Inspection on 26/03/07 for Trelana Nursing Home

This inspection was carried out on 26th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Trelana Nursing Home 24/02/10

Trelana Nursing Home 24/03/09

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Trelana Nursing Home Poughill Bude Cornwall EX23 9EL Lead Inspector Elaine Bruce and Melanie Hutton Key Unannounced Inspection 26th March 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trelana Nursing Home Address Poughill Bude Cornwall EX23 9EL 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) 01288 354613 01288 354110 European Care (South) Limited Mrs Jacqueline Ann Welch Care Home 50 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (50), of places Physical disability over 65 years of age (4) Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. One named under age service user with a physical disability for ongoing respite care. To include one additional named service user under the age of 65 years and outside of the registered category Total number of service users not to exceed a maximum of 50 Date of last inspection Brief Description of the Service: Trelana is situated in a small village on the outskirts of Bude. The village has a shop, post office, public house and a church. These facilities are within walking distance for any one without mobility problems. Accommodation is provided on two floors in the original house. Bedrooms are provided with en-suite facilities and can be accessed by a lift if required. A new purpose built area with facilities for service users with a dementia is also available at the home. Single bedrooms are of generous proportions with full en suite shower, toilet and wash hand basins. Communal areas are available in parts of the home on different levels. There is a large patio area with table and chairs with umbrellas and cushions. Service users with a physical disability can access this area. Generous parking is available in the grounds of the home. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection at Trelana was a key unannounced inspection, the first inspection following change of ownership of the home. The inspection took place with two inspectors over the hours of 09.00 to 17.30. Trelana is run as two distinct separate areas for service users with nursing needs and service users with specific needs due to having dementia. Those service users with a dementia are cared for in a wing of the home with communal facilities and en suite bedrooms. There is a nurse on duty at all times in this area and all records and associated documentation is available in an office in this area. Trelana is also providing a short stay service for service users with “intermediate” care needs who are supported by health care professionals as required. These service users usually return home at the end of a period that is on average between 7 to 10 days. The home has admitted 105 service users under intermediate care over the last 12 months. 91 of these have been discharged back home. The registered manager was on duty during the course of the inspection. A programme manager from the new organisation was also present during the course of the day. He was fulfilling the responsibilities of legislation re Regulation 26 requirements as well as undertaking an arranged supervision session with the manager. Case tracking took place with service users and service users were spoken to during the course of the day. Satisfaction was expressed with the standard of the care that they are receiving. Prior to the inspection five service user comment cards were received. One indicated that they did not like living at the home, but did feel that he was well cared for. The rest of the feedback indicated that service users are satisfied with the standard of the care that they are receiving at the home. The one relative/visitors card also indicated complete satisfaction with the care provided to their relative. The weekly range of fees at the home is from £444.25 to £725 depending on care needs. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The meals at the home are good, special diets are catered for and a choice of meal always available. To meet the requirements of legislation records of all meals provided must be recorded and this was not the case on the day of the inspection. This is included in this inspection report as a statutory requirement. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 7 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. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager assesses all service users prior to admission to the home to ensure that the home will be able to meet their care needs. The home is meeting the care needs of the service users who are referred for intermediate care. EVIDENCE: Potential service users are welcomed to visit the home in person for a meal or a short stay prior to deciding whether or not to seek admission. This facility is not generally available to those service users admitted to the home solely for intermediate care. This is due to the short notice of the admission and the short stay of the admission. This service user group generally have health Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 10 care needs which are met by a number of health care professionals attending the home. The statement of purpose document was not assessed formally during the course of the inspection. It was though recommended that the intermediate care facility that the home is providing should be clearly stated in the statement of purpose. A pre admission document is in place and this is being used for assessment purposes. A good practice recommendation was made at the time of the inspection to include more information on oral care. It is also recommended that pre admission assessment documentation should be in place from funding authorities where appropriate. