Inspection on 29/12/08 for Tregothnan Retirement Home

This inspection was carried out on 29th December 2008.

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

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

Tregothnan Retirement Home 05/11/09

Tregothnan Retirement Home 15/11/06

Tregothnan Retirement Home 24/11/05

Tregothnan Retirement Home 13/05/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tregothnan Retirement Home 112 Balmoral Road Morecambe Lancashire LA3 1ST     The quality rating for this care home is:   two star good 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: Denise Upton     Date: 2 9 1 2 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 Older People 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 Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 Older People Page 3 of 35 Information about the care home Name of care home: Address: Tregothnan Retirement Home 112 Balmoral Road Morecambe Lancashire LA3 1ST 01524412259 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Robert Thackray Type of registration: Number of places registered: Thackray Care Services Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 13 Date of last inspection Brief description of the care home Tregothnan Residential Home is situated on one of the main roads leading into the West End of Morecambe, in a fairly quiet residential area, close to local shops and amenities. There is a ramp leading up to the side of the front door for use by wheelchair users, but there is still a small step to enter the front door. The home is a Victorian terrace built over three floors, accessible by a passenger lift. Four of the bedrooms have an ensuite facility and, for the remainder, there is a bathroom/toilet within easy reach. There are communal areas including a small roof terrace, a dining room and lounge. There are toilets on all floors which are accessible to residents. Care Homes for Older People Page 4 of 35 0 Over 65 13 Care Homes for Older People Page 5 of 35 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection site visit took place during the morning and early afternoon period of a mid week day and spanned a period of approximately six and a half hours. At the time of this visit, 10 people were in residence. Twenty three of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a further standard relating to supervision arrangements. A reassessment also took place of the requirements and recommendations made at the last key inspection. We spoke with the registered manager and three members of the care staff team. In addition, two residents who were at home were also individually spoken with and brief discussion took place with several other residents in the lounge area of the home. Care Homes for Older People Page 6 of 35 Information was also gained from four residents who completed and returned a Commission for Social Care Inspection (CSCI) survey prior to the site visit taking place. This all helped to form an opinion as to whether The Tregothan care home was meeting the needs and expectations of the people who live there. A number of documents and records were examined and a tour of the building took place including communal areas of the home, toilets and bathrooms, some bedroom accommodation and the laundry and kitchen areas. There is a passenger lift in place to assist those residents who cannot manage the stairs. Details of current fees and what is included in the fees is available from the home. The last key inspection at The Tregothnan took place on 15th November 2006 and an Annual Service Review was undertaken on 13th November 2007. The report relating to the service review is held at the CSCI office and would be made available on request. What the care home does well: What has improved since the last inspection? What they could do better: All care plans and personal risk assessments should be formally reviewed and amended as necessary on at least a monthly basis. This would make sure that all staff had the same written up to date information about each resident to ensure that a consistent Care Homes for Older People Page 8 of 35 service was provided. As care staff have responsibility for devising, preparing and cooking the menu for the day rather than a dedicated cook, it has been recommended that care staff be provided with training with regard to the nutritional needs of the elderly. This would help ensure that residents always received a nutritionally balanced diet that suited their taste and choice and assist with menu planning. In the main, residents did however say that they liked the meals served at the home. Although staff receive induction training about working at the home, there is a nationally recognised induction training programme that care staff should complete to make sure that they have the basic skills to provide an adequate level of care. There is no evidence that this training has been provided to newly appointed staff. It has also been recommended that a staff training matrix be introduced to record the actual training that individual staff have completed and to highlight when refresher training is due. All care staff must receive manual handling training and first aid training as this helps to protect residents. Infection control and food hygiene training has also been recommended for those staff that have not undertaken this training. 