Inspection on 22/08/06 for Tremanse Care Home

This inspection was carried out on 22nd August 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tremanse Care Home 27/07/09

Tremanse Care Home 12/08/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Tremanse Care Home Fore Street Bodmin Cornwall PL31 2HR Lead Inspector Philippa Cutting Key Unannounced Inspection 22nd August 2006 09:45 22/08/06 Tremanse Care Home DS0000061991.V303566.R02.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.V303566.R02.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.V303566.R02.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 Suzanne Vanda Dennis Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 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 find it difficult. It 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 clement 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. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place between 09.40 and 15.40 on a weekday (Tuesday). The inspector spoke with service users, staff and the registered manager. The records & care plans relating to service users were sampled and checked, as were maintenance documents. Information relating to this was received prior to the inspection from the registered manager. The premises were inspected. Redecoration has been on going in the home and is continuing. The first impressions on entering the home is that it is now much lighter and brighter as the dark stained woodwork that prevailed in the hall has been glossed white. Bedrooms are also being decorated in turn with new carpets etc laid. Some of the furniture that has been purchased looks attractive but is very large for the size of the rooms and, as was noted at the last inspection, the internal fittings of cupboards are not practical, as they do not provide hanging space. At the time of this inspection the atmosphere in the home seemed more relaxed than on previous inspections and staff commented that a number of the service users are mixing more and spending longer periods in the sitting room. Records were well organised and presented in clear format. The overall impression was of a well organised home that offers good care for the service users and good support for the staff. Fees range between £290.00 to £480.00 What the service does well: What has improved since the last inspection? What they could do better: Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 6 The programme to provide radiator covers need to be completed for health & safety reasons. 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. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 7 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.V303566.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5, These standards were shown to be well met with service users being provided with information about the home and its services. Not all chose to read the information but staff will spend time explaining it. People have the opportunity to visit before deciding whether or not to live there. The views and mix of current service users are sought before deciding whether or not to make an offer of accommodation. EVIDENCE: The service user group is generally stable but a new service user has recently taken up residence. He was provided with a service users guide which the registered manager said she spent time going through with him. The statement of purpose has been reviewed and updated as needed, mainly in relation to staff details. It is available for all service users but the majority have taken little heed of it. The prospective service user was invited to spend time in the home, including an overnight stay before deciding whether or not to seek admission. Good details were obtained prior to this from the agencies involved and the home sought further details of their own. Signed contracts of care were seen in service users’ files. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 9 The home has demonstrated that it will address problems constructively when it can no longer meet the needs of service users, referring them on to other agencies as appropriate. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 The outcome group for these standards is judged as excellent. Records are clear, complete and reviewed regularly. The physical aspects of care as well as the psychological needs of service users have been included in care plans so that a more comprehensive picture is maintained. Service users are encouraged to be involved in decision-making regarding the home and provided with opportunities to do so. EVIDENCE: Care plans are provided in a clear format that contains essential personal information, assessment of psychological needs and risk areas. Trigger factors to look out for are listed where necessary. The care plans have now added a brief assessment of service users’ functional abilities. This is good as some of the service users are beginning to experience difficulties associated with ageing. A key to the scoring is needed to ensure consistency. Entries in records are signed and dated. Service users are encouraged to participate in reviews and sign these. The registered manager said that the service users are all aware that records are kept and that they could read Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 11 entries if they wished although people rarely expressed any interest in doing so. Some people who prefer to spend the majority of their time in their rooms come and tell staff what they have been doing, knowing that this will be included in a daily record. Regular meetings are held with the service users and staff where everyone is encouraged to express their point of view. This is minuted and where possible actioned – quickly if it relates to menus or more information gathered if there is a query re activities etc. People can raise concerns at these meetings or speak privately to a member of staff or the registered manager, as they prefer. Care plans are made available to all staff so that they can check on any details but as they are usually involved in any reviews or updates they are aware of the contents. All staff are made aware of the importance of confidentiality in regard to information concerning service users. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 The outcome for this group of standards is good. There are limitations on what can be arranged to improve people’s lifestyle outside the home as the facilities in the area generally are not abundant and some people’s motivation is diminished but staff have become more involved in planning activities with service users in house, with a good response. People’s privacy is respected and they are encouraged to be in charge of their lives as much as possible. Help or advice is provided where service users experience difficulties in making choices and support is offered to carry decisions through. Meal times are part of the social process and are taken together in the dining room. Choice is offered at each meal with drinks or snacks being available at other times although some choose to buy their own snacks or additional ‘takeaway’s to eat or keep in their rooms. Tremanse is very much regarded as the service users’ home and they are encouraged to be as independent as possible within it. EVIDENCE: Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 13 There is a dearth of meaningful activities in the local community for anyone with mental health problems but where ever possible service users at Tremanse are encouraged to participate in day centres or ‘Fit for Life’ schemes. Staff help people seek out opportunities that interest them and provide support as needed to attend sessions. The majority no longer have meaningful family contacts but where these or other friendships exist they are encouraged, although in some cases with certain agreed constraints. Activities are being encouraged within the home; these are usually instigated and led by staff who keep a note of what was done and people’s participation. The inspector was shown those relating to discussion groups that had been held. Staff commented that more service users are joining in and whilst some may express strong opinions, they will respect opportunities for others to comment. Smoking is tolerated in the home but only in a designated area. People are asked to respect this and in some cases have agreed that staff should hold lighters etc for safekeeping. People can go into town regularly or visit other local centres further afield according to their wishes. Service users are asked to sign in and out when leaving the home for reasons of safety in case of any emergency. The registered manager said that asking people to be responsible for this themselves was a relatively recent innovation and she was pleased with the positive response. Everyone is encouraged to come to the dining room for their meals although these would be served in a person’s room if they were unwell. The menu is displayed daily and offers a choice, including one at breakfast. The chef discusses preferences with service users and tries to accommodate these. Diets for diabetes or weight reduction are provided; any other dietary requirements would be addressed on an ‘as needed basis. Opportunities are made for service users to helping the kitchen, either by clearing away after meals or by simple meal preparation. Generally service users said they liked the food both the quantity and variety. It was noted though that whilst health eating was prompted a number of people supplemented their diets with fizzy drinks and biscuits etc of their choice, bought in town. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The personal & healthcare needs of service users are well met with service users’ wishes being taken in to account. For example, service users can be accompanied when attending the Doctor or clinics if they want but a preference not to do so would be respected. Staff are aware that some service users are beginning to experience ageing problems but not all are happy to use equipment such as mobility or hearing aids that might assist them. In such instances advice is sought and then a way to assist that is acceptable sought. The importance of correct medication procedures is recognised and supported by the home’s policies and procedures that are reviewed and updated periodically and with regular staff training. EVIDENCE: The registered manager said that the service users are registered with local health centres in Bodmin. They tend to use the same one as the doctors there have developed an understanding of the service users’ particular problems. People are offered well man/well woman checks in addition to any other specific symptoms that may need attention. The home has support from local Community Psychiatric Nurses although its efficacy can be variable. They visit regularly to administer certain medication or to provide advice /participate in a review with service users. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 15 Reviews with other agencies and consultants are sought as needed but the registered manager commented that she sometimes has difficulty in getting support when it is needed and it may take persistence on the part of the home to achieve this. Medication is kept locked when not in use. It is supplied in a monitored dose system from a local pharmacy. All staff are encouraged to learn about medication and be able to administer it after assessment and training according to their ability. The home has written policies and procedures relating to the receipt, storage, administration and return of medication. It has been updated recently. All staff attend a ‘safe handling of medication’ certificated course. The majority of medication is administered by staff on behalf of service users but if, following assessment, people wish to undertake this for themselves, it is recorded and monitored discreetly. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 These standards are judged as having a good outcome as staff are aware of the service users’ vulnerability and provide opportunities for them to voice concerns either formally or informally. EVIDENCE: All staff, but the registered manager in particular, are readily available for service users who may have a problem or concern that they wish to raise. To date there has been little need to use the ‘official’ complaints procedure. The protection of vulnerable adults (PoVA) and an awareness of abuse was discussed with staff. There has been difficulty in getting enough places for staff on the ‘whistle blowing’ seminars currently being run across the county but this is gradually being addressed. Issues relating to abuse are raised in National Vocational Qualifications training so staff are aware of the need for vigilance. They recognise that some of the service users may be particularly vulnerable to unscrupulous people they meet and they try to offer help to prevent such situations from arising. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,30 The outcome for these standards is satisfactory- there is still room for improvement but progress is being made to upgrade the fabric and furnishings in the home. The location and layout of the home does mean that it would not be so suitable for anyone with marked mobility problems. EVIDENCE: The home as a whole is improving as redecoration is taking place. Some rooms are still dark although trimming back trees has helped. When asked people said their rooms were alright. No one commented that they were dissatisfied with their accommodation but it is possible that some service users have lived in constrained circumstances for a long time before coming to Tremanse so that they might not think to question their surroundings. There are showers and bathrooms available although the some are small, apart from one bathroom that is large enough to allow a carer to assist a person who may have mobility problems. As some of the service users are ageing staff should consider asking for advice from an Occupational Therapist about suitable bath aids &/or rails to assist them in getting in & out. Communal space is provided on the ground floor with an area in the lounge away from the television for people who do not want to watch. Televisions and Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 18 music centres etc were seen in various bedrooms, indicating that people had a choice of viewing and leisure entertainment. The conservatory has been designated as an area where smoking is permitted in the home. At the time of this inspection it was a comfortable temperature, clean & tidy. Service users had been using the conservatory to house grow bags for tomatoes. There was additional seating provided outside the conservatory on a patio. The registered manager said that it was likely that the present office would be moved to a smaller room to enable the office space to provide a new bedroom. The use of rooms on the top floor, which are not currently registered, is also under consideration. It has been noted on previous inspections that the furniture in the bedrooms – cupboards in particular - & the dining chairs are more decorative than functional. The seats on a couple of dining chairs had given way, making them uncomfortable. The laundry for the home is done in a large area that houses the boilers so that there are always drying facilities. The laundry appeared to be reasonably well organised; staff explained the procedure for keeping clean & dirty washing apart. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 These standards were seen to be met with a good outcome as attention is given to training for staff, relevant for their needs. Service users appeared to feel comfortable in approaching staff with any comments or queries and staff demonstrated a good knowledge of people’s needs and preferences. EVIDENCE: Staff records are kept securely in individual files. These were seen to contain references, Criminal Records Bureau checks, a job description and signed contracts. Training is afforded a high priority with different courses being identified in supervision sessions. One of the files that was sampled showed how a member of staff had progressed from an initial appointment to becoming one of the senior staff members. The registered manager said that she was considering with the staff how the new induction training ’skills for life’ would be introduced. Service users are consulted when a person is interviewed as a potential new member of staff. They are invited to meet anyone who is being shown around the home. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 The registered manager’s input means that the daily management for the home is good with clear directions and purpose. Evidence of support from the responsible individual is lacking. The policies and procedures that staff adhere to mean that service users are provided with a good quality service at all times and one that takes account of their health, safety & well being. EVIDENCE: The registered manager is experienced and holds her registered manager’s award. She is currently involved with another home as the responsible individual. This has revealed difficulties that have engaged her time but the staff team is sufficiently effective that Tremanse can cope with this. Open management is encouraged with the views of service users and staff being sought. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 21 The most effective way of managing quality assurance is under consideration as the service users do not all wish to make comments; however their views are sought as much as possible. The home has policies and procedures that are available for reference. The records required by statute are maintained properly. Health & safety is monitored regularly with checks being made on electrical goods, Legionnella, gas etc. Tremanse Care Home DS0000061991.V303566.R02.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 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 x Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 YA6 YA24 YA29 Good Practice Recommendations A key to ensure consistency in scoring functional and personal activities of daily living should be provided. The programme to provide radiator covers must continue and be completed as soon as possible. Advice should be sought from a qualified Occupational Therapist regarding the provision of suitable bath aids and/or grab rails. Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 24 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 Tremanse Care Home DS0000061991.V303566.R02.S.doc Version 5.2 Page 25 - 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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