Inspection on 15/11/05 for Tremona

This inspection was carried out on 15th November 2005.

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

Other inspections for this house

Tremona 09/08/07

Tremona 31/07/06

Tremona 04/05/05

Tremona 11/11/04

Tremona 24/08/04

Tremona 27/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tremona 18 Alexandra Road Watford Hertfordshire WD17 4QY Lead Inspector Marian Byrne Unannounced Inspection 15th November 2005 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 Tremona DS0000019597.V266560.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 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. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tremona Address 18 Alexandra Road Watford Hertfordshire WD17 4QY 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) 01923 228 211 01923 226 982 B & M Investments Limited (Trading as B & M Care) Jacqueline June Hall Care Home 39 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (39) of places Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: Tremona is a three-storey detached building that offers 37 single occupancy rooms and one that can be offered for shared occupancy. It has four lounges, a dining room and a hairdressing salon as well as a range of support function. There is a secure rear garden which contains a number of attractive features as well as ramps and a level footpath to enable access to service users with impared mobility. The Home offers a variety of activities and encourages service users to maintain community links. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over one day. It was a positive inspection despite the requirements left. The manager and staff have worked very hard to improve the home and the living experiences of service users at the home. Service users informed the inspector that the home is a happy place and that they are much happier since the new manager took over. While this was a positive inspection there is still much work to be completed particularly on the environment and the care plans. The staff were positive and reported that they felt very well supported by the manager. What the service does well: What has improved since the last inspection? 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. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 6 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 Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 7 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): 1,2,3,4,5. An up to date statement of purpose is not available. Service users had a written contract. All service users are assessed prior to moving into the home. All service users have their care reviewed. Service users and their representatives are invited to visit the home prior to moving in. EVIDENCE: The home must provide an up to date Statement of Purpose for prospective service users. Where inspected service users had contracts. All service users are assessed prior to admission to the home to ensure that their needs can be met. They are then invited to visit the home prior to admission and following admission they are given a six week period to decide if their needs are being met. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 8 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): 7,8,9,10. Some care plans identify service users needs. Service users have access to health professionals. Medication is administered appropriately. Service users were treated with respect and dignity. EVIDENCE: Care plans were being reviewed at the time of the inspection. Because care plans are not up to date it is not possible to know if all the needs of service users have been identified and are being met. Good progress has been made and the manager is aware of what information must be included in a care plan. All service users have access to health professionals who are called in to attend to service users appropriately. Medication was administered and recorded appropriately however the storage of medication must be reviewed. The Registered Manager had identified an area where the medication trolley could be stored to ensure that the temperature the medication is stored at is controlled. Controlled medication must be stored in line with the guidelines of the Royal Pharmacutical Society. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 9 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): 11,12,13,14,15. Daily life and social activities meet the service users needs. There was no restriction on visiting. The food was of good quality. EVIDENCE: On the day of the inspection the home was very lively. On approaching the home the inspector could hear laughter and lively conversation. The home has an activity organiser who was including many service users in activities that day. She had very good interaction with the service users particularly those who have dementia. The home welcomes visitors at all reasonable times on the day of the inspection there was a constant stream of visitors. There are good connections with the local community and some of the service users use the local facilities. The inspector tasted the lunch and found it to be presented nicely and tasty. The staff had a very good interaction with the service users at lunchtime. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 10 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): 16,17,18, Service users are protected from abuse. EVIDENCE: The staff spoken with on the day of the inspection were aware of the Whistle Blowing policy and the protection of vulnerable adults. They were able to talk the inspector through what they would do should they be aware of any incidents of abuse within the home. The home has a complaints procedure. There were no complaints since the last inspection. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 11 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): 19,21,26. Areas of the environment do not meet the needs of the service users. EVIDENCE: There was an odour that could be associated with incontinence in the corridor outside the dining room. This corridor was dimly lit and uninviting. The downstairs bathroom does not have any bath aids and the service users who live on the ground floor have to use the upstairs bathroom. The shower room upstairs is used as a storage area. There is an alarm on the front door which sounds when the door is open this alarm is very loud and intrusive. The home must find a less intrusive way of alerting staff of visitors. New furniture has been purchased for the sitting rooms. The sitting rooms were bright and clean. The dining room is in constant use. The service users sit there to read newspapers and to meet their visitors. There is ample space to see visitors in private should they wish. Service users use all the sitting rooms at different times depending on their moods and requirements. The front of the home is very social and lively while the back is quieter. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 12 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): 27,28,29,30. Service users needs are met through the recruitment procedures and the staffing of the home. EVIDENCE: The home has a core of well trained and dedicated staff. Staff spoken with were able to give the inspector details of the training they had received this included all the core training required. Service users were very complimentary about the staff and how their care is delivered. The new Registered Manager has conducted and audit on all staffing files and has identified and addressed any paperwork not available this included some Criminal Records Bureau checks. All staff who are working now have the required identity and security checks in place. One staff member who is on an extended holiday had a photocopy of a CRB check. This is not sufficient and must have original up to date paperwork. The Registered Manager is aware that this member of staff cannot work unsupervised until this security check is in place. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 13 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): 31,33,35,38. The home is run in the best interests of service users. Policies and procedures are in place to ensure the safety of service users. EVIDENCE: Since the last inspection the Manager was registered with this Commission. She has worked very hard to improve the home. She has conducted out of hours inspection herself and has addressed bad practices in the home. Service users appear to hold her in high regard and informed the inspector that they are much happier in the home since she became manager. Staff informed the inspector that they felt well supported and that the manager was very approachable. The needs of service users is the focus of the home. All equipment pertinent to the health and safety of the service users was maintained and serviced appropriately. Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 14 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 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 3 Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 15 Are there any outstanding requirements from the last inspection? YES 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 OP8OP7 Regulation 15 (1) Requirement The Registered Provider must ensure that care plans reflect the needs of service users and that the needs are met appropriately. This standard was not met. The Registered Provider must ensure that the home can meet the needs of the service user admitted to the home. This standard was met. The Registered Provide must ensure that service users lifestyles satisfy their cultural and social needs. This standard was met. The Registered Provider must ensure the safety and protection of service users by following robust recruitment policies The home must report all POVA incidents to CSCI and all incidents reportable under section 37 of the Care Standard Act must be reported to this Commission. Timescale for action 30/06/05 2. OP8 14(1)(a) 04/05/05 3. OP12 14(1)(a) 30/06/05 4. OP18 37(1)(e) 04/05/05 Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 16 5. OP19 23(2)(a) This standard was met. The Registered Provider must ensure that the safety of service users within the home is ensured. This standard was met. The Registered Provider must ensure that the home free from odours that could be associated incontinence. This standard was not met. 04/05/05 6. OP26 23(2)(d) 04/05/05 7. OP30 18(1) The Registered Provider must ensure that staffs training is up to date. This standard was met. The Registered Provider must ensure the home has a registered Manager and is managed in a manner that meets the requirements of the Care Standards Act 2000. This standard was met. The Registered Provider must ensure that medication is stored at no more than 25 degrees Centigrade. The recording of medication administered must reflect the medication administered. This standard was not met. The use of door wedges must cease failure to comply this requirement will lead to a Notice of legal action being taken. This standard was met. The Registered Manger must ensure that the home has a Statement of Purpose as set out in the Care Standards Act 2000. 30/06/05 8. OP31 8(1)(b)(i) 04/05/05 9. OP9 13(2) 04/05/05 10. OP19 23(4)(a) 04/05/05 11 OP1 4 31/12/05 Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 18 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 © 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 Tremona DS0000019597.V266560.R01.S.doc Version 5.0 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!