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 Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. The pre admission assessment process helps to make sure that only people are admitted to the home if their needs and requirements could be met. Evidence: Prospective residents are provided with the written information they need to make an informed choice about whether to live at the home. As recommended at the last key inspection, an individual copy of the Service Users Guide is now given to each new resident. In order to ensure that residents are only admitted to The Tregothnan care home if their health, personal and social care needs could be met, prior to admission the registered manager undertakes an assessment of peoples current strengths and needs in order to determine if the level of care and support required could be provided at the home. This information is recorded, which in some cases is supported by a Health Care Homes for Older People Page 11 of 35 Evidence: and/or Social Services assessment of current requirements. In the main this collated information, along with any further information provided by family or other advocates, provides the basis of the initial plan of care. All this helps to make sure that as much information as possible is gained in order for the registered manager to make an informed judgement as to whether the home could provide the care required. A resident spoken with confirmed that the pre admission assessment had been undertaken prior to her admission to the home and that her daughter had been involved in selecting The Tregothnan and in providing some information during the pre admission assessment. This same person went on to say that she was Very happy living here and that All the staff are nice. Whilst it appeared that the needs and requirements of people living at the home were being well met, there is a requirement that any person that has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective residents current needs and requirements could be met at the home or alternatively that they could not be met. This should be provided prior to admission. There was no evidence that this had occurred. Care Homes for Older People Page 12 of 35 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of well being and confidence that any health issue would be dealt with. Evidence: In the main, individual plans of care were in place and two of these were viewed. However in respect of one recently admitted resident there was no actual care plan, staff were relying on the pre admission assessment information and other professional assessments available in order to provide the level of care required. Whilst there is no suggestion that this ladys needs were not being met, given the pre admission information available, there was no reason for a rudimentary care plan not to be in place. An initial care plan should be developed from the pre admission assessment information and further developed over the first few weeks as new information becomes available. This would support the verbal information sharing about a new resident and ensure that all staff had the same written information about the level of care and support required. Care Homes for Older People Page 13 of 35 Evidence: Residents and/or their relatives had been given opportunity to be involved in the care planning process, so that they could have some say about the care provided. Risk assessments are also conducted as required with significant outcomes identified in the plan of care. In the main, care plans were sufficiently detailed to provide staff with the necessary information to provide a consistent level of care and support. However occasionally a care plan could have been improved by instead of indicating that help with personal care was required, actually detailing the type of help required. This would help to make sure that residents were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. There was also a detailed daily routines of the resident section that provided good information of the chosen lifestyle of individual residents. There was evidence that care plans are being formally reviewed and signed by the reviewer and the resident however this is not necessarily on a monthly basis. In one instance there was only evidence of a formal review having taken place in January 2008, February 2008, May 2008 and October 2008. The registered manager acknowledged that care plan and risk assessment reviews had not been undertaken on a monthly basis but stated that care plans are reviewed and amended if any changes occur. It is recommended as good practice, that all care plans and risk assessments are automatically reviewed and amended as required on at least a monthly basis or more frequently if needed. This would make sure that the level of care required is regularly reviewed and ensure that the written care plan is up to date and accurate. Whilst formal reviews are signed by the resident, care plans are not. It is recommended that wherever possible, the content of the care plan be explained to the resident or alternatively the resident be provided with a copy of their plan of care. The resident should then be asked to sign to acknowledge their understanding and acceptance of the content. Alternatively, with the residents consent, a family member or other advocate of the residents choice could be approached to read and sign the care plan on behalf of the resident. Although somewhat vague as to the detail of her care plan, one resident spoken with was full of praise for the help and support she received from the staff team and confirmed that her needs were being well met. It was evident through discussion, observation and documentation that residents health care needs are being fully met. This was also confirmed through comments in the resident CSCI surveys that had been returned. All stated that people living at the home always received the medical attention that they needed when they needed it. As Care Homes for Older People Page 14 of 35 Evidence: this is a small home, staff get to know people well and can spot any changes in health and well being. There is a good relationship with health and social care professionals in order to maintain residents health and social well-being. An individual record is maintained of all health professional visits for each client. This ensures that a good record is kept of health care visits and the frequency of need. Discussion with a number of residents and some members of staff confirmed that