Inspection on 30/06/05 for Trelawn House

This inspection was carried out on 30th June 2005.

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

Trelawn House 01/11/07

Trelawn House 16/11/05

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

CARE HOME ADULTS 18-65 Trelawn House 30 Russell Hill Purley Croydon CR8 2JA Lead Inspector Michael Williams Unannounced 30th June 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Trelawn House Address 30 Russell Hill, Purley, Croydon, CR8 2JA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8660 4586 020 8763 0979 Mr Steven Rossell Mr Melvyn Higgs Care Home 15 Category(ies) of Drug Dependence past/present 18 years - 65 registration, with number years (15) of places Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6/1/05 Brief Description of the Service: Trelawn is a large traditional brick built domestic style property situated near the Purley crossroads (A22/A23) and the Purley shopping centre. The property has a number of lounges including a combined lounge/dining room on the ground floor, a meeting room and a small “quiet” lounge on the first floor. There are 2 shared and 11 single bedrooms situated on the three floors of the house. None of the bedrooms have en-suite facilities other than wash hand basins. There are toilets and bathrooms throughout the home. The home has as its Statement of Purpose “to provide rehabilitation for people with drug and alcohol problems and adults recovering from abuse”. This is a rehabilitation unit, not a detoxification unit. It is expected that service users will move on after a 16 week programme of intensive support. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Trelawn has changed registered owners and is now part of the ‘Cranstoun’ organisation. This company specialises in the care and rehabilitation of people with drug and alcohol problems. This unannounced inspection was conducted at midday on 30th June. During the course of the inspection support groups were underway. The service users, staff and manager contributed to the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users are being assessed prior to admission so as to assure prospective service user that all their health and social care needs, including their specialist needs, can be met when admitted. EVIDENCE: Various case files were checked and service users contributed to the inspection and confirmed the conditions for admission, which requires that service users have already undergone drug or alcohol withdrawal where this is necessary. Assessments are in place for each service user and form the basis of the initial care plan and risk assessments and this includes analysis of their particular rehabilitation needs. It is made clear from the outset that service users are to participate in the rehab’ programme and this condition forms the basis of their care contract. Also included in the pre-admission assessment are any court orders such as compulsory drug testing or bail conditions. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 7 9 The care planning process is a central tenet of the work in this home; service users not only know that their care plans reflect their needs but are expected to assist in drawing up the plans, this ensures their specific needs can be addressed. Responsible decision-making is also a key element, this will assist service users achieve their potential and help service users take responsible risks but eschew dangerous, unhealthy or unacceptable risks. EVIDENCE: Each service users is expected to be fully involved in identifying their needs and the issues in their lives that need to be addressed. This home is exceptional in expecting that all service users will be involved in their own care planning, it will not be acceptable for them to merely arrive and passively accept care and accommodation. Service users will be expected to address their addictive behaviour and this may include confronting long-standing personal and family issues that might have lead to self-harming or anti-social behaviours and addictions. Service users confirmed that they are fully involved in their care planning in decision making within the home and are supported in addresses addictive and risk-taking behaviour. Equally importantly, they are aware of the consequences of non-compliance and this is also covered in contracts and care plans. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 15 16 17 A range of appropriate activities is provided so as to ensure service user rehabilitation; this includes group sessions throughout the week. Service users are free to make use of the local community resources and are free to maintain personal relationships that do not affect their rehab’ programme but allows them to still have contact with the community. All service users will participate in the running of the home’s programme of care, with the aim that they develop respect for themselves and each other. Service users are also expected to act responsibly with the aim that they have a lifestyle that encourages their personal development. EVIDENCE: A key feature of this type of home is the aim to help service users achieve personal development when they may not have done so with great success in the past. Service users confirmed that they are expected, as part of their contract, to actively engage in all aspects of the home’s support programmes and are expected to comply with house rules. The rehab’ programme is peer and age appropriate and respects the cultural and religious background of service users. The programme includes a range of meetings some for the whole group of service users and others with more specific aims for smaller groups such as those recovering from abuse. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 10 Staff and service users are quite clear about the consequences of noncompliance. For the staff this means they must act in a coordinated and constituent manner and for service users this means they are aware that failure to use the programme effectively will include peremptory discharge or in limited cases a ‘relapse’ programme - which provides for an even more supportive, and restrictive, programme of rehab’ requiring increased cooperation and engagement by service users. Involvement in the community is less important during the rehabilitation programme but during free time service users can make use of the community as they may wish and most are quite competent to do so without support or guidance from the home’s staff team. Risk assessment are in place to deal with risk-taking activity such as visiting pubs or clubs that may adversely affect a service user’s rehabilitation. Service users are supported in maintaining links with family and friends but here they may also need support in avoiding relationships that may affect their progress in the home. Service rights are respected but admission to this home is conditional so if a service user perceives a right to drink or take recreational drugs he or she may forfeit their place in the home; in other respects service users rights are supported and counselling and legal advice can be arranged if service users need technical help to assert their rights. The service users organise the menus, buy the food and help prepare it. They confirmed that the arrangements for meals are acceptable, indeed many service users will be learning or re-learning catering skills to improve their selfhelp skills in this area. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 19 20 Service users are receiving support in the manner they require to help them rebuild their lives. Service users’ emotional, social and health care needs are being met so as to ensure their wellbeing. Service users are supported in taking responsibility for their own medication, however there is no record made of the number of tablets at the start of the medication chart and when new medication is added during the month which could compromise their safety. EVIDENCE: As a rehabilitation unit the service users acknowledge that the help they require is not always in keeping with the lifestyle they would have previously chosen or prefer – such as total abstinence from the use of ‘recreational’ drugs and alcohol. Service users nevertheless agree to the personal support that the home provides as part of the contractual conditions for admission. Staff provide close and continuing support to all service users and the service user themselves provide peer support throughout their stay. The service users case files indicate that health care needs are being met with the support of community health agencies such as General Practitioners, hospital clinics and so forth. Several service users may at any one time have considerable health problems that may not have been effectively managed in the past so this home provides an opportunity for them to get suitable health care in an effective and well managed way. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 12 Service users are expected to control their own medication but this is with the support of staff, who monitor medication administration and remind service users of the need for repeat prescriptions and of course counsel service users on the importance of taking prescribed medication regularly and at the intervals advised by their doctor. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 23 The arrangements and effective procedures that are in place to ensure that service users and their representatives are either able to complain about or compliment the service. Service users are confident that the effective procedures that are in place to deal with any complaints will ensure that they dealt with fairly and in a timely manner. Policies, procedures and staff training that are in place regarding abuse protect the service users. EVIDENCE: A record of complaints is in place and show that no complaints have been raised or required to be dealt with by the home since the previous inspection. No complaints arose during the course of the inspection. One suggestion arose about giving service users clearer feedback about why they are discharged and this was discussed with the manager as part of the feedback meeting. Whilst no complaints were received during the inspection, several complimentary comments were made by the service users, which indicates they clearly recognise the value of this specialised service. The home has a copy of the local authority’s procedures for dealing with allegations of abuse but no such issues, have arisen since the previous inspection. Staff were interviewed during the inspection and they were aware of their responsibilities to protect service users and in reporting allegations of abuse or misconduct. Service users are articulate and well-informed adults and they had no complaints to make and gave no indication of abusive behaviour occurring in the home. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 30 This is a comfortable and safe environment, which ensure the wellbeing and safety of service users. The home was in a reasonable state of cleanliness, repair and decoration, however although much of the outside has improved, internally some areas need attention. To ensure that service users are protected from infection the kitchen would benefit from a thorough deep-clean and the fridge needs to be checked to ensure it can hold the correct temperature. EVIDENCE: The new kitchen cabinet doors look very good but the frames of the cabinets, are deteriorating and will soon need to be replaced. A recommendation is made to this effect. The kitchen once again needs a thorough ‘deep’ clean especially above eye level. The refrigerator must be checked and replace if it cannot maintain a safe temperature. Some bedrooms have stained walls and need to be repainted. Requirements are therefore made in respect of standards in the kitchen and in other areas of the home. Builders’ rubbish also needs to be cleared from the site once the external work is complete. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staffing levels and staff qualifications appeared adequate to meet the needs of current service users. EVIDENCE: Staffing levels for existing care homes, including those that providing mental health or social care, must be no less than the guidance issued by the previous regulating body, the Local Authority as at 2002. A training programme was in place under the previous owners of this establishment but the new providers are still in the process of establishing a training programme for this particular care home, which has only recently joined the company. New staff confirmed that, under the auspices of the old organisation, they receive induction training and are still ongoing support and supervision. This includes supervision from an independent agency – this provides an opportunity for the whole staff team to reflect upon their practice and the tensions that arise in this intensively therapeutic regime. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 42 Service users are involved in a great many aspects of the running of this service as part of their rehabilitation. As they progress through the rehab’ programme, they form part of the support of newer service users at the beginning of the process. No hazards were identified during this inspection and it appears to be a well managed service thus ensuring the safety and wellbeing of service users. EVIDENCE: During the course of the inspection service users outlined the contribution they make to the running of the home; this includes domestic aspects such as shopping, cooking, cleaning and more therapeutic aspects such as their full participation in the house groups that are run daily. This is a rehabilitation unit so it aims to maintain the interest of the service user by improving the quality of their lives and aims to do so in the short time they stay in the unit; other aspects of the running of the home such as staff recruitment and the maintenance of the building and management of the business are of less interest to them. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 17 No health and safety hazards were identified during the course of this inspection – which included a tour of the premises and the grounds. Service users participate inn the running of the home and in doing so receive support and guidance in safe handling of chemicals, how to reduce hazards and how to maintain a safe environment. Trelawn House G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trelawn House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x G53-G53 S62556 Trelawn 221848 Stage 0.doc Version 1.30 Page 19 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 24 Regulation 16(2)(j) Requirement Kitchen: the kitchen and kitchen equipment must be kept clean and in a good state of repair. Timescale for action 30/9/05 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 20 Good Practice Recommendations Medication: when medicines are not provided in monthly dosette pack it is recommended that the number of tablets held is entered on each medicine chart at the beginning of the chart and when there is a new supply. 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