Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 06/06/06 for Trelawney House

Also see our care home review for Trelawney House for more information

This inspection was carried out on 6th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Trelawney provides a very pleasant, comfortable and homely environment for service users living there. Service users were mostly very positive about how staff work with them and the support they receive. The building is maintained to a good standard. It is apparent the registered providers are aiming to make further improvements to the service and building. The majority of service users were very happy living at the home. The inspector spoke to the relatives of some service users, and to visiting professionals (such as district nurses) who were also very positive about staff and care practices.

What has improved since the last inspection?

The registered providers have developed a suitable statement of purpose and service user guide. These documents outline what services are provided, and outline service users` rights and responsibilities. Further work has been carried out to improve the building. For example the registered providers have begun to install a new kitchen, and some of the rooms have been redecorated A manager has been employed to assist the registered providers to run the home.

What the care home could do better:

This inspection has resulted in nine statutory requirements. Although all service users have a care plan, these need to be improved so the home`s system is fully implemented, care plans adequately detail what help service users need from staff and care plans are regularly reviewed. This will ensure, for example, new staff know what support service users need, care plans are accurate and care can be delivered consistently. The medication system needs to be improved. On some occasions staff failed to sign medication sheets. Storage of medication was not satisfactory, and some medication needed to be disposed of as it was no longer required. Staff also need to receive training, for example, by the pharmacist. Staff records need to be improved. For example there needs to be records that checks have been carried out on new staff when they commence employment. This must include evidence of a Criminal Record Bureau check, Protection of Vulnerable Adults Check, Two written references addressed to the registered provider, and evidence of identity. The registered providers have recognised they need to employ additional staff as at times the existing staff team is stretched, particularly Mr Gatzianidis, who appears to work an excessive number of hours. Staff training needs improvement. This includes moving and handling, fire training, food handling etc. Staff would also benefit having some training regarding the needs of people with dementia. The registered providers need to introduce a quality assurance system. This should demonstrate they ascertain the views of people who use, and are involved with the home, and where necessary bring about improvements. Health and safety standards need improvement for example ensuring electrical appliances and the heating are regularly serviced. A system of health and safety risk assessment also needs to be implemented. Three good practice recommendations were made. Firstly to develop further opportunities for day activities. Secondly to improve satisfaction of some service users unhappy with the meals, and lastly to check whether recommendations made regarding lift and hoist maintenance need addressing.

CARE HOMES FOR OLDER PEOPLE Trelawney House Polladras Carleen Helston Cornwall TR13 9NT Lead Inspector Ian Wright Key Unannounced Inspection 10:00 6th and 8th June 2006 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 Trelawney House DS0000053715.V293666.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. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trelawney House Address Polladras Carleen Helston Cornwall TR13 9NT 01736 763334 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) Christine Anne Gatzianidis Rigas Gatzianidis Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named service user with dementia, which is outside the registered category. 17th November 2005 Date of last inspection Brief Description of the Service: Trelawney Care Home is situated in Polladras, about five miles from the town of Helston. The registered persons provide residential care for up to eleven elderly people. Day-care is also available for people living in the community. The home is set in spacious grounds with seating provided for service users. There is sufficient car parking available. Accommodation is on two floors; the first floor can be accessed by a shaft lift. There is one large lounge and a smaller television lounge. Meals are cooked in a large kitchen and served in the dining room. Trelawney provide a meals on wheels facility and supply around ten meals to people in the community each day. The homeowners live adjacent to the care home and are actively involved in the day-to-day running of the home. Care staff provide personal care and the home has a friendly, atmosphere. There are opportunities for socialising and visitors are encouraged. A copy of the inspection report is not on public display, and it is suggested a copy is requested from management if required. The range of fees at the time of the inspection is £325-£450 per week. There are additional charges e.g. for hairdressing, chiropody, trips out and newspapers etc. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection took place over sixteen and a half hours over two days. All of the Key Standards were inspected. A second inspector, Ms P. Hayward, accompanied the lead inspector on the second day of the inspection. The methodology used for this inspection was: • To case track four service users. This included interviewing the service users about their experiences and inspecting their records. • Interviewing two staff about their experiences working in the home. • Informal discussion with other service users and staff. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), were used to help form the judgements made in the report. A random inspection was completed on 23rd May 2006 following concerns raised by a member of public. The concerns were not substantiated. What the service does well: What has improved since the last inspection? The registered providers have developed a suitable statement of purpose and service user guide. These documents outline what services are provided, and outline service users’ rights and responsibilities. Further work has been carried out to improve the building. For example the registered providers have begun to install a new kitchen, and some of the rooms have been redecorated A manager has been employed to assist the registered providers to run the home. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 7 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 Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Service users are issued with either suitable terms and conditions of residency or a social service contract at the time of admission. This enables service users to be aware of their rights and responsibilities. The pre admission assessment procedure is good and enables the registered persons to ascertain they can meet the needs of service users before admission is arranged. EVIDENCE: Copies of resident contracts (if privately funded) were available for inspection in service user files. Service users funded by statutory authorities only receive a social services contract. Mrs Gatzianidis assesses service users before they are admitted. Service users confirmed they or their relatives visited the home before formal admission was arranged. Service users said an assessment was completed before admission was arranged. Copies of assessments were available for inspection in service user files. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. All service users have a care plan, although care plans do not provide sufficient information to guide staff, and there appears no system of review. This could lead to staff support being inconsistent. Healthcare support seems appropriate so service users can be assured they will receive suitable support from medical practitioners. The operation of the medication system is poor, and service users cannot currently be assured staff handle their medication appropriately. Staff however work with service users in a manner which respects their privacy and dignity. Issues regarding the diverse backgrounds of service users appear suitably addressed. EVIDENCE: There is a copy of a care plan on each service user file. Staff said care plans were accessible to them. The care plan format is generally satisfactory, although implementation of the system is variable. There is no section within the care plan which states service users’ abilities and what interventions are required by staff. Advice was given on this matter. There is also little evidence of care plan review and advice was given on this matter. Service users said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. The inspector spoke to several district nurses who said health Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 10 care support was good. Service users said doctors are called when necessary. However the registered provider and inspector were concerned about the care provided to one service user. The service user will now be reassessed by social services and the health trust. The registered providers have a satisfactory medication policy. Medication is administered via the NOMAD system (dossetts packed by the pharmacist). No service users currently self-administer medication. Inspection of the medication system presented a number of problems: • Some medication is stored in an unlocked cabinet. The registered providers said they would dispose of this immediately after the inspection. • Some medication was not signed for, although it appears it was administered. • There was excess medication stored for some service users. • Some medication was not labelled. In some cases the label was taken off the bottle / tube and stuck on the medication sheet. • A record was not made when, for example, bottles of eye drops were opened. The date of opening needs to be recorded as in some cases the medication needs to be disposed of within a set time. • Some medication was not disposed of when no longer required or after the use by date. • Some medication was not recorded on the medication sheets. Staff must receive training regarding the storage and handling of medication, for example from the pharmacist. Service users said they felt staff worked with them in a manner which respected their privacy and dignity. The majority of service users were positive about their care. For example service users comments included that said staff were ‘kind’, were ‘angels.’ and assisted them to provide choice e.g. regarding food, However a minority of service users were less satisfied, for example, regarding some staff attitudes and the quality of the food. All however said personal care was provided to a good standard, and there were no abusive practices. The registered provider has appropriate policies regarding equal opportunities and anti discrimination. The registered providers were able to demonstrate suitable knowledge and awareness of equality and diversity issues regarding the care of service users. There are currently no service users from ethnic minorities, although the registered providers stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Routines are individualised so service users can live a lifestyle according to their wishes and needs. Although some activities are provided this could be developed further. Visiting arrangements are flexible. Arrangements to assist service users with their finances are satisfactory so service users can maintain choice and control over their lives. Meals are provided to a satisfactory standard, although work should continue to take place to assist a minority of service users who are unhappy with some of the food. EVIDENCE: Service users said they could get up and go to bed when they wished. Some spend the majority of their time in one of the lounges, while others choose to spend the majority of their time