the maintenance of residents privacy and dignity is upheld at all times. One lady told us that she Felt comfortable when staff were assisting her with personal care and she had no concerns at all. Policies and procedures are in place that guide staff to ensure residents privacy and dignity is respected at all times. These important topics also form part of the National Vocational Qualification (NVQ) training that has been undertaken by the majority of staff. The preferred term of address of each resident is identified at the time of admission and always respected. The majority of medication is dispensed into blister packs by the pharmacist and stored safely in the home in a locked cabinet. The registered manager confirmed that all staff that have responsibility for the administration and recording of medication have received appropriate training. However this could not be evidenced at the time of the inspection as there was no staff training matrix in place. Two members of the care staff team confirmed that they had received medication training however a third member of staff, who only gave medication occasionally, was unsure if she had received appropriate medication training or not. However this member of staff did confirm that she had received medication training in-house including initially through shadowing an experienced member of staff and then being shadowed herself for a period of time until she was considered competent to administer medication independently. It is important that in order to keep residents safe, staff who will have responsibility for the administration and recording of medication be well trained. This can be in-house so long as the person providing the training is qualified to do so and the training provided is of the same standard and content as that of an external training organisation. The person receiving the training should be provided with a certificate and there should be documentation signed by the trainer confirming that the person that has received the medication training is competent to administer the medication and record accurately. The medication administration records of two people were viewed. These had been completed correctly and most had a photograph of the person attached, this is good practice and helps prevent mistakes being made. Following a risk assessment, people are able to look after their own medication either totally or in part if this is deemed to be safe. Currently one resident is self administering their own prescribed medication in part. A locked facility is provided in his individual bedroom accommodation for the safe Care Homes for Older People Page 15 of 35 Evidence: storage of personal items such as medication. Generally medication is well managed, however it is recommended that when ever a hand written entry is required on the drug administration record, as well as this being signed and dated by the person making the recording, a second member of staff should check the entry and countersign to confirm accuracy of the recording. This should be the exact replica of the pharmacist label. This would help to keep people safe. It is also recommended that short life medication such as eye drops be dated on opening. This would ensure that all staff would be aware of the date the medication was first administered and help prevent medication being used past its expiry date. An amended Regulation has recently been introduced with regard to the storage of controlled drugs in care homes. The requirements of the amended Regulation was explained to the registered manager. These requirements must be put into place within a specified time scale. It is understood that this requirement will be addressed by the registered manager within the time scale specified. Care Homes for Older People Page 16 of 35 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People had choice and support to meet their expectations and preferences regarding their daily lifestyle. Evidence: A number of activities are arranged including a weekly music session that residents are encouraged to participate in, that is provided by an external entertainer and very regular Tai Chi. A number of board games are also available and staff told us that they have time in the daily routines to just sit and chat with residents. Other residents enjoy watching television and just socialising with each other. One resident particularly enjoys reading while another resident enjoys painting and drawing. Suitable materials are provided by a close relative and it is understood that the registered manager would also make sure that materials were available if required. Individual discussion with this person confirmed that he is able to pursue his hobby but that there was not much room in the lounge area to do this. It was suggested that he used one of the dining room tables when not in use in order to paint and draw in comfort, staff felt that this would be no problem at all. Although the range of activities appeared somewhat limited, residents that completed the Commission for Social Care Inspection surveys all said that there was always or usually activities arranged by the home that they could Care Homes for Older People Page 17 of 35 Evidence: take part in. One resident told us, Not particularly bothered about joining in activities. A bird in a cage is in the lounge area of the home that also provides an interest for those living at The Tregothnan . Residents are also encouraged to access community resources and activities. One resident goes out most days independently whilst other residents enjoy outings with their family. Outings with staff are infrequent however the registered manager explained that if a resident did want to go out for a short while, this could be arranged, however some residents had no wish to go out at all. It was noted that on some care plans more detail was provided about social activities than on others. For example, with regard to