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user’s health, personal and social care needs are being met by the staff and multidisciplinary staff as required. Medication is being administered correctly to the service users but one good practice recommendation is made as a result of this inspection. Service users stated that they were treated kindly and with respect when being helped with personal care. EVIDENCE: Care plans are in place for each service user with photographs for identification should agency staff be working at the home. Daily records are maintained by Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 12 the nursing and the care staff. These are completed well. Key workers are responsible for keeping care plans up to date and ensuring that they are reviewed on an at least monthly basis. Key worker information that is personalised and individual has been included in care planning information. Nutritional good practice screening documentation is in place in care planning. It is recommended that more information is recorded where a service user is identified at being at risk re nutrition and how these particular needs are addressed. The service users are being weighed monthly. Continence assessments are in place as are fall risk and manual handling assessments. Good working relationships were observed with all health care professionals who attended the home during the course of day. Medication administration was found to be satisfactory at the home on the day of the inspection. All qualified nurses have responsibility for these duties and have received training for these duties. Two separate storage areas and medicine trolleys are kept for the two different areas of the home. A policy and procedure on safe medication is in place to guide the nursing staff on good practice. It is recommended that additional information is included in the policy and procedure re retaining medication for seven days following a death and to clarify the policy clearly on homely remedies. Medication administration records were found to be completed appropriately on the day of the inspection to include controlled medication records. Care plan audits and medication audits are carried out weekly by the registered manager. The programme manager at the home during the course of the day was carrying out an audit of the medication arrangements as part of his responsibilities and duties. Service users spoken to during the course of the day expressed positive comments as to the delivery of their care. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are organised and meet the needs of the service users. A staff member is employed specifically for these duties. Arrangements are in place for service users to receive their visitors. The meals in the home are good offering both choice and variety and catering for special dietary needs. To ensure that requirements of legislation are met records of meals provided must be in place. EVIDENCE: The home provides activities for the service users and a staff member specifically for these duties is employed. (09.00 to 14.15) She was observed during the course of the morning in a group activity with the service users in the dementia wing. She is also involved in the records that are kept of activities. In addition to these records a social care assessment is in place for Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 14 each service user as well as a family tree. This documentation is completed well. In addition to organised group activities one to one time is encouraged with each service user should they so wish. Weekly activities include a church service, arts and crafts and organist and chair aerobics and music to movement. On the afternoon of the inspection there was to be an “open forum” for service users/relatives/visitors to meet with the Company Director. The dementia wing is provided with a safe area outside where a sensory garden is evolving and plants are being grown for the service users to plant up and enjoy. Generally, the interior space in the home is generous so that service users who are mobile can move around the home and visit others. Visitors to the home are welcomed and all visitors are asked to sign into the home on arrival. The menu of the meals provided at the home are worked out by the cook. There is a cook on duty all day from 08.00 to 19.00. The service users are asked the day before what they would like to eat. Two choices are offered or their own choice if that is feasible. The menu rotates over a four week period. Home made cakes are made on a daily basis. At this time records of meals are not in place as required by legislation. This is included in this inspection report as a statutory requirement. Meals and drinks are regularly available during the course of the day to include breakfast, lunch, tea, supper and a late snack if required. The home has been awarded a “gold” award from the District Council Environmental Health Officer for their high standard of meals. Service users said that they enjoyed their food. Those service users who require help feeding are given this assistance in a quiet setting. Relatives can should they so wish, for a small charge have a meal with their relative. The meals for the day are displayed on a board outside the dining room. The main meals of the day is served at 13.00 hours. A mobile trolley with a number of provisions for sale is taken around the home twice a week, where the service users may purchase items that they may require. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure provided to the service users and their representatives. The adult protection policy and procedure should be reviewed and updated. In addition all staff should attend training in this important area to ensure the safety and well being of the service users at all times. EVIDENCE: The home has in place a satisfactory complaints policy and procedure that was reviewed in October 2006. The home has in place a policy and procedure to guide staff on good practice re adult protection. Inspection of this documentation recommends that it is reviewed to ensure that multidisciplinary good practice procedures are included. This includes for example involvement with adult social care departments as being the lead re investigations of protection issues. Adult protection training is included in the induction training that all staff receive. It is appropriate for all staff to receive adult protection training from Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 16 an external provider to ensure the safety and well being of the service users at all times. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a very high standard of accommodation internally and externally that is well maintained and very comfortable. EVIDENCE: Trelana is situated in very spacious accessible grounds that are safe and tidy. Everything is well signed. There is a small field area provided with seating, a very generous parking area and a large patio area. The patio area is attractive and well maintained with pots/tubs, seats and umbrellas for shade. Communal areas are spacious and provided with quality furniture and fittings. Bedrooms are spacious and very comfortable with en-suite facilities that have at a minimum a wash hand basin and toilet. The new area of the home has en suite facilities that include a shower as well as a toilet and wash hand basin. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 18 Bedrooms are provided with good quality furniture with the scope for service uses to bring in their own pieces should they so wish. Everyone is provided with an adjustable modern electric bed with very good quality bed linen and towels. CCTV cameras are available in the main entrance corridors. Satellite television is provided in each bedroom. An inspection of the premises by the County Fire Brigade took place on the 7th May 2006. Requirements from this inspection were found to be met. The home employs a full time maintenance person for all general duties internally and externally. Staff identify any jobs that need undertaking and log these in a job book in the office. These are signed off when completed. On going maintenance takes place as and when required. The laundry area is of good standard with washing and drying machines being of industrial nature. The standard of cleanliness in the home on the day of the inspection was found to be good. Cleaning cover is available every day of the week and week end. A recommendation was made to close storage areas with doors to prevent any risk infection. The manager advised that this has already been identified and there are plans in hand for this to happen. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory to meet the needs of the service users. All staff caring for any service user with a dementia have received training to enable them to meet these specific care needs. More staff should be encouraged to undertake NVQ training. Recruitment procedures for new staff were found to be satisfactory. EVIDENCE: Staffing levels are as are per the staffing rota. The home is staffed as two distinct areas to include a separate wing for the service users with a dementia. On the dementia wing there is an RMN on duty at all times during the day. All the RGN nurses have received dementia training. The nurses direct the delivery of care to the care staff who are on duty in numbers that enable them to meet the care needs of all the service users Both the registered manager and matron work shifts on the floor so that they remain in touch with the service users and staff. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 20 Staff training is on going at the home. Moving and handling training is regularly taking place, with most staff having received this training. The home is covered with someone always on duty having been trained in first aid, and therefore able to respond to any emergencies. All staff are receiving statutory fire drill training as recommended by the County Council Fire Brigade. Although new staff are receiving induction training, good practice “Skills for Care” is not yet in place, but there are plans for this to happen. In addition more NVQ training should be taking place to meet the National Minimum Standards. Care staff are presently receiving dementia training. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The change of ownership at Trelana appears to have gone smoothly. The manager presented well on the day of the inspection with the large number of professional visitors to the home and the inspection process. EVIDENCE: The registered manager and matron are both experienced nurses. They are now supported in their roles and responsibilities by a visit from a representative of the new Company twice a month. They are fulfilling their Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 22 statutory duties by sending the CSCI a monthly visit of their inspection. The manager is also supported in her duties by her husband who keeps documentation in place as required re staff recruitment and training, contracts and bills for example. Both the registered manager and matron are undertaking studies to obtain their registered managers award qualification. The Company will be undertaking a quality assurance/quality auditing process to relatives, service users and representatives during the course of the year. This documentation is detailed and the company undertake this process twice yearly. The home does not hold any money for service users and encourages family/representatives to undertake these responsibilities. The majority of the service uses have a power of attorney in place. All maintenance records are in place as required for health and safety requirements. Policies and procedures are also in place for health and safety good practice. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? 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 OP15 Regulation 17(2) Schedule 4 Requirement Records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. Timescale for action 30/04/07 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 OP1 Good Practice Recommendations To update the service user guide/statement of purpose to indicate fully how the assessment process works and the fees for placement in the dementia wing of Trelana. To access (where appropriate) pre admission assessment documentation from health and social care professionals. To ensue nutritional screening documentation is fully in place and evidence how needs are met when risk is high. To include additional information in the medication policy DS0000067813.V325674.R01.S.doc Version 5.2 Page 25 2. 3. 4. OP3 OP8 OP9 Trelana Nursing Home 5. 6. OP18 OP28 and procedure as discussed at the time of the inspection. The adult protection policy and procedure should be updated and all staff encouraged to attend external adult protection training. To encourage more staff to undertake NVQ training. Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trelana Nursing Home DS0000067813.V325674.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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