in their bedrooms. Some service users are able to go out on their own for example to church or chapel. There are only limited organised activities for example an occasional trip out and a weekly entertainer. Service users seemed happy how they spent their time. However the registered provider should explore additional opportunities for activities such as gentle exercise, bingo etc. A visiting library service could be offered. One lady appears to need a supervised walk each day. Service users said they could receive visitors when they wished. The inspectors spoke to several service users friends and relatives who said they felt the Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 12 home offered a good service. The registered provider said good links have developed with the local church and chapel. The registered provider said she looks after small amounts of money on behalf of one service user. Suitable records are kept regarding this. Service users said they either look after their own monies or these are managed by their relatives / legal representatives e.g. via power of attorney arrangements. Service users said they were able to bring small items of furniture and their belongings to the home. The inspector shared a meal with service users on the first day of the inspection. This comprised of meat pie, fresh vegetables and potatoes. For sweet, fresh fruit and yoghurt was served. The meal was to a good standard. The majority of service users said they enjoyed the food provided, although a minority said they did not like some of the food; particularly pre prepared meals / convenience foods, purchased from the supermarket. The registered provider acknowledged it was difficult to please every body, but emphasised service users were provided with a choice of meals, and effort was made to please everybody. The providers said convenience meals were only provided on two days a week, and other days fresh meat etc. was provided. The registered provider should continue to work with service users to increase satisfaction with meals provided. Service users said they had a choice of breakfast- and a cooked breakfast was provided some mornings. At tea times a choice was provided e.g. a cooked snack, cakes and / or sandwiches. Drinks are provided throughout the day. Special diets (e.g. pureed meals) are provided as required. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered providers have suitable procedures regarding complaints and adult protection, so service users and their relatives have suitable redress if they have an allegation of abuse, concern or complaint. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say who they would approach if they had a complaint or were concerned about abuse. The registered provider said all staff were required to read the adult protection policy when they commenced employment. Staff are encouraged to attend courses regarding adult protection although available places are limited. Staff and service users all said they had not witnessed any bad or abusive practices. It is of concern that Criminal Record Bureau / Protection of Vulnerable Adult checks have not been always completed appropriately (as discussed in the staffing section). This could undermine the work completed in the above areas. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Trelawney provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. The home is situated in a rural area surrounded by beautiful countryside. There is a pleasant garden, which service users can use. A bench is provided outside the back door for service users benefit. It would be beneficial if the garden furniture could be put out so service users can use the garden if they wish. All communal rooms are homely and comfortable, and bedrooms are individualised and comfortable. A lift is provided for service users to useunusual for such a small home. The majority of bedrooms have an ensuite toilet and shower. The showers however offer limited access for people with mobility problems and do not appear to be used. There is a bathroom which has a chairlift to enable access. The bathroom door however was not lockable, Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 15 and a lock needs to be provided-particularly as the bathroom contains a toilet. One bedroom had a slight smell of urine which the registered providers are trying to address. The registered provider is currently refitting the kitchen. This will be a significant improvement, although the current facility is clean and safe. The new kitchen will include a wash hand basin as required in previous CSCI reports. Satisfactory laundry facilities are provided. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this area is poor to adequate. The judgement has been made using available evidence including a visit to the service. There appears to be satisfactory numbers of staff on duty, although further recruitment needs to occur to increase staff numbers. Recruitment records of variable, and the absence of appropriate recruitment checks e.g. references and CRB /POVA checks on staff could put service users at risk. Evidence of training needs improvement. Staff must receive appropriate training as required by regulation so service users can be assured staff have suitable skills to cater for their needs. Equal opportunities issues regarding recruitment and work practices seem appropriately addressed. EVIDENCE: Rotas show at least two members of staff are on duty from 0800 to 2100. There is a waking night member of staff from 2100 to 0800.There have been some staffing problems which have resulted in only one care assistant being on duty during parts of the waking day. Mr or Mrs Gatzianidis have assured the Commission that on these occasions either one of them will cover the shift. They have also appointed a manager-Mark Thomas, who will also cover shifts. Mr Gatzianidis completes the waking night duties, and will also cook the meals the following morning. The Commission remains slightly concerned that Mr Gatzianidis may overstretch himself (e.g. working waking nights, and during part of the waking day) and this could affect service user care. However the registered providers are currently trying to appoint more staff to ease the problem. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 17 The registered provider has a suitable approach to providing National Vocational Qualifications for care staff. The inspector spoke to an NVQ assessor who said one of the staff has just enrolled on an NVQ 2 in care. Two members of staff said they were encouraged to complete NVQ qualifications. Evidence of training required by regulation is variable. Staff files inspected show some gaps in training required by regulation. This includes first aid, manual handling, infection control, handling of medication, food handling and fire instruction. All staff need to receive training in infection control, fire and manual handling. If staff handle food (e.g. from making a sandwich) they must receive suitable external training e.g. a food hygiene certificate. There must always be at least an ‘approved first aider’ on the premises. All staff handling medication must receive training from an external trainer e.g. a pharmacist. The inspector suggests staff complete short courses e.g. from the health promotion agency / primary care trust (infection control), St John’s Ambulance (first aid), the pharmacist (medication), local college (food hygiene). Video based training / Management instruction (fire). This should meet regulatory requirements. Some service users are becoming increasingly confused and / or have been diagnosed with dementia. Subsequently staff should be provided at least with a short course in dementia so they can develop an understanding of these peoples’ needs. Suitable evidence must be available to demonstrate staff have received appropriate training. For example copies of certificates. There must also be evidence when staff have completed their National Vocational Qualifications in care (e.g. a copy of the certificate.) Recruitment records were also inspected. Records were variable, and these did not contain all the appropriate information as required by regulation. All staff files must contain for example a copy of an application form (these were provided), a copy of two written references, a copy of a criminal records bureau check, a copy of a protection of vulnerable adults check-including a POVA first check (as applicable), a copy of e.g. a birth certificate to validate the person’s identity. A full list of information required is contained in Schedule 4 of the Care Homes Regulations 2002. Staff, the inspector spoke to, said they received an induction when they started work at the home. There is a copy of an induction checklist on most staff files. Some recruitment records are of cause for concern. For example on one application form there were gaps in a member of staff’s employment history which were unaccounted for. Some references were not obtained, and some staff failed to give their last employer as a referee. Some references were addressed ‘To whom it may concern’ rather than being addressed to the Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 18 registered provider. There was not a record of verbal references, and these were not followed up in writing. Criminal Record Bureau / Protection of Vulnerable Adults checks were not obtained for some staff, and these staff were not adequately supervised despite a previous regulatory requirement. For example on the afternoon of the second day of the inspection two staff were on duty, for whom CRB/POVA checks had been applied for but not obtained. Although the staff seemed pleasant and trustworthy, without the appropriate disclosures there is no evidence that service users are not put at risk. The registered provider has appropriate policies regarding equal opportunities and anti discrimination. The registered providers were able to demonstrate suitable knowledge and awareness of equality and diversity issues regarding the appointment and management of staff. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this area is poor to adequate. The judgement has been made using available evidence including a visit to the service. The registered providers appear to be suitably experienced and qualified to manage the home. However, they need to increase their focus to ensure regulatory issues are addressed. This will ensure residents receive a service, which should be consistently good in all areas. There is little evidence of quality assurance activity taking place. Subsequently the registered providers ability to demonstrate they are listening and addressing issues of concern from service users is limited. The registered providers approach to handling service users monies is satisfactory, so service users can be assured their financial interests are safeguarded, where the registered providers are involved in this area of their lives. The management of health and safety issues is poor and subsequently service users cannot be assured they live in a safe environment. EVIDENCE: The registered providers appear approachable, competent and have appropriate qualifications to manage the care home. The staff the inspector Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 20 spoke to said the providers were good to work for, and provided sufficient guidance and support to help them to do their jobs. Relatives of service users were positive about the registered providers approach. Most service users found the registered providers supportive and approachable. The Commission has received some concerns regarding the registered providers’ attitude but these have not been upheld. The report highlights some issues of concern regarding medication and staffing issues, some of which are renotified from the previous report. These present a negatively skewed picture of service outcomes, and these issues require urgent attention on the part of the registered providers. This is disappointing as many of the other service outcomes are very positive. The registered providers have realised their limitations, and employed a manager-Mark Thomas. Mr Thomas appears to have varied attributes, such as organisational and training skills, which should help the providers to address the shortfalls