the gentleman that enjoys drawing, there was nothing on his care plan to suggest this even though staff were assisting him to pursue his hobby. Full details of all social activities enjoyed by each resident should be included in their individual care plan along with any assistance required by staff to enable the resident to enjoy the activity. People are encouraged to maintain contact with family, so that they can continue to be part of family life. Visitors are made welcome at any reasonable time and residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. Information is kept about peoples religious needs and representatives of local churches visit the home when requested, to offer communion and talk with residents. One resident visits a local church independently twice a week, an activity that is important to him. On other occasions parishioners escort residents to church and previously staff at the home escorted one lady to church on a weekly basis. People are encouraged to exercises choice and maintain control of their lives. Advocacy information is available. People are also supported to manage their own financial affairs for as long as they wish to and are able to, although in reality most people are assisted in this task by a relative or other advocate. People spoken with said they were happy with the meals provided. One person told us, Food is more than enough, well fed. Meat beautifully cooked, could not do better at home. The main meal is served at lunchtime and is generally a set meal. However residents are told what the planned lunchtime meal is earlier in the morning and if required, an alternative meal of the residents choice is made available. Observation of the record maintained in respect of meals served showed that residents sometimes do choose not to have the set meal but an alternative meal of their choice. A member of staff spoken with explained there was no actual specific weekly or monthly menu, this was determined by the cook of the day. As The Tregothnan care Care Homes for Older People Page 18 of 35 Evidence: home accommodated only a small number of people, staff are very aware of each persons likes and dislikes and meals are planned with this in mind. The record of meals served in the preceding week were viewed that showed a varied, cooked two course lunch and a snack type meal in the late afternoon had been served. The teatime meal is of the residents choice. Again each person is asked individually what they would like for tea and it was seen that a variety of different teatime meals had been served. Fresh fruit is served daily and there is a free choice of food at breakfast. Supper is served in the evening and hot and drinks are provided at regular intervals throughout the day or on request. Some residents have chosen to have their meals in their bedroom and this is supported. One resident chooses to have her meal mashed for ease of eating and the meat cut up. Staff do this discretely to maintain the dignity of this person. Another resident is diabetic and his menu is determined by this. Specialist diets can be provided if required. Although residents that completed a CSCI survey said they always or usually like the meals served, a resident spoken with told us Meals good, cannot grumble but then went on to say that there was Much the sameness about the meals served. The same person also went on to say that he had not asked for an alternative meal, did not really know what he would have liked to eat, but that he ate things because they were there. It is difficult for staff to serve meals of choice if a resident is reluctant to say or if the person is unsure of what they would like to eat. In order to try and address this, a discussion could perhaps be introduced about food and meals served, during the periods when staff have time to sit and chat with residents. This way, some residents, during general discussion, might say what they had liked to eat when living at home that could then be incorporated in the menu. As recommended in the last key inspection report, given that meals are devised and cooked by care staff rather than a dedicated cook, it is recommended that consideration be given to staff receiving training with regard to the nutrition needs of the elderly. This would help to ensure a good nutritional balance and be helpful in menu planning. Care Homes for Older People Page 19 of 35 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 has a satisfactory complaints policy and adult protection policy in place. This, along with staff training helps to protect residents. Evidence: The Tregothnan Care Home has a complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the registered manager prior to the site visit, a record of complaints is kept that includes details of any action/investigation taken. The complaint procedure is displayed in various areas of the home including the main hallway, and written details of the complaint procedure are incorporated in the Service User Guide, a copy of which is provided to each resident. At present it is understood that there is no specific complaint form. It is suggested that a formal complaint form could be devised to provide clear details of the complaint, the method of investigation, the outcome of the investigation, any action taken as as result of the investigation and the date the complainant was informed in writing of the outcome of their complaint. This would then provide a clear record of the complaint from receipt to completion. Residents spoken with were very clear about who they would speak with if they did have a concern or complaint but one resident spoken with told us that he Had no complaints. There have been no complaints made about the home since the last Care Homes for Older People Page 20 of 35 Evidence: inspection and The Commission for Social Care Inspection did not receive any complaints. During the visit, it was clear that people living at the home had formed good relationships with staff, meaning that any issues could be raised and dealt with informally as part of day to day life at the home. The Tregothnan continues to have a variety of policies and procedures in place for the protection of residents. This includes an adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received training regarding protection and abuse. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Through observation of the adult abuse policy and procedure, it was evident that this did not contain detail of the local protocols for reporting or investigating alleged abuse as identified in the No Secrets In Lancashire document. This should be included. It would also be useful to obtain a copy of the No Secrets In Lancashire document as this provides clear advice and guidance on what should and should not be done and can also be used to review and amend the current adult protection procedures and as an aid to staff training. Care Homes for Older People Page 21 of 35 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, 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. 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. A clean, homely and warm environment is provided however some parts of the building are a bit tired looking and will benefit from the on-going redecoration programme. Evidence: The Tregothnan is a none smoking care home. This information is verbally provided when an enquiry is made and also highlighted in the Service User Guide. This makes sure that prior to admission, people have the right sort of information to make an informed choice about living at the home. However it is acknowledged that some people who have smoked for a considerable period of time would like to continue with this activity and residents are enabled to smoke outside the actual building if they so wish. The Tregothnan is a large semi detached house built in the Victorian era. It is situated close to local amenities including a park and local shops. As with a lot of domestic houses built at that time, outdoor space is limited however there is a first floor garden terrace where people can sit out and enjoy the warmer weather. One resident spoken with said she really enjoyed this facility. Communal areas of the home consist of a pleasant lounge and dining room to the front of the building that are light and airy. There is a passenger lift installed for ease of access to all parts of the building. There Care Homes for Older People Page 22 of 35 Evidence: are eleven bedrooms for single occupancy and one shared room. Four of the single rooms are provided with a full en-suite facility. There are sufficient communal bathrooms and toilets that are located close to communal areas of the home and individual bedroom accommodation. Appropriate aids to promote independence are provided. The home is clean, warm and homely. Residents are encouraged to personalise their bedrooms with important items from home. This may range from small pictures and ornaments to pieces of furniture, chairs, televisions and radios. One resident, spoken with individually in her bedroom accommodation, had numerous personal items that she had brought into the home with her to make her bedroom comfortable and just as she wanted it. People living at the home who wish to, are enabled to choose there own decoration including colour scheme. Residents are provided with a key to their individual bedroom accommodation if they so wish, but it is understood that at present no resident wishes to do this. Resident safety and well being is given high priority and all bedrooms and communal areas of the home are provided with radiator guards to prevent the risk of accidental injury, hot water outlets are provided with a thermostatic device to prevent the risk of accidental scalding and an emergency call bell is provided in every room used by people living at the home to alert staff if assistance is required. Residents spoken with all said that they were happy with their bedroom accommodation and the communal accommodation provided. Feedback from people living at the home who completed CSCI surveys confirmed that the home was always kept fresh and clean. Although clean and maintained, it was noted that some bathrooms and toilets would benefit from upgrading as would parts of the kitchen area. It is however acknowledged that these are expensive items and the manager had given priority to redecoration and carpeting of lounge and dining areas and individual bedroom accommodation. A refurbishment programme is ongoing. It was also noted that not all bedroom accommodation was provided with a locked facility for the safe storage of personal items. This should be provided to ensure a private place to store personal possessions especially as residents have chosen not to lock their bedroom door. This is especially important if any resident is self medicating their own prescribed medication. In these instances, a secure space must be provided to store the medication in order to protect all residents. It was also noted that one toilet door on an upper floor was half glassed. The glass area of this door should be provided with some sort of covering to ensure privacy when using the facility. A hospital type bed had been purchased. One of the residents is currently using this Care Homes for Older People Page 23 of 35 Evidence: bed. However there was no evidence that a formal risk assessment had been undertaken to assess the suitability of this bed for the resident. It is recommended that whenever a specialist type of bed is used for an individual resident, a formal risk assessment should be undertaken. Some beds, especially those with bed sides attached, can be a hazard in themselves for some people. It is also important that any specialist bed purchased is suitable for the intended occupant. A risk assessment should also be in place to establish if protective bed side bumpers are required or whether these too