CARE HOMES FOR OLDER PEOPLE
Trembaths Talbot Way Letchworth Hertfordshire SG6 1UA Lead Inspector
Louise Bushell Unannounced Inspection 22nd February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Trembaths Address Talbot Way Letchworth Hertfordshire SG6 1UA 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) 01462 481 694 01462 485 606 home.let@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mr Alan Dickinson Care Home 41 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (15), Old age, not falling within any other of places category (41) Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. This home may accommodate 15 older people who require personal care. This home may accommodate 15 older people with dementia who require personal care. This home may accommodate 31 older people who require nursing care. The home may accommodate one named service user who is currently under 65 years of age. The manager must inform the CSCI when this named service users leaves the home or reaches the age of 65, whichever comes first. This variation only applied to this named service users and ceases to be in force when he leaves the home or reaches the age of 65, whichever comes first. 21st April 2005 Date of last inspection Brief Description of the Service: Trembaths is a two-storey, purpose-built care home providing nursing, personal care and accommodation for 40 persons over 65 yrs of age. It is owned by Methodist Homes and is situated in a quiet residential area of Letchworth within easy reach of the town and shopping facilities. All bedrooms are single with en suite wash hand basin and toilet. The ground floor comprises a self-contained unit for 15 persons with dementia. The ground floor has its own lounge, dining room, kitchenette, 4 assisted bathrooms and three separate assisted toilets. Also on the ground floor are a main lounge, a hairdressing salon, an administration office, a smaller office, the main kitchen, the laundry room and a staff dining and changing room. The second floor is divided into 2 units for a total of 25 persons requiring nursing care. Each unit has its own lounge, dining room and kitchenette and shares 5 assisted bathrooms and 4 assisted toilets. The managers office is located on the first floor. To the front, the home affords ample parking spaces. It has a very pleasant rear garden, which is securely enclosed, with a patio, a circular concrete path, a summerhouse and a gazebo. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection of the year, taking place during the morning. This was an extremely positive inspection, reflecting the positive comments made by both service users and staff. This visit aimed to inspect the remaining core standards that were not inspected during the last visit. The reader is encouraged to read the last report in conjunction with this report to ensure a entire view is gained of the home. Where information has remained the same from the last report this has been carried forward to this report. What the service does well:
NVQ completion in home is excellent, with almost all of the team having completed at least NVQ level II. This is a commendable level, ensuring that all care staff have had this training available and have been supported in the process of completion. Supervision and appraisals are continued to be offered and feedback from staff spoken to confirm that the process was effective and a useful tool. Records were well maintained for all staff. The home offers a comprehensive and extremely well structured induction programme for all new employee’s. This ensures that core skills and a value base practices are established prior to working with the service users. The environment continues to be maintained to a high standard with both internal and external decoration being well maintained and presenting a homely feel. All service users rooms are decorated to personal taste and all are encouraged to personalise their rooms. During the inspection the views of a visitor to the home was sought, many positive comments were made in respect of the home in general a visitor summed up the home as being “a wonderfully caring and compassionate source.” A wide range of activities are provided and employs a specific activity coordinator is employed to work with service users who have dementia. Feedback from service users confirmed the range of activities available and comments were received stating, “we always have fun and like the music and games.” The home has 3 small kitchenettes, which are based on each area of the building. There is one main large industrial kitchen where all main meals and lunch’s are prepared. The kitchen is very clean and well maintained. Records observed were precise and well organised. The menu is a four-week rolling menu, all service users have a variety of choices available to them and are
Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 6 actively empowered and encouraged to make choices. The menus are seasonal, offering an array of meals and options. An extremely detailed and effective quality assurance system is in place, actively seeking the views of the service users, relatives and other visiting professionals. The internal audits occur every 6 months with specific auditors in the home covering a range of measurable indicators. What has improved since the last inspection?
A new style and system for care planning has recently been introduced. The system, although in its implementation stage appears very effective ensuring all service users needs are met, through a system of continuous reviewing to meet changing needs. This continues to evolve and is an effective system meeting needs of al service users. The home also now holds core team leaders meetings for all team leaders that manage the shifts on the ground floor. This ensures continuity of working practices and empowers leadership amongst the developing team. Following the last inspection an additional service has been introduced. This is through the use of a holistic therapist who is completing massage with a number of service users. Feedback from service users has been positive regarding this service. Following the last inspection a number of areas have undergone internal redecoration, this includes a kitchen refit and general redecoration of lounges and communal areas. Pictures have been added to the dementia unit with images relating to historical facts; this was encouraged by the dementia accreditation team and increased the visual aptitude of the home. The staff and management team are currently integrating a new uniform system for the staff that are working on the dementia unit, this involves the use of different brightly coloured tops to encourage visual recognition and stimulation for the service user group. The sensory garden is now complete and is a very well presented relaxing area for all to enjoy. An additional garden area has also been transformed for service users and this has a small water feature. A new 42-inch TV has been purchased for the main lounge and can now provide film nights for service users. All staff have recently received an awareness course in Alzheimer’s Disease and feedback received was very positive. A new training matrix has been devised showing training completed by all. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Service users are appropriately supported in the management of their medication so their welfare is protected. EVIDENCE: The home uses the Manrex system of blistered medicines. Records are kept of medicines received and their administration to service users. Records were kept in a good order with accurate booking in of prescribed medicines. The senior nurse in charge, manages the administrations of medications and completes the reordering as required. Qualified nurses and team leaders administer medicines to service users and the home’s pharmacy offers training to staff. The pharmacy also carries out audits within the home every three months. The NMC code of practice for the use of covert administration of medicines is fully adhered to and all relevant documents were in place. Currently no service users self-administer their medication. Medication systems and the internal management and audit has greatly improved. A number of recommendations have been made to further aid in the effective management of medicines.
Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. EVIDENCE: These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. EVIDENCE: These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. EVIDENCE: These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. EVIDENCE: These standards were not inspected on this occasion. The reader is encouraged to refer to the previous report for further information. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Suitable systems are in place for the management of financial issues and thus ensuring that service users rights and welfare is safeguarded. EVIDENCE: Secure facilities are provided for the safekeeping of money and valuables on behalf of the service user. Records and receipts are kept of possessions handed over for safekeeping. The registered manager may be appointed as an agent for a service user only where no other individual is available. In this case, the manager ensures that, the registration authority is notified on inspection and records are kept of all incoming and outgoing payments. Where the money of individual service users is handled, the manager ensures that the personal allowances of these service users are not pooled and appropriate records and receipts are kept. Written records of all transactions are maintained. The registered manager ensures that service users control
Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 16 their own money except when they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 18 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 OP9 Regulation 13 (2) Requirement All medicines must be stored as prescribed. All medicines must have a date opening added upon opening. All medicines must be administered as prescribed, where omissions occur accurate coding must be entered to the MAR. Timescale for action 14/04/06 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that the manager records the temperature of the medication room daily. It is recommended that the sample signature sheets are available on each floor for auditing purposes.
Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 19 Trembaths DS0000019596.V285173.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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