Inspection on 26/01/06 for Tremanse Care Home

This inspection was carried out on 26th January 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 found no outstanding requirements from the previous inspection report, but made 4 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 12/08/08

Tremanse Care Home 22/08/06

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 Announced Inspection 26th January 2006 09:30 Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 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.V271984.R01.S.doc Version 5.0 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.V271984.R01.S.doc Version 5.0 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.V271984.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2005 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 immediate access to the home is up a steep hill 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.There is a garden in the front of the home with a small level patio area. The company that own the home have also purchased a second property, currently empty, behind Tremanse but sharing a common driveway. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out on a weekday between 09.30 am and 5.0pm. The inspector examined records, spoke to service users, (although not all wished to talk) and staff, plus a relative who was visiting. The premises were inspected with the responsible individual who was in the home on the day of this inspection. All the rooms were seen including those that are not registered as providing care under the Care Standards Act 2000. Redecoration is on going giving the property a much needed facelift and using lighter colours. The registered provider has purchased a quantity of new furniture. It looks attractive but on closer examination the inspector felt not all the items were suitable for the purpose for which they were intended. What the service does well: What has improved since the last inspection? What they could do better: The redecoration is on going. The registered provider &/or responsible individual need to consult with the registered manager and service users before buying various items, especially Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 6 furniture, to ensure that it is what is needed, as identified by those who will be using it. Attention needs to be given to assessing the risk of unguarded hot radiators and providing covers for them. 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.V271984.R01.S.doc Version 5.0 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.V271984.R01.S.doc Version 5.0 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): 1,5 Information about the home and its services is available, full & given to all service users. It was not possible to ascertain whether the service users had read and fully understood it. EVIDENCE: The statement of purpose was re-read prior to the inspection & a service users guide was seen in some bedrooms. There have been no new service users as all the registered beds are full. Service users have signed their contract from the home, which specifies fees and their payment source and states that people have had copies of the terms and conditions of residence at Tremanse. The registered manager commented that there have been considerable delays in receiving contracts, or renewals, from the funding authorities. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 9 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 Service users’ needs are reviewed regularly and involve the person concerned so that goals and risks can be recognised and agreed. Everyone is given opportunities and encouraged to contribute their thoughts about the care and services provided, with confidentiality regarded as important. EVIDENCE: A sample of seven plans was inspected. These showed that each service user has a care plan that is set out clearly with goals and action. Risks are noted with warning signs and advisable intervention recorded. There may be trigger factors that could be included for some people. Care plans are reviewed each month and completely revised six monthly. Of the care plans seen all had been had signed by the service users and staff member. The registered manager commented that one person had elected not to do so and this had been noted. As well as having input into their care plans service users can voice their opinions about the home in the regular residents meetings or in any one:one discussion. The registered manager said she felt the atmosphere in the home was much calmer than in previous times (due largely to a change in Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 10 ownership) and that service users were gradually beginning to express their views more. Confidentiality of information is stressed at all times and staff sign the policies regarding this. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 11 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): 11,12,13,14,15,16,17,18 The service users are encouraged to be active and independent with opportunities for leisure and activity sought in house and the community. Family contact, where this exists, is encouraged with choices about who and who not to see etc respected. Meals are usually taken together but a wish not to do so would be noted. EVIDENCE: Staff try to establish people’s interests and then seek outlets for these both inside and outside the home in order to foster personal development. Reviews for a number of service users have been requested from the Social Services Department and/or the mental health team but the response has been poor or very slow to materialise in most cases. However service users do attend various clubs, day centres, drop in facilities etc that gives them the opportunity to meet other people and try new skills. Travelling alone or with an escort depends on an individual assessment of the situation but independence is promoted as much as possible. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 12 Only about half of the people living at Tremanse are still in touch with families but contact is sought wherever possible. Social interaction is promoted at mealtimes with everyone being encouraged to come to the dining room. The wish not to do so is respected but if this persists, a tactful enquiry would be made as to the reason. Service users who bothered to comment were generally satisfied with their food. A good selection is kept so, for example, some days people can choose to have a cooked breakfast if they wish. The main meal is taken in the evening when everyone is in, with a lighter sandwich lunch being provided at midday. The registered manager commented that food was a frequent topic at house meetings. Sample menus were provided for the inspection and the selection for the day was written on a board for people to choose. The Environmental Health Officer inspected the kitchen in June 2005 and left a satisfactory report with three minor requirements. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 13 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 Service users are assisted with whatever level of help they need, with their physical and mental health being regularly monitored. Medication is carefully recorded and administered with steps being taken to ensure mistakes do not occur. EVIDENCE: Generally the service users’ physical health is not giving cause for concern and they attend their local Health Centre on an ‘as needed’ basis. A few instances of age related physical symptoms were beginning to show themselves. A record of people’s functional ability (i.e. ability to wash, dress, walk independently etc.) would be helpful especially if difficulties are present, as this will provide a point from which any changes can be monitored. Services provided by professions supplementary to medicine, such as chiropody, optical & dentistry are arranged. There was a discussion about the delays the home had experienced when help was needed from the Adult Mental Health team for one person in particular. Medication is carefully stored and recorded. Staff have taken part in the Safe Handling of Medication training and have a further course booked. Boots, who supply medication in a monitored dose system, audit the home’s practice Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 14 annually. The home will promote self-medication if they feel a service user could manage this successfully. It is gradual process and monitored carefully. The inspector feels that if someone might be able to move onto looking after his or her own medication this should become an aim in the care plan so that progress & success is recorded. There are currently no controlled drugs in the home. The registered manager said that illness and dying is discussed within the staff team as few staff have had experience of this to date. It is the home’s policy to care for anyone as long as the staff are able, with the appropriate support. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 15 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 Information is available to service users and help would be given to anyone wishing to make a complaint. The home takes the Protection of Vulnerable Adults (PoVA) seriously as staff are aware that the service users living at Tremanse could easily fall into this category. EVIDENCE: The home has a complaints policy which is included the statement of purpose. Staff said that the service users were not afraid to voice their opinion if they had a problem. Help and advice would be provided. A complaint is currently under investigation by the registered manager. PoVA issues are raised during National Vocational Qualifications training and places have been booked on the current ‘Whistle Blowing’ seminars organised by Social Services. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 16 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): 24,25,26,27,28,29,30 The home was clean and warm. Service users are at liberty to use the communal areas or remain in their own rooms as they wish. The décor is being improved but the new furniture is not entirely satisfactory. EVIDENCE: The inspector walked round the home, service users’ rooms in particular, with the responsible individual. She commented that it had been sometime since she had last seen the service users’ rooms. Redecorating is on going throughout the home. Individual rooms are being painted and re-carpeted; the hall and ground floor passage are lighter with the use of white paint rather than dark stain. The rest of the property is designated for attention gradually. Never the less some rooms are very dark due to the proximity of the surrounding buildings and walls. The registered provider has bought a quantity of new furniture from abroad. It looks attractive but in the inspector’s view it does not fulfil its purpose satisfactorily. There are six compactum type cupboards. These are big and two in a double room has reduced the available space and light for the service users. Further inspection revealed that there is no hanging space in them so their use as a clothes storage facility is limited, especially for women who may Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 17 have dresses etc. The drawers were very heavy to open when full. If one comes out when pulled, it could cause an injury. New chairs have been provided for the dining room. These are a ‘tub’ type design. Again they look attractive but are not supportive for anyone’s back. Staff will have to be observant and provide a cushion if a need is indicated. The sitting room was warm and had comfortable chairs