Inspection on 12/08/08 for Tremanse Care Home

This inspection was carried out on 12th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tremanse Care Home 27/07/09

Tremanse Care Home 22/08/06

Tremanse Care Home 26/01/06

Tremanse Care Home 09/08/05

Tremanse Care Home 07/03/05

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Tremanse Care Home Fore Street Bodmin Cornwall PL31 2HR Lead Inspector Helen Tworkowski Unannounced Inspection 12th August 2008 10:00 Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 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 Tremanse Care Home DS0000061991.V367572.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 Adults 18-65. 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. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tremanse Care Home Address Fore Street Bodmin Cornwall PL31 2HR 01208 74717 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) Vivacare Limited Manager post vacant Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Tremanse is a large older style house situated in the centre of Bodmin. Whilst within walking distance of the town, the access to the home is up a steep hill for vehicles or through the garden for pedestrians, so that anyone with reduced mobility might have difficulties. The home provides rooms on three floors although not all are registered to provide care and accommodation. Those that are, are registered for people with mental health problems. There are communal rooms on the ground floor that comprises a large sitting room, conservatory and dining room. The kitchen and utility areas are on the ground floor. The garden in the front of the home has a level patio area, furnished with tables and chairs for people to use in fine weather. The company that owns the home also own a second, unregistered property behind Tremanse. There is limited car parking at the rear of the property. The fees structure and any additional information on charges are to be obtained from the Registered Provider. The Service User Guide and Statement of Purpose, that provides information about the home, are available in the care home office. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and took place between 10am and 7.15 pm on 12th August 08. Prior to this inspection the Commission required that an Annual Quality Assurance Assessment be completed, no completed form was received. We also sent surveys to both staff and the people who live in the home, none were returned and no one in the home knew about these forms. There is no Registered Manager, however a new Manager had been appointed and had started work on the day before this inspection. She was present in the home throughout the visit. As part of this inspection we looked around the building, we saw the communal areas of the home, and some of the bedrooms. We spent time talking with the manager and staff on duty, with some of the people who live at the home and had lunch and a coffee break with people. We looked at the way medication was managed and looked at administration records. We also looked at records in relation to care, to staffing and to safety in the home. What the service does well: All of the people at Tremanse with whom we spoke were generally happy with the service provided. One person commented that there was a warm feeling in the home and that it felt welcoming. A number of people have pets, and this adds to the feeling that this is a home. The meals in the home reflect people’s likes; their views are central to planning the menu. One of the people who lives at Tremanse described the food as “brilliant”. The staff we spoke with all had a very clear commitment to providing a good service. The people who live at Tremanse were satisfied with the care they received from staff. One person said that the care side was “brilliant”. There are care plans, which outline the care to be provided, and staff and the people who live at Tremanse sit down regularly together each month to review how things are going. The house is generally comfortable, and people are able to furnish their rooms in the way they choose. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 6 There is a good level of staff for the 14 people for whom this home is registered. What has improved since the last inspection? What they could do better: We found that in many ways the home was run in kind but rather institutional manner. There are a number of practices- such as putting sugar and milk in the teapot and using a tannoy system to announce meals that cannot be considered good or up to date practice. The facilities do not promote or encourage people to maintain their independence: there is nowhere to make tea, the kitchen has very limited access, and the laundry is kept locked. There were also unwritten rules that limit people’s freedom. Such rules need to be made explicit and to reflect the needs of the people at Tremanse. We found that the “call system” could be used inappropriately to listen in on people and was being used as a tannoy system. People who live at Tremanse could not switch this system off. There is a lack of record of assessment of people’s needs prior to moving to Tremanse, and in one case the information indicated that the home would be an inappropriate and risky place to live. However the admission still took place with no evidence of systems to protect the individuals concerned. We found that comprehensive risk assessments were not carried out where there were identified risks such as the risk of self-harm. Staff showed a high degree of commitment to the work, however no one had had any training in mental health, although this is the category of people the home accommodates. We were also told that there was no training in managing aggression though again this was an area staff had to deal with. Training in relation to moving and handling had only been theoretical. Until the day before the inspection there had been no manager in the home for some months. We found that during this intervening period people had not known who was in charge. The Commission had not been informed of any interim management arrangements. We were unable to look at the monies held on behalf of people in the home, or to look at contracts that related to their care. We were told that the lack of access to cash meant that staff were sometimes placed in the inappropriate position of loaning money to people. We also found that there were some concerns about safety in the building. Bedroom door locks could be locked so that no one could get in the room in an emergency, a fire exit was locked shut, fire doors were wedged open, and there were no risk assessments in relation to the risk of scalding or burns from hot radiators. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 7 We noted that there were 19 people living at Tremanse on the day of inspection. We were told that 15 of these people were in receipt of “residential care” whilst the other 4 were in receipt of “supported living”. The Commission is looking into these issues with the Provider. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People moving to Tremanse cannot be assured that their needs will be known, and therefore met when they move to Tremanse. Information about what a person can expect if they were to move to the home (Statement of Purpose and Service User Guide) is in need of updating and should better reflect the reality of life at the home. EVIDENCE: We looked at what the management and staff at Tremanse knew about two people who had recently moved to the home. We were unable to find any up to date assessments that had been completed either by someone working at the home or by someone such as a social worker or community psychiatric nurse. We were told that one of the individuals concerned had been accompanied to the home by her social worker and an assessment had been done then. However there was no record of this. There was also no information on file to indicate what sort of mental health diagnosis or needs this individual had. We looked at the information in the care plan about of one of the individuals who had moved to the home and found that there were a number of issues that might pose a risk. However the lack of assessment meant that there was no evidence that these additional risks were taken into account when a move to the home was planned. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 10 We were given a copy of two documents that contained information about the home: the “Statement of Purpose” and the “Service User Guide” or Clients Guide. The Clients Guide (Service User Guide) and the Statement of Purpose are in need of up dating as they do not reflect the current management arrangements. The Client Guide says that people will have opportunities for development, however during this inspection we found that there were many ways in which development was limited. For example drinks and meals are provided at set times, and there is little or no opportunity to cook or make a drink; access to the laundry is limited; residents are not allowed in each other’s rooms. The information about what a home aims to do must be accurate and reflect the reality for people who live in the home. If there are rules, to ensure that people can live amicably together, then these should be spelt out so that anyone thinking about moving to this home knows what to expect before they move. We were not able to see any contracts for anyone living at the home, as the people on duty did not have access to them on the day of this visit. All records relating to people living in a care home must be available for inspection. We discussed with staff their understanding of the support and care people were contracting for. It was unclear as to the nature of the service people should be receiving. This issue is to be followed up outside this inspection. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Tremanse are generally well supported, however the lack of good risk assessment means that actions may not be taken to keep people safe. Rules about life at Tremanse limit individual ability to make decisions and to take appropriate risks. EVIDENCE: We talked with some of the people who live at Tremanse about the help they receive and we looked at the information that was on file about the help people needed and how it was to be given. The people we spoke with were happy about the care and support they received at Tremanse. When we looked at the files we found that Care Plans identified what individuals needs are and described how they would be met. There were also bar and pie charts that identified areas of skill in different Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 12 aspects of life such as diet, hygiene, financial affairs. It was not apparent was how these assessments were made or the assessment tool that was used. Each month one of the staff meet with each individual and reviews their care needs. The reviews seen were comprehensive and well recorded. We were aware during this inspection that one of the staff and people who live at Tremanse were meeting together to complete such a review. Each of the plans seen contained information about any potential risk factors, and whether an additional detailed assessment was required. It was of concern however that it was not considered necessary for an individual to have more detailed risk assessment completed, even if the risk related to self-harm or suicide. We also found that one of the individuals had problems with mobility such that she needed a hoist to use the bath, however no moving and handling assessment had been carried out. The lack of pre-admission assessment and lack of in depth risk assessments means that the care plans will not cover all of the areas that the plan should. We looked at daily recording, and this did not reflect the much higher standard of recording set in the monthly care reviews. Daily recording tended to focus on meals and drinks. We asked some of the people at Tremanse about whether there were any “rules”, people told us that they could get up and go to bed when they chose, however there were a number of rules. One person said he was told about these by the other people who live at Tremanse. These rules included the people at Tremanse are not allowed to have another resident in their room and no visitors after 8.30pm. We were also told that meals and drinks are only to be taken in the dining room, the laundry is locked and people must be supervised when using it. Whilst it may be appropriate to have “house rules”, people who move to Tremanse should be clear what these are. Where it is necessary to limit individual freedoms this should be done through a multi disciplinary process this should be in the individual’s best interests. We asked about residents’ finances and we were unable to see any of the documents relating to contracts, benefits or money held on behalf of people at the home. We were told that people at Tremanse can only access money held by the home twice a week, and less frequently if the person who deals with this is away. Staff told us that this has sometimes meant that staff lend people at Tremanse money. Such transactions, whilst well meant, are not appropriate. People at Tremanse must be able to have reasonable access to their own money. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Tremanse are provided with a good standard of meals, There are very limited opportunities for people to maintain or develop any independence skills. Some activities are provided at Tremanse, however there are few opportunities for trips out, particularly for people who have difficulties walking. EVIDENCE: As part of our visit to Tremanse we ate a meal and had a tea break with the people who live at Tremanse. Both the lunch and tea had been chosen by residents whose birthdays fell on the day of the inspection. The lunch was well cooked, and was enjoyed by those who ate it. We talked to the cook about meals and was told that he spends time with each person and records their likes and dislikes, he discusses the menu with people and produces a menu to reflect their tastes. It was clear that a great deal of effort was taken to produce meals of a high standard that are enjoyed by all. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 14 We talked to the cook about whether there was sufficient food, and was told that at times the lack of access to cash meant that he had to spend his own money to ensure that the food that was on the menu was provided. He said that the lack of any stock of food meant that they had turned of freezers as they were empty. There was no evidence that service user had gone without food, however it was of concern that the arrangements for buying food were not robust and might not take into account an emergency. During a tour of the building we noted that there was a “call system” in each room. This system meant that individuals could call for assistance if they needed it, however the system also allowed staff to listen in on what was happening in any room, and to make an announcement to an individual or to all rooms. We were told that this system is used to call people for meals and for tea and coffee. One of the people we spoke to commented on how annoying it was to have this system. The general announcement system is indicative of institutionalised rather than personalised care and is poor practice. No one should have the ability to listen in on another person with out there being a specific agreement that this is needed. We were told that all drinks are provided at set times and there are no tea or coffee making facilities available. When we had tea with the people who live at Tremanse we found that milk and sugar had already been put in the teapot. This practice is more reminiscent of many long stay institutions that have now closed. The people at Tremanse should be able to have access to drinks when it suites them, to be able to make their own drinks, and to be able put their own milk and sugar in drinks. We were told that a few of the people who live in “supported living” accommodation cook their own meal once a week. However there are no cooking facilities for people who wish to develop skills or maintain existing skills. We asked about laundry and was told for people in the residential home, staff provide support. The laundry is kept locked when not in use, and the waking night staff do the ironing. On the wall in the dining room there are a number of leaflets about places that it was possible to visit, and also about activities on offer. We asked staff about going out to the locations advertised and was told that this had not been possible for some time due to the lack of transport. We were told that activities are provided in Tremanse, and we noted that this was the case. We spoke to people at Tremanse about how they spent their time. A couple of people said they went to an art class, some distance away, which they funded themselves. Another person was on a work placement. A number of people went out into town during the day. However as Tremanse is on a steep hill, some of the older residents would have difficulty accessing the town without transport. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Tremanse are provided with the care and support they feel they need. Medication is generally well managed, EVIDENCE: We observed medication being administered as part of this visit. Staff took care to ensure that people got given the correct medication and that this was recorded. Individuals were offered pain relief if it is prescribed. Records of administration were up to date, and staff had received training. There was no separate fridge for medication in that needed to be kept cool; we would recommend that the use of such a fridge be considered. Some of the people who live at Tremanse self medicate, and receive their medication once per week. Whilst there is a record of the medication being received into the home, there is no record of the weekly lots of medication being given to the individuals for self-administration. People spoken with said that they were happy with the support they received. People were well dressed and it was clear that they either had the ability to self-care or were given the support that they needed in this area. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 16 There were records of health checks on file, though we were told that most people did not have active involvement from a community psychiatric nurse. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are trained in relation to safeguarding and there are procedures to deal with complaints. However where there are potential risks to people, these have not been avoided nor were strategies put in place to reduce the risk. EVIDENCE: We asked people at Tremanse if they felt able to complain, and they said that this was the case. One person told us that she had complained that she had no key to her bedroom for the last two or three years but nothing had been done. Staff told us that no complaints had been received recently. We asked about whether staff had received training in relation to the protecting people from abuse and was told that all but the most recent staff had received training from the local authority. Staff spoken with during this inspection knew what to do if they had concerns. We asked about the systems put in place following the admission of an individual who had allegedly been abusive to one of the people already living at Tremanse. We were told that their had been accusations at first but that staff checked on where individuals were every few hours, at night. We were told that there is no specific guidance on this. Given that one person has allegedly abuse another individual, it of serious concern that these to individual were place in the same accommodation. It is of further concern that no specific arrangements appear to have been put in place to ensure their safety. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and comfortable, however risks to individuals have not always been assessed and appropriate actions taken to ensure safety. EVIDENCE: We looked around all communal areas of the home and some of the bedrooms. We found that the home was generally clean and in good order. Some of the people who live at Tremanse had personalised their rooms so that they reflected their tastes. To get to one of the ground floor ensuite bedrooms you have to go outside the building through the fire exit door, which cannot be opened from the outside. We asked how the individual who lives in this room gets into the home and was told that staff know when she needs help and go out to her and let her in, or she could use the call bell. The people who live at Tremanse should be able to readily access the communal spaces of the home. The use of such “external bedrooms” may be useful in some situations where independence is being promoted, however this was not such a situation. The home is to review the use of this room and ensure that there anyone who Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 19 occupies it is able to independently access the communal facilities and that any risks are assessed. We found that up to five of the bedrooms at the top of the house are occupied by people who were described as being in “Supported Living” rather than in receipt of residential care. It was of concern that we were not able to identify that the service they received was indeed a “Supported Living” service, as it appeared to be essentially the same as the service received by everyone else living in the care home. This matter is to be followed up with the Registered Provider. We were told that the people who lived at Tremanse did have keys to their rooms, and that staff were able to access the rooms in an emergency. However the locks are Yale locks, and by putting down the snib it is possible to lock the door from the inside so that no one could enter in an emergency. One of the people who lives in the home, told us she did this each night. The communal areas were generally well furnished and comfortable. However in the dining room we found that the dining chairs were too low to be comfortable to sit and eat at a table. This was made worse by some of the chairs being broken, so that the seat area sagged. It was also noted that there were insufficient dining spaces to accommodate everyone who was living at Tremanse. There is a large conservatory that is used for smoking, and is clearly a place where some of the people who live at Tremanse enjoy sitting. However one of the other people at the home did complain that this very sunny area cannot be used by people who do not smoke because of the smell and the affect on their health. We looked at the laundry, and found that the room was extremely cluttered, with cardboard boxes stacked on the boiler. This room is kept locked, which clearly limits its use. There were no proper hand-washing facilities in the laundry. We discussed with staff the storage of mops in the laundry that are used in the kitchen, and the need to review control of infection procedures so that any infections are not spread unnecessarily. We asked about moving and handling equipment and was told that the only hoist in the home was broken and awaiting repair. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff at Tremanse, they are highly regarded by the people who live in the home. The recruitment systems are not as thorough as is required. Staff have a comprehensive initial induction with on going training, however the training does not fully reflect the needs of the people who live at Tremanse. EVIDENCE: As part of this inspection we asked the people at Tremanse about the care staff. All commented that they were happy with the staff, and it was clear the staff and people who live at Tremanse were comfortable in each others company. We looked at records of recruitment; we found that whilst that there was a system of checks, that these were incomplete. Two references had not always been taken for each applicant, and there was no evidence that a check of a list of people who are considered unsuitable to work in a care home, had been checked. We were told that all staff completed a comprehensive induction procedure. We asked about training and that staff did receive training. We were told that they there was no practical element to the moving and handling training. Moving and handling is practical skill and people need to demonstrate their practical competence. We asked staff what training they had received in Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 21 relation to working with people with mental health needs. We were told that there had been no such training, and what staff knew they had learnt from their own reading. Staff expressed concerns that they had received no training in relation to dealing with people who might at times be aggressive. We asked about supervision, as there had been no manager for the last three months. We were told that senior staff offered support but that there was no formal supervision. There were four care staff, a cleaner, cook, deputy manager and recently appointed manager on duty on the first day of this inspection. This is sufficient staff for the 14 people that the home is registered to accommodate. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ethos of this home does not promote or maintain the independence of the people who live there. There have been periods in this home where there have been no clear management arrangements. Not all health and safety checks have been completed. EVIDENCE: The Registered Manager at Tremanse left the home in May 08 and the Commission has not been advised as is required of the management arrangements or of when a new manager is to apply for registration. When we visited the home we were informed that a new manager had started on the previous day, though as yet had not applied for registration. We asked the staff about the management arrangements that had been in place during the intervening period. We were told that no one had been told who was in charge Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 23 and that staff had done the best they could to deal with the situation and manage in the interim. We asked about visits by representatives of Vivacare Ltd, the Registered Provider. We were told that that visits did occur, however copies of any reports of these visits were not available as is required. It was also of concern that