could become a hazard. There are a variety of policies and procedures to advise staff in the control of infection. However not all staff have been provided with infection control training. This should be provided to make sure that all staff are aware of how to prevent cross infection. Laundry facilities are sited in the basement area of the home in an outside cellar and do not intrude on residents. The two industrial washing machines have the capacity to meet disinfectant standards and floor and wall finishes are easily cleanable. Care staff carry out laundry tasks, with the night staff doing the ironing. The registered manager explained that there is a good system in place to ensure that residents freshly laundered clothes are returned to them. Care Homes for Older People Page 24 of 35 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. National Vocational Qualification (NVQ) training is positively encouraged. This helps to ensure that people living at the home are supported by a staff group with the skills to provide a good quality service. Evidence: On the day of this inspection visit there were two care staff on duty along with the registered manager. As well as care duties, care staff also have responsibility for cooking and domestic tasks. The registered manager explained that there were always two care staff on duty throughout the waking day, with a waking watch member of staff on duty during the night time period. The registered manager also stated that at night, there were members of staff with on-call responsibility that lived no more than two minutes away from the home, and that he was always on-call, although it would take about ten minutes to reach the home. A member of staff spoken with confirmed that he had on-call responsibility and lived within two minutes of the home, however he stated that it was very rare that additional assistance was required during the night. Discussion with both residents and staff confirmed that they felt that sufficient staff were on duty at all times and that needs were being well met including the night time period. The home also has a small number of bank staff although they may not be able to provided support and assistance if an emergency occurred during the night. Care Homes for Older People Page 25 of 35 Evidence: Whilst it appears that sufficient staff are on duty at this present time, staffing levels should be kept under constant review. This is especially important should the needs of residents change and dependency levels increase. It is also important that people are only admitted to the home if there current needs and requirements could be met within the existing staffing structure, alternatively additional staff would be required. From information in the AQAA, there is a strong commitment to National Vocational Qualification (NVQ) training that has resulted in all but one member of the care staff team having achieved an NVQ qualification. This is commendable and helps to ensure that care staff have the skills and understanding to provide a good standard of care. The registered manager explained that except for NVQ training and fire awareness training, there had been no specific training provided during the last twelve months. It is important that all staff have opportunity to extend their knowledge through a variety of relevant training appropriate to their individual needs, to complement the NVQ training already provided. From evidence of a recently completed annual staff appraisal record, one member of staff self identified that they would benefit from dementia care training. The registered manager explained that this would be provided in due course. The recruitment records of three recently appointed members of staff were viewed. Records included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people have been deemed unsuitable to work with vulnerable people. Copies of certificates relating to training completed with their previous employer were also available. However it was noted that on one application form, there were apparent gaps in the employment record. The registered manager explained that this had been explored at interview but that no interview notes were kept. It is recommended that interview notes be kept to provide a written record of the interview and the responses of the applicant. This would have provided clear evidence of the explanation the applicant had given for the gaps in employment rather than have to rely on memory that the applicant may dispute at a later date. At the time of this site visit there was no training matrix available. Therefore it was difficult to establish just what training staff had been provided including mandatory health and safety training. It is recommended that a staff training matrix be developed in respect of all staff. This would provide evidence of all staff training that had been successfully completed and provide a trigger for when refresher training is due. There was evidence that staff had been provided with an induction training programme specific to the home but no evidence that staff had undertaken the Skills for Care common induction standards. This is a nationally recognised induction training Care Homes for Older People Page 26 of 35 Evidence: programme covering a variety of topics, that all care staff are expected to have undertaken within the first six weeks of their appointment. It is strongly recommended that all newly appointed care staff that do not have an NVQ qualification, be provided with this important training. This would ensure that they had the basic skills to provide an adequate and appropriate level of care and support. Residents spoken with were complementary about the staff team. One person told us that she Cannot speak too highly of the staff and that All the staff are nice, I am happy here. Another person said that they Got on well with the staff, very good, kind and helpful and a third person stated that she