highlighted in the report. A second key inspection will be completed by April 2007 to reassess the key standards. The registered providers have a quality assurance policy, but there is no evidence this is implemented. The registered provider has said results of the previous survey were forwarded to the Commission following a requirement in the last report. However the Commission has no record of receiving this information, and the registered providers said they did not keep a copy of the report. A suitable quality assurance system must be introduced. This may for example include surveying service users and other stakeholders, introducing various quality assurance checks and /or having an annual development plan outlining improvements the registered providers intend to make. Staff, relative and /or resident meetings may provide a useful tool for ascertaining stakeholder views, and developing a plan for improvement if and where this is necessary. Any quality assurance system should include a plan to ensure the health and safety legal requirements, the National Minimum Standards for Older People, and any CSCI requirements are implemented. Generally the registered providers said they do not look after service user monies. They said the service user / their representative/ next of kin is invoiced for any agreed expenditure such as hairdressing. The registered provider said some support is provided to look after small amounts of money for one service user, for which suitable records are maintained. The registered provider has a suitable health and safety policy. However records of checks required by regulation are variable. There are suitable records that fire equipment is checked. For example records are kept regarding the testing of fire alarm call points and emergency lighting. The accident book is maintained, and there does not appear to have been any issues of concern. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 21 The lift and hoist were serviced, but it is not clear whether the recommendations made in the contractor’s report are legally required or have been implemented. The registered provider should seek advice on this, and take appropriate action as necessary. The home has oil central heating. The registered providers said this is serviced but no evidence was produced, and this needs to be available for inspection. There are no health and safety risk assessments, and these need to be developed as required by law. This should include a risk assessment regarding the prevention of Legionella. The electrical hardwire circuit does not appear to have been tested, and this is required every five years. Portable electrical appliances also have not been tested and these must be tested at least annually. Gaps in health and safety training are highlighted in the ‘Staffing’ section of the report. Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 22 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 1 Trelawney House DS0000053715.V293666.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP7 Regulation 15 15(2) (b) Requirement Timescale for action 01/09/06 Each service user must have a comprehensive care plan. There must be evidence that 01/09/06 care plans are reviewed regularly Deadline of 13/02/06 not met Second Notification 3 OP9 13 The registered provider must operate a safe system for storing and handling medication. The registered provider must ensure all staff handling medication receive suitable training (e.g. from the pharmacist) Staff must work under supervision at all times until a satisfactory CRB check has been received. Deadline of 17/11/05 not met Second Notification 01/07/06 4 OP9 13 01/09/06 5 OP18 OP29 18, 19 01/07/06 6 OP29 17, 19 Schedule 4.6. Staff must not commence work until a satisfactory POVA check and two references have been received DS0000053715.V293666.R01.S.doc 01/09/06 Trelawney House Version 5.2 Page 24 Deadline of 17/11/2005 not met Second Notification Other staff records required by regulation must be obtained for example evidence of identity (such as a copy of a birth certificate), CRB etc. as outlined within the Care Homes Regulations 7 OP30 18 The registered providers must 01/12/06 provide staff with suitable training to do their jobs and meet regulatory requirements. Suitable evidence of training must be maintained. Training must include fire training, food handling (if food is handled), infection control, first aid (i.e. there must always be a member of staff qualified to appointed person level on duty), manual handling. Staff must also have training in dementia awareness. The registered providers must 01/09/06 develop and implement an appropriate quality assurance system. This should include a process to ensure any CSCI requirements are implemented. The registered providers must 01/09/06 ensure health and safety standards are appropriately met. There must be evidence available for inspection that: (a) The boiler, and oil central heating system is serviced regularly e.g. annually. (b) Health and safety risk assessments are completed and reviewed at least annually. This should include assessing the risk of DS0000053715.V293666.R01.S.doc Version 5.2 Page 25 8 OP33 24 9 OP38 13 Trelawney House (c) (d) Legionella and outline any preventative measures. The electrical circuit (hardwire) is tested at least every five years. Portable electrical appliances are tested at least annually. 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. 2. 3. Refer to Standard OP12 OP15 OP38 Good Practice Recommendations Further opportunities for day /evening activities for service users should be explored. Continue to work with a minority of service users to improve satisfaction regarding meals provided. Seek advice whether the recommendations in the lift / hoist service report are legally required, whether failure to implement these could endanger service users. As necessary take appropriate action. Trelawney House DS0000053715.V293666.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: 0845 015 0120 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 Trelawney House DS0000053715.V293666.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!