the Annual Quality Assurance Assessment that should have been completed prior to this visit had not been returned to the Commission. We asked about staff and resident surveys that had been sent to the home, no one knew anything about these surveys. We were told that until the new manager had started post was not opened on a daily basis. In looking at many aspects of the running of Tremanse it was apparent that the model of care was institutional rather than focused on the individual needs. Drinks are only available at set times, guests are not allowed in rooms, people are summoned to meals by a tannoy system, tea comes served with milk and sugar in the pot, and there is no access to the facilities that would maintain or promote independence. We asked if there was a system in place for assuring the quality of the service and was told that whilst some work had started on a system that there was nothing in place as yet. We were however told by people who live at Tremanse that they do have meetings about what happens in the home. In looking round the home we found that there were a number of concerns with regard to fire safety. One of the doors marked as a fire exit was locked and the key had been removed, fire doors to the kitchen, lounge and dining room were wedged open, the fire risk assessment had not been reviewed, and it was not clear if there were proper fire escape arrangements for people who live on the second floor. We were told that people did receive regular fire training and that that checks were made of water to ensure that there was no risk of Legionella infection. We asked about radiator covers as this had been a recommendation at the previous inspection. We found that only a few radiators had been covered in communal areas. We asked about risk assessments for those not covered and was told that there were no such assessments. We were told that there was plenty of hot water, and when we checked this there was. We found that the water was sufficiently hot that it could potentially scald. We asked if there were risk assessments in relation to this and was told that there were no such assessments. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 2 2 1 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 x 26 2 27 x 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 x 34 2 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 1 X 1 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 1 2 x x 1 x Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4, 5 Requirement The Statement of Purpose and Service User Guide (Client Guide) must be updated so that they include accurate information about the home as specified in the regulations. People must be fully assessed before they move to Tremanse. A copy of that assessment must be available for inspection. Contracts/ terms and conditions should be available of inspection and should accurately reflect the circumstances relating to the accommodation of each individual. Risk of self-harm, suicide, or aggression should be comprehensively assessed and action taken where appropriate. The home must have systems in place so that the people who live at Tremanse have reasonable access to their money. Staff must not loan money to residents. People’s ability to make decisions about their lives should not be restricted unless it is in their best interests, they lack DS0000061991.V367572.R01.S.doc Timescale for action 01/11/08 2 YA2 14 (1) 01/11/08 3 YA5 17 01/11/08 4 YA7 4 01/11/08 5 YA8 12 01/11/08 6 YA9 12 01/11/08 Tremanse Care Home Version 5.2 Page 26 7 YA16 12(4) a 8 YA23 13(6) 9 YA24 16(2)c 10 YA24 23(2) 11 YA26 13 (4)a 12 YA34 19 13 YA35 18 (c)i 14 YA37 38 capacity, and that it is appropriately discussed and recorded. The call system must be changed so that it is not possible to listen in on individuals without their consent, or be used as a tannoy system. There must be systems in place to ensure that people in Tremanse are protected from abuse. The furniture in the dining room must be suited to its purpose and in good repair, so that people can eat their meals in comfort. The use of the bedroom with external access must be reviewed. Any one occupying such a room must have ready access to all communal facilities and have been assessed as suited to use such a room. Bedroom door locks must be suited to the needs of the people and be capable of being readily over-ridden in an emergency. The recruitment procedure must include thorough checks, including taking two written references and ensuring that an individual has completed a “POVA” check before they are employed. Care staff must have received training where appropriate to ensure that they have the skills and competences to carry out their role. Where appropriate training in relation to mental health, moving and handling, and in relation to managing aggression must be provided. The Registered Provider must make appropriate arrangements for the management of the home prior to a manager being DS0000061991.V367572.R01.S.doc 01/11/08 01/11/08 01/11/08 01/11/08 01/11/08 01/11/08 01/12/08 01/11/08 Tremanse Care Home Version 5.2 Page 27 15 YA38 12 16 YA42 23(4) registered and must inform the Commission of these arrangements. The home must be run in a 01/12/08 manner that reflects current good practice that is based on individualised care rather than institutionalised practices. Effective fire safety precautions 01/11/08 must be in place. The advice of the Fire Authority must be taken into account in relation to locking fire exits, wedging fire doors, and accommodating people on the second floor of the building. 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 4 5 6 7 Refer to Standard YA20 YA20 YA26 YA29 YA30 YA42 YA42 Good Practice Recommendations A separate medication fridge should be provided for medication that needs to be kept cool. A record of medication given to individuals who self medicate should be kept. There should be sufficient space for all of the people who live in the home to sit down to eat in the dining room. The hoist should be repaired. Control of infection procedures should be reviewed in relation to the provision of hand washing facilities and in relation to the management of laundry. Risk assessment must be in place to manage the risk posed of scalds from hot water particularly in baths and showers. Risk assessments must be made to manage the risk of injury from hot radiators. Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tremanse Care Home DS0000061991.V367572.R01.S.doc Version 5.2 Page 29 - 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. 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