and sofas. Service users were watching television and all those who wanted to watch had a clear view of the screen. The conservatory has, by agreement, been designated as the smoking area. It was cold in there, despite additional heating, as it was a cold day outside. Bathrooms, showers and toilets were all seen to be clean. It was noted that there is a shower, wash hand basin & WC between rooms 4 & 4a. The door between 4 & the washing facilities was bolted and the inspector got the impression that they were used solely by the occupant in 4a. This means that room 4 has no wash hand basin. There is an additional complication in that 4a has to be accessed from outside as the alternate route is through room 4 which is not satisfactory. Clarity needs to be given to the use of these two rooms, especially whether or not the washing facilities are en suite to one room or a shared facility. Either way there appears to be a need for an additional wash hand basin in one of the rooms. There are no radiator covers in the home. Some radiators were very hot to the touch. Risk assessments and preferably guards need to be put in place now. The laundry is large and copes with the volume of washing that is required. There is a satisfactory system to keep clean and dirty washing separate. The burn mark on the ironing board showed that a very hot iron must have been left on the board for a long time as the covering was burnt down to the metal. This indicates a serious fire hazard and greater vigilance, or supervision, is required. It was noted that a room on the top floor is used for the member of staff who sleeps in at night. As there are no service users occupying registered rooms on the top floor but there are on the first floor, consideration should be given to moving the sleeping room to a small room on the first floor. In this way the member of staff will be more easily accessible to the awake staff and any service users who may need help. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 18 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 Staff were pleasant and friendly. They were seen to be spending time with the service users, engaging them in activities and conversation. All have or are receiving training appropriate to their work. EVIDENCE: A selection of staff records was inspected. There is a file for each person containing evidence of the person’s application, job description, Criminal Records Bureau check, contracts, supervision notes and training. Staff views as to the quality of services provided by the home have been sought. Staff are required to sign to say that they have read and understood the home’s policies and procedures. The registered manager said that all staff, bar one new person, have got or are doing National Vocational Qualifications courses, levels ll & lll. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 19 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): 37,38,39,40,41,42 The home is being well managed. The records, policies and procedures needed to support this are in place and properly maintained by the registered manager. There is a need to address the potential risk from hot radiator surfaces to ensure that Tremanse maintains a good health & safety record. EVIDENCE: The registered manager has her National Vocational Qualifications at level lV and has one final unit to complete her Registered Manager’s Award. She promotes the service users’ well being as has been seen in the records when additional help has been needed for them. Five service users had completed a Comment Cards on how they found living in Tremanse. All said they liked living there, none wished to be more involved with decision making in the home and none indicated that they wanted to talk to the inspector – although some in fact did, albeit briefly. The home as recently gained its Investors in People Award. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 20 Records required by statute are kept. The accident records were seen – there have been very few. Any incidents or events notifiable under Regulation 37 have been forwarded to the Commission. Fire training and equipment/alarm testing is up to date. A First Aid course is been organised as a refresher for staff. Documentation regarding the maintenance of equipment and systems was supplied. The lack of radiator covers has already been mentioned but thermo-static control valves have been fitted to hot water outlets. A risk assessment on potential hazards within the property has been carried out. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 2 2 2 X 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tremanse Care Home Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 X DS0000061991.V271984.R01.S.doc Version 5.0 Page 22 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 YA9YA42 13.(4) 2 YA26 16 Regulation Requirement The registered provider must assess the risk to service users from unprotected radiators and take action to reduce the risk. The registered provider must provide furniture that is suitable for the purpose for which it is intended The registered provider must ensure that rooms 4 & 4a each have adequate washing facilities. Timescale for action 01/03/06 01/03/06 3 YA26 22 01/03/06 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 Refer to Standard YA6 YA33 Good Practice Recommendations Service users care plans should include an assessment of peoples functional abilities. The sleeping room for staff should be on the first floor rather than the second so that it is in closer proximity to service users. Tremanse Care Home DS0000061991.V271984.R01.S.doc Version 5.0 Page 23 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.V271984.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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