was Satisfied altogether with the care and support received. Care Homes for Older People Page 27 of 35 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 organised and managed in a way to ensure that residents experience a good quality of care however improvements could be made in the way internal quality monitoring is measured. Evidence: The registered manager at The Tregothnan care home is qualified and experienced and has achieved the Registered Managers Award, a qualification that all managers of care homes are expected to achieve to ensure they have the skills to manage the care home in the best interests of the residents. Staff spoken with said that they felt well supported by the registered manager who was approachable and ran the home well. Quality assurance systems in the home are limited to informal discussion with residents and their relatives to establish whether people think that the home is adequately meeting the needs and expectation of residents accommodated. Resident meetings do not currently take place, the registered manager said that people Care Homes for Older People Page 28 of 35 Evidence: preferred to speak informally with staff. Whilst this may be appropriate in some instances, the range of topics discussed may be restricted and may not give a comprehensive account of residents experience of life at the home. Further quality assurance systems should be developed and introduced to ensure that residents and other people with an interest in the home are able to give their views and opinions anonymously. To supplement the informal system in place, anonymous resident satisfaction questionnaires covering a variety of topics should be provided at regular intervals to enable residents to formally have their say and influence change. Questionnaires, specific to relatives and friends and also for other people that have a interest in the home such as District Nurses, G.P., Social Workers, the hairdresser, pharmacist and entertainer should also be developed and introduced. This would provide a more comprehensive record of the views of other people on how the home is achieving goals for residents that would also assist in the internal quality assurance audit. The home has achieved the Investor in People award that is an external quality management award that is only given when a certain standard has been achieved. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. In consequence the home does not normally hold any money in safe keeping or assist residents with their personal allowance. However at present, a specific amount of money is held in safe keeping for one resident. This is appropriately documented and held in a secure safe. Records of staff supervision were viewed in relation to three members of staff. Although there was evidence of some recent staff supervision taking place, it was evident that this was not as frequent as recommended. For example, in respect of one member of staff there was evidence that formal, recorded supervision had taken place in July 2007, August 2007 but not again until November 2008. Formal, one to one staff supervision that takes place at least six times a year is considered to be good practice. This should be put in place in order to provide staff with opportunity to speak privately with the supervisor about any matter of relevance to them. Supervision should cover at minimum all aspects of practise, philosophy of care in the home and career development needs. The supervision records evidenced suggested that formal supervision was being used as a training tool rather than actual comprehensive supervision. For example, one supervision record showed that only the use of hoists and other lifting aids had been discussed, the registered manager explained that other topics chosen for future staff supervision consisted of Parkinsons disease, sensory disorders, dementia, and risk Care Homes for Older People Page 29 of 35 Evidence: assessments. Whilst these subjects are important, such a rigid content does not allow for staff to bring their own agenda to supervision or cover the other good practise recommendations for discussion during supervision. Supervision is a specific task and it is important that supervisors have the skills and understanding to provide effective supervision for the development of the care worker and the ultimate good care of residents. All staff do receive daily informal supervision as part of the management role. There was evidence that staff appraisals do take place. The registered manager explained that staff appraisals are planned to take place at six monthly intervals but recently this had lapsed some what with formal appraisals taking place more often than not on an annually basis. Generally there are good arrangements in place for maintaining the health and safety of those living at the home. Maintenance records were available to confirm that various routine health and safety checks are maintained on a regular basis including weekly fire alarm tests, fire safety drills, the last one taking place in November 2008, the testing of small electrical appliances and servicing of equipment. It is also understood that the water temperature of hot water outlets in resident accommodation, that helps to prevent the risk of accidental scalding, is also regularly tested but that this is not recorded. It is recommended that a record be maintained of when the temperature of the hot water is tested and any significant outcomes including any action take to maintain an appropriate temperature. All staff should receive a variety of health and safety training that is regularly updated. Manual handling training and first aid training are mandatory for all care staff and must be provided, food hygiene training, infection control training along with fire safety training are also recommended. Infection control training would equip staff with the understanding and knowledge to help prevent the risk of cross