Inspection on 11/11/08 for Trelowen

This inspection was carried out on 11th November 2008.

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

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

Other inspections for this house

Trelowen 08/01/07

Trelowen 12/01/06

Trelowen 19/04/05

Trelowen 05/10/04

Trelowen 05/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Trelowen 1 Blowinghouse Lane St Austell Cornwall PL25 5AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Trelowen 1 Blowinghouse Lane St Austell Cornwall PL25 5AT 0172665366 0172666775 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anne-Marie May Type of registration: Number of places registered: Home Farm Trust care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Trelowen is a care home registered to provide personal care and accommodation for up to 7 adult service users with a learning disability. The home is in a residential area of St. Austell and conveniently placed for service users to access community facilities. The Home Farm Trust have recently completed building work at the home to provide 2 additional ground floor bedrooms and additional communal space. Service users are accommodated in single rooms on the ground and first floors, the new rooms have en suite bathrooms and toilet facilities, with over head tracking to assist service users with additional physical disabilities. 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place on the 11th November 2008, over a period of approximately 6 hours. The inspection included: discussion with staff, a tour of the premises, examination of relevant documentation, and the inspector met with some of the people that live there. We also looked at the responses from surveys received from the people that use the service and others, which were sent out prior to the inspection. The staff have a good understanding of the care needs of the people that live at Trelowen, and the overall rating reflects the staffs continued hard work to meet the needs of the residents. Care Homes for Adults (18-65 years) Page 5 of 26 Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a current statement of purpose and service users guide that provides information about the home in an appropriate format. A thorough assessment is always carried out for all prospective residents. Evidence: The people that live at Trelowen have a wide range of complex care needs and capabilities. The registered manager and staff confirmed that when everyone is home they routinely split the group into two to cater for their different needs and interests. The current ages of the population range from mid twentys to early sixtys. The inspector was advised that the statement of purpose and service users guide is currently under review, and once completed will be provided to all residents and/or their representatives in an appropriate format (e.g. braille, spoken word, video). There is a need for alternative formats to ensure that people have the information they need. The staff assist the people that live at Trelowen to maintain good links with families and people important to them. Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: There have been no new admissions since the last inspection. The registered manager and staff are fully aware of the need for a proper pre-admission assessment, and this has been carried out for previous admissions to the home. The home currently provides care and accommodation for 6 people. One resident experienced a gradual introduction to the home before admission took place, and this included a visit for a cup of tea, a visit for an evening meal, and then an overnight stay. The fee for care and accommodation ranges from 800 pounds per week. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents, who are involved to the best of their capabilities in decision-making and self-determination. Evidence: The registered manager and staff demonstrated a detailed understanding of the complex range of needs that are presented by residents and the care plans inspected detailed how the relevant support is provided. The plans of care involved health care issues, and residents aims and aspirations in educational or social interactions. The plans of care are developed with input from other agencies, such health or the Department for Adult Social Care (DASC). The care plans were seen to be informative and provided direction to staff how to meet the care needs of the resident. There was insufficient evidence that care plans are reviewed at the frequency stated in the national minimum standards and with the involvement of the resident and/or their representative. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Daily records were seen to be sporadic (in one instance only 4 entries made this month), though when made, informative of the residents day and lifestyle, including choices made. The use of the HFT computer system (SPARS) was discussed at length. The inspector was advised that staff had received instruction from HFT Senior Management not to record daily entries if the event was specified in the care plan. The Commission consider the daily entries to be an important contribution to the evidence of the care actually provided and the lifestyle of the people that live at the home. Staff also described difficulties in the use of the SPARS system (you might wait 15 minutes to log on). The staff confirmed that residents do enjoy varied activities, and described how residents would be involved in decision making. The residents have key staff to assist them. Training for staff about the Mental Capacity Act is being arranged. The staff do liaise with other professionals to ensure the rights of the residents are safeguarded, and their right to self-determination is not compromised. Residents were seen to be assisted discreetly and sensitively. Risk assessments are completed for various aspects of residents needs, capabilities, and activities, and include instruction how the identified risk is to be managed. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social and recreational opportunity is provided in keeping with known preferences and capabilities. Residents engage with the local community, and all have appropriate contact with people important to them. Residents rights and capacity as adults is recognised. A balanced diet is provided. Evidence: The residents, staff, and care records confirm that residents are involved in a range of appropriate leisure activities and maintain contact with people important to them. Staff did say they would like to see a greater range of activities, though the inspector was advised that this is dependent on the care hours available and existing arrangements (e.g. purchased time at day centres). One resident has made friends through participation in public/community activities, and there are plans in place for an educational course in the new year. Two residents have work placements. The staff Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: recognise the residents right to determine their own waking day within the parameters of meeting their health care needs, but this is not reflected in the daily care notes. Residents are able to choose when to be alone or in company, and when not to join an activity. Staff were observed to knock before entering residents rooms. Contact with family members and friends is encouraged and assisted where necessary. Social/recreational activities are recorded in individual plans and the home provides appropriate staff to support these activities. The parent organisation has its own vehicles to assist residents attend appointments, events, or meet with people important to them. The residents at home at the time of the inspection interacted freely with the staff and the inspector. Interactions between staff and residents were seen to be adult, friendly, and professional. All staff have a responsibility for meal preparation and relevant training has been undertaken. The kitchen is domestic, well equipped and clean. The inspector was shown a pictorial menu tool, which is used to help residents make choices. Some residents have a hot meal whilst out on activities during the week, but there is always a hot meal option available in the evenings. There is a paper record of the diet provided, though staff agreed that this could be recorded on SPARS. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of residents are met with evidence of promoting privacy, dignity and good multi-disciplinary working taking place. Evidence: The care records, and discussion with the registered manager and staff show that the residents waking day is flexible, within the parameters of their care plan. The staff ensure that the residents receive health care services as required, and in accordance with the residents known preferences. Staff keep contact records for all healthcare professionals and services in the daily notes. The care plans detail health care needs and how these are met. All residents are registered with local GPs. Daily records and correspondence document the monitoring and addressing of residents healthcare needs and referral to appropriate healthcare professionals and specialist workers. A number of residents have regular contacts with consultants and other clinical specialists for specific health issues. The medication records, procedures and storage facilities are appropriately maintained. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Medicine Administration Records (MAR) were seen to be in order. The policy and procedure covers the required areas, and there is a record of receipt and disposal of medicines. Records of administration were consistently signed and appeared well maintained, and included a photo of the respective resident. Staff who administer medicines have completed a course in the safe handling of medicines. The MAR are written by staff, and countersigned once checked for accuracy. There is no evidence of the actual prescription made, and discussion took place as to how this could be obtained (e.g. fax repeat prescriptions, thereby keeping the original). Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were seen to interact with staff in a relaxed manner. The staff have a clear understanding of Adult Protection issues and procedures that will protect residents from abuse. Evidence: The people that live at Trelowen are enabled to maintain contact with relatives and friends, and external agencies through visits and telephone calls. The homes complaints procedure is not currently provided to residents or their representatives (see comments on the Statement of Purpose and Service User Guide). The home has a policy and procedure regarding complaints and concerns. Neither the home nor Commission for Social Care Inspection have received any complaints since the last inspection. Advice regarding various forms of potential abusive situations and procedure are available to staff and are raised during induction training. The home has a written policy and procedure for protecting residents against abuse and supplementary guidance on the nature of abuse. Staff have undertaken relevant training. Home Farm trust are fully aware of the need for prompt reporting of any concerns. