description of the Service: Tregonwell Lodge and Two Wells is owned by The Regard Partnership, which is a national organisation with several residential homes around the country. This organisation took over ownership of the home in April 2003. Tregonwell Lodge and Two Wells provide accommodation for 16 adults. The home specialises in providing care and support to people who have a learning disability. The current age range of service users living at Tregonwell is 19 to 45 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 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 rural village, and has easy access to the local shop, pub, post office and restaurant. The accommodation comprises of the main lodge, which has 10 first floor bedrooms, communal lounge, kitchen, dining room and bathrooms, and a staff sleep in room. In the courtyard is a further accommodation block, providing 3 bedrooms and one bathroom. One of these bedrooms has been arranged as a bed-sit. Two Wells is a 4 bedroom property, providing accommodation to 3 service users, a staff sleep in room, lounge, dining room, conservatory and kitchen. The grounds include extensive vegetable plantings, greenhouses, lawn areas, woodland trails, ducks, courtyard with seating, toilets and workshops for carpentry. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act, 2000. Tregonwell Lodge & Two Wells were assessed according to the Care Home for Adults (18-65) National Minimum Standards. The overall time spent to complete the inspection process was a total of ten hours; four of which were spent at the home(s) meeting and discussing living and working at the home with residents, staff, and the Registered Manager. Records and documents were also checked during this time. What the service does well: What has improved since the last inspection? Where necessary professional health advice has been sought and this helped both the residents and the staff in their understanding of the most suitable and safe method of managing the resident’s needs. The requirements and good practice recommendations made at the last inspection whilst not fully complete are in hand. This information was provided by the manager and verified from training records available on the day of the inspection. The Resident’s Individual Essential Life Style Plans continue to evolve, though the final format for these working documents has not yet been decided. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 6 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. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 7 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.V274396.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 • The admission process is good ensuring that resident’s needs are identified before they and their representatives make the commitment of a move to Tregonwell Lodge. • Prospective service users have the opportunity to participate in the assessment process and this helps ensure their needs and aspirations can be met by the staffing, services and facilities at Tregonwell Lodge. EVIDENCE: There have been no new admissions to Tregonwell Lodge since the last inspection. In view of this the inspector discussed the principles for any prospective service user being considered for a placement with the Registered Manager. It was clear from these discussions that their knowledge and understanding of good working practices would ensure any prospective resident’s needs would be fully identified through comprehensive assessments prior to considering a move to the home. The records of a service user who had moved to Tregonwell Lodge in the Spring of 2005 were read and provided a full picture of the person’s needs and abilities and preferences. The assessment and contact visits were well documented with clear questions and choices addressed to the service user to help identify their particular likes/ dislikes and preferences in their daily routine. “How I choose who supports me and how I am supported” is a section in the assessment. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 9 Interested people considering a move to Tregonwell Lodge may either contact the home direct or the company’s head office. (Regard Partnership). From this contact an initial assessment is completed with the Service user and significant others and if the service user’s identified needs can be matched through the staffing, services and facilities at the home a series of introductory visits and over night stays are arranged. The service user’s needs and abilities and preferences are reviewed initially after six weeks and then again after a further six months. Throughout this time their Individual Essential Life Style Plan is being developed with them and their designated keyworker. Each new resident receives a Client Information Pack, which contains both essential information about the home, services and facilities and is used by both the service user and their key worker to record information about their activities, meetings. The pack also contains the Service User satisfaction questionnaire which provides staff with information on how the resident perceives their life and services at Tregonwell Lodge. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were not assessed having been met at the previous inspection. EVIDENCE: Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15,16 & 17 • Staff ensure residents are supported in maintaining contact with family members and in developing appropriate friendships. • Resident’s rights are respected and where possible independence and choice and freedom of movement are promoted within the home. • Meals are healthy and mealtime’s flexible to suit residents’ lives. EVIDENCE: The evidence for these standards was obtained from discussion with residents, staff and from reading records of two residents. All the residents have regular contact with their family and several spoke enthusiastically of the recent Christmas & New Year stays with their families. Staff confirmed that all the residents are supported to maintain contact/visit their family and friends. There was evidence of regular liaison with relatives and family details and contact information was documented. The residents consider themselves friends with each other living at Tregonwell Lodge & Two Wells and also said their friends were “the staff”. Some resident’s have extended their social network through contact with peers at College and work placements. Two residents who work locally have Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 12 established friends with other locals and one resident told the inspector “sometimes I go and have tea with them on Sundays”. From observations made throughout the inspection visit it was clear that staff respect the wishes of residents but balance this with positive encouragement and support to develop individual levels of independence in the resident’s daily lives. Four residents were spoken with and collectively they said that the “staff were good and kind and funny”. Residents have unrestricted access to the home and grounds and their wish for time “alone” is respected. The menu is planned with the residents at their monthly meeting and is agreed on a four weekly cycle and then displayed in the large family style kitchen. One resident has a special diet and their menu is specifically written and displayed alongside the main menu. The main meal is in the evening. At lunchtime residents are encouraged to chose and cook their own snack lunch with staff support. The inspector observed a very busy lunchtime with much banter and laughter while the residents made their own snacks. Two members of staff were in the kitchen with the residents at all times advising and supporting them to complete both the cooking and clearing up. Ample fresh fruit and juices are consumed daily and there was a large fruit bowl on the main sideboard in the hallway and another in the dining room. Residents’ said the meals “were good”. The home continues to grow and harvest their own vegetables and where possible use local suppliers. One resident is studying for the City & Guild NVQ in catering and showed the inspector their portfolio of work, which was commendable. Records were noted of the temperatures of appliances, cleaning rota, and cooked food temperatures. There was a record of food consumed. However, this did not indicate where any resident had chosen to eat an alternative from the menu and should where possible include food consumed away from the home. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 • Medication is kept safely within the home and records are maintained to ensure the safe handling and administering of medication. EVIDENCE: The inspector was shown and read the Home’s policy & procedures for the safe administration of medicines. The procedures are clear and concise and provide staff with good information and instructions including what to do if an error should occur. Facts sheets on all medicines are on file and these include the description i.e. shape and colour together with the trade name of the medicines. There is one large file containing separate information sheets and photographs of each resident. Included with this information is a list of homely remedies and consent forms completed and signed by the resident’s GP sanctioning the use of them. When resident’s are on leave or away from the home a transit form is used which lists the medication taken out of the home and a further form is completed recording any returned. Information from these sheets was crossreferenced with the MAR sheets. This is good practice though unfortunately not all the transit forms were dated. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 14 Records of the administration of medication (MAR sheets) were reviewed and found satisfactory and it is an important part of the Home’s policy that only the pharmacist or GP will alter or amended the MAR sheets. Three residents self medicate and are given a monthly supply to manage. However, no resident is allowed to use homely remedies without staff sanctioning and monitoring the dose. All staff who administer the medication must complete the in house training before being allowed to undertake these duties. Sample signatures of these staff are held in the main office. It is important that there is written evidence to verify the amount and date when the medication is received in the home. Each resident has their own nail clippers and file and three staff have completed a training course in foot care practice. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (NMS23) Please note the requirement made at the last inspection regarding the need for all staff to receive training in the Needs and Protection of Vulnerable Adults remains outstanding. However, it should be noted that the Registered Manager has requested further training sessions to be organised by the Area Training Officer and it is understood that further sessions are now pending. All senior staff and managers have completed the Multi Agency Training provided by Dorset Health & Social Care. In addition the Registered Manager has issued a new resource pack, which provides up to date information, contacts and policies and procedures to all senior staff. EVIDENCE: Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS24 Please note the good practice recommendation to consider replacing the furniture in the lounge in Tregonwell Lodge remains outstanding. However, the Registered Manager hopes replacement furniture can be chosen and purchased in this financial year. EVIDENCE: Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 • Staffing numbers are appropriate to the existing needs of the residents and staff are well supported in terms of induction and training. • Employment procedures are thorough ensuring all statutory checks and references are obtained which affords a level of protection to the residents. EVIDENCE: At the time of this inspection thirteen support staff were registered to complete NVQ level 2 and three staff are studying for their NVQ level 3. Six staff have already successfully obtained NVQ levels 2 /3. This is a positive commitment by Regard Partnership and the Registered Manager to encourage and facilitate opportunities for all the support staff to achieve NVQ’s. Since the last inspection new staff have successfully been recruited and the files of two staff were checked. Each was found to have all the requirements, identification and photographs, references and statutory checks. Contracts of employment are only offered to new staff once the probation and induction training has successfully been completed. New staff are supernumerary on the rota for the first two weeks of their employment and this time is used to shadow and observe experienced staff and complete basic Health & Safety training. Once the probation period is Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 18 completed further and more extensive training on Health and Safety is undertaken. Twelve staff have recently completed training on Crisis Intervention and three completed Epilepsy Awareness training. Each member of staff has their own training record and certificates. Staff commented to the inspector that they felt “well supported” and there was “always back up”. Each senior support worker has recently been issued with an “on call folder” which provides them with contact numbers and information of both Regard Partnership staff and essential services in the community. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 & 42 • Resident’s benefit from a home that is managed well ensuring their health, safety and welfare is maintained EVIDENCE: From observations made throughout the inspection visit and in discussions with both residents and staff it is clear that they all benefit from the positive and open attitude adopted by the Registered Manager. The Registered Manager has established a good rapport with the residents and this was evident in the easy open way they spoke and communicated together. Staff said that the Registered Manager had provided good leadership over the past months, which for some staff and residents has been a difficult period. Fire Prevention Training is booked every three months. However, not all staff have attended recent sessions and therefore this essential statutory training is not being completed according to the requirements. This also applies to Manual Handling and Health & Safety training. The latter two training courses are arranged through the Area Training Officer and it is understood a further sixteen staff are due to complete the Manual Handling Training. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 20 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 2 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 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x x 3 x x x 2 x Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 21 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. 1. 2 Standard YA20 YA23 Regulation 13(2) 13(6) Requirement Timescale for action 31/01/06 3 YA42 23 A written record of all medicines being received into the home must be completed. The Registered Manager must 31/03/06 ensure that all staff receive training in the Protection of Vulnerable Adults. Please note at the time of this inspection further training requests have been made to the Area Training Officer to ensure this Standard will be met. All statutory training must be 31/01/06 completed within the required timescales. This refers to Manual Handling, Health & safety & Fire Prevention. Please note this refers to only a minority of staff who have not attended when training sessions have been running. Tregonwell Lodge & Two Wells DS0000034481.V274396.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard YA24 Good Practice Recommendations The Registered Manager should consider replacing aspects of the furniture in the main lounge and consider a general refurbishment of this room to create a more homely and comfortable feel. Consideration needs to be given to replacing carpets throughout the home in the communal areas which are beginning to show signs of wear and tear. 2. 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