infection and food hygiene training should be made available to all staff that prepare, cook or serve food to ensure safe food and hygiene practises. Refresher training should be provided as recommended to ensure that staff have up to date information regarding best practise. The registered manager said that not all staff had received all the above health and safety training. As there was no training matrix available, it was unclear if the people that had not received all the required health and safety training were very recent employees or established staff. It is important that all staff are provided with this training for the protection of residents and to ensure a safe environment. Care Homes for Older People Page 30 of 35 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 Older People Page 31 of 35 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 1 3 14 Following the pre admission 28/02/2009 assessment, the prospective resident must be informed in writing the outcome of the assessment. This would confirm to the prospective resident that their current needs and requirements could be met at the home. 2 9 13 The storage of controlled drugs must be in line with the recently amended Regulation. This would make sure that controlled drugs maintained at the home are stored as safely as possible. All staff that have not done so must be provided with with manual handling training and basic first aid training. This is for the protection of residents and staff. 31/03/2009 3 38 13 30/04/2009 Care Homes for Older People Page 32 of 35 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 7 Some entries in care plans could be more detailed to indicate the exact level of care required. This would help to ensure that the resident is encouraged to do what they can for themselves and that staff provide a consistant level of support. A rudimentary care plan should be in place, based on the pre admission assessment information from the day of admission. This should be further developed over the first few weeks as additional information becomes available. This would give all staff the same written information about the needs and requirements of each new resident. All short life medication should be dated on opening to ensure that it is not used past its expiry date. All hand written entries in the drug administration record should be countersigned by a second member of staff to confirm accuracy of the recording. All staff with responsibility for the administration and recording of medication should have received appropriate medication training. It is essential that a record of this training and subsequent refresher training be available. The social interests of each resident should be incorporated in their individual care plan. This would make sure that all staff had information about each persons social interests and the assistance required to support this activity. It is recommended that care staff be provided with training with regard to the nutritional needs of the elderly. This would help to ensure that residents always received a nutritionally balanced diet that suits their taste and choice and assist with menu planning. It is suggested that a specific form be devised to record any complaint received, the method of investigation and outcome. It is recommended that a copy of the No Secrets in Lancashire document be obtained and the local protocols in respect of any allegation of abuse be included in the adult protection policy and procedure. A formal risk assessment should be undertaken in respect 2 7 3 4 9 9 5 9 6 12 7 15 8 16 9 18 10 19 Care Homes for Older People Page 33 of 35 of the hospital type bed. This would ensure that it is safe for the occupant. 11 19 The bathroom door on an upper floor that is part glass should be provided with appropriate covering to maintain privacy. All bedroom accommodation should be provided with a locked cupboard or drawer for the safe storage of items of a personal nature. All staff that have not done so should be provided with infection control training to help prevent the risk of cross infection. Staffing levels should be kept under constant review to ensure that residents individual needs and requirements could always be met within a reasonable timescale. It is recommended that interview notes be maintained to provide a written record of what the applicant said at interview. The training needs of all staff should be discussed at regular intervals throughout the year and training provided appropriate for the individual to complement NVQ training. It is strongly recommended that Skills for Care common induction standards be provided to newly appointed care staff within the first six weeks of their employment. This would help to ensure that newly appointed care staff have basic skills. It is recommended that an up to date staff training matrix be developed to highlight the training undertaken and to prompt when refresher training is due. Internal quality assurance systems should be further developed to include anonymous questionnaires for residents, relatives and other interested parties. Consideration should be given to introducing residents meetings so that residents could formally have their say and influence change. Formal one to one staff supervision should take place at least six times a year and should cover at minimum all aspects of practice, philosophy of care in the home and career development needs. All care staff that have not done so should be provided with infection control training and food hygiene training. Refresher health and safety training should be provided as recommended to ensure all staff have updated information regarding best practice. 12 19 13 26 14 27 15 29 16 30 17 30 18 30 19 33 20 36 21 38 Care Homes for Older People Page 34 of 35 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 © (2009) 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. 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