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of furnishings and fittings is generally good and residents live in a safe, clean, and homely environment. Improvements are needed in recognition of changing care needs. Evidence: Everywhere was tidy, pleasantly decorated and furnished in a homely way. The bedrooms seen were personalised, reflecting individuals interests and preferences. Residents appeared to be very satisfied with the accommodation and facilities provided. Rooms are well furnished and comfortable. The Home Farm Trust have increased the registered numbers from a maximum of 6 to 7 residents. Two en-suite bedrooms with overhead tracking and an additional communal space have been provided. Trelowen provides a homely and comfortable environment in a domestic style dwelling. There is ramped access to the front and rear. The single bedrooms are individually decorated and furnished. The home was clean, warm and hygienic. The laundry is small and fitted with domestic washing machine and dryer. The inspector was advised that there is an almost daily need to clean fouled linen and Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: clothes. The home is not provided with alginate bags for fouled laundry, and the existing equipment does not provide a sluice cycle and hot wash. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider encourages and promotes staff training. The home adheres to a robust employment procedure. Staffing levels provide flexible support to the residents. Evidence: There is normally a minimum of 3 members of staff available to provide for the welfare of residents. A sleeping night care worker is provided for people that may require attention at night and an on call support system is provided. The registered manager is advised to encourage entries in the care notes (SPARS) by night staff and to monitor care activity at night (review the dependency levels of service users and the staffing required). A discussion with staff confirmed that a stable staff team is available that is providing continuity and a consistent approach to care. The staff team are involved in NVQ training, six staff having achieved NVQ Level 2 or above, with a further 2 about to commence this training. Other training has been completed in first aid, food hygiene, health and safety, moving and handling, dementia, epilepsy, diabetes, makaton, and autism. Staff were confident in their Knowledge of the service users needs, and were observed to exhibit a positive regard and appropriate attitudes in their interactions. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: Inspection of the personnel file of the most recent employee demonstrated adherence to a robust employment procedure. Staff records and the staff confirmed that they receive regular supervision. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide for the safety and welfare of residents, though some checks are overdue. The home does have a registered manager. Evidence: The registered manager has successfully completed the registration process and the completion of the Registered Managers Award (RMA) and units of NVQ level 4 in Care are conditional to this registration. The registered manager advised the inspector that she anticipates completing the RMA at the end of this month. Staff said that they had confidence in the registered manager, and confirmed they felt supported in their roles. The staff expressed their approval of communication systems and staff meetings occur at regular intervals at the home, one was planned for the day of the inspection. A senior HFT manager completes a monthly report on the conduct of the home, and this has been developed and expanded to be a comprehensive internal quality assurance (QA) tool. The inspector was also shown a new QA tool, which is being developed to ascertain the views of the people that use the service and/or their representatives. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: Records showed that fire precautions are maintained, that health and safety checks are completed and the homes liability insurance was appropriately displayed. Relevant maintenance and safety records are generally up to date, with the exception of the following: electrical appliance testing (due July 08); confirmation of the date and findings of the last hard wiring inspection is requested; gas safety certificate expired October 08. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 37 9 The registered manager is 31/03/2007 required by regulation to obtain the NVQ 4 and Registered Managers Award to demonstrate she is qualified to run the home and meet its stated purpose of providing for service users with complex learning disabilities. Home Farm Trust and the registered manager are required to submit proposals and timescales to comply with this regulation. Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered manager should ensure there is a current service user guide and statement of purpose in an appropriate format. The registered manager should review the collective care needs and expectations of the residents to ensure that no individual is disadvantage by virtue of age or capability. The registered manager should ensure this is taken into consideration for new admissions. The registered manager should ensure that daily entries reflect the care provided (as directed by the plan of care) and the lifestyle of the residents. The registered manager should ensure there is evidence of prescription for the medicines administered. The registered manager should ensure that people know how to complain. The registered manager and registered provider should consider the option available to improve the laundry facility. The registered manager should implement the proposed quality assurance tool to ascertain the views of the residents and their representatives about the service provided by Trelowen. Page 25 of 26 2 3 3 7 4 5 6 20 22 30 7 39 Care Homes for Adults (18-65 years) Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - 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!