Inspection on 31/07/06 for Tremona

This inspection was carried out on 31st July 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

Tremona 09/08/07

Tremona 15/11/05

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 Yoke-Lan Jackson Unannounced Inspection 31st July 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 Tremona DS0000019597.V306531.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 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.V306531.R02.S.doc Version 5.2 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.V306531.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Tremona, provided by B & M Care, is a residential care home for 39 service users in the Old Age category, some of who may have dementia. The home is situated in a residential area within walking distance from the town centre of Watford. There are parking spaces to the side of the building and in front. The home charges £400 - £620 per week The building is a three-storey detached house with 37 single bedrooms and one double bedroom (for a couple). The bedrooms are on the first and second floor with toilet and bathroom facilities nearby. All floors are served by a lift. The administrative office, the laundry room, kitchen, dining room and all 4 lounges are on the ground floor. The home has a large back garden and a patio with attractive garden features and ample seating for service users. The garden is wheelchair accessible. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 31/06/06. The Registered Manager and the Care and Development Manager were present. The home has 38 service users. The inspection began in the dining room where the service users were waiting to be served their lunch. Several service users were eager to give their feedback about the care and service provided. A number of relatives and members of staff were interviewed. This was followed by a tour of the premises. Documents were examined. The inspection ended with a detailed discussion with the managers. (See below for details of the inspection findings). What the service does well: What has improved since the last inspection? The home has been in the doldrums for sometime. There have been significant improvements in the standard of care and service since the appointment of the current manager a year ago. She has responded to this inspection with an immediate action plan and is proactive in her approach to endeavour to improve the service and to raise the standard of care and service above the National Minimum Standards. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 6 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.V306531.R02.S.doc Version 5.2 Page 7 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.V306531.R02.S.doc Version 5.2 Page 8 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. Standard 6 is not applicable. Prospective service users have the information they need to make an informed choice. A pre-admission assessment is conducted. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a revised Statement of Purpose, a copy of which was submitted to the Commission. A service user interviewed said that his daughter viewed the home on his behalf and made the appropriate arrangements before he moved into the home. Another service user said that he made all the arrangements himself. Both said that they are “happy living in the home”. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 9 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. Service users are treated with respect and their right to privacy is upheld. Each service user’s health, personal and social care needs are set out in their written care plan. Service users have access to healthcare services to meet their assessed needs. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has recently revised the format of the written care plans. The latter have been updated to reflect the changing care needs of the individual service users. Further revision is required to include those with dementia and other medical conditions. All the service users share the same communal space regardless of their physical and mental health status. One service user with dementia is given the freedom to pace the corridors, as she prefers, and the choice to have her meals wherever she likes, with staff supervision. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 10 The service users have opportunities for appropriate exercise and physical activities. On the day of the inspection, the activity co-ordinator was busy accompanying some service users on a walk down the road. Service users have their own doctor, who visits them regularly. On the day of the inspection, the district nurse was changing the leg dressings of a service user. All medicines are now kept in a storage room. A cooling unit was installed to maintain the room temperature below 25 degrees centigrade. An additional locked door is to be constructed within the storage room. Some Medication Administration Record (MAR) charts examined had handwritten notes that were not signed or dated. All handwritten notes must be signed and dated by the author. A 3 month printed MAR chart should be obtained from the supplying Pharmacist for one service user. There are a number of service users whose medication should be reviewed by their doctor to ensure that prescribed medicines that are no longer required are returned regularly to the pharmacy. (See Statutory Requirements). Tremona DS0000019597.V306531.R02.S.doc Version 5.2 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): 12, 13, 14, 15. Service users find the living experience in the home suits their expectations and preferences. They are encouraged to exercise control over their lives and to maintain contact with families and friends. The activities provided are varied and flexible to suit individual service users. The meals provided are wholesome and nutritious. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: All the service users interviewed praised the staff in the home and are generally satisfied with the service and care given. One said, “The care is excellent. I have no complaints”. Another said, “I chose this home myself and I am very satisfied.” It was noted that the activity co-ordinator was busy escorting service users for a walking exercise before lunchtime. An individual file was kept for each service user in regards to their activities and their likes and dislikes. The Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 12 activity of the day was handwritten on the notice board. A copy of the planned programme is kept in the home record on activities. There were several visitors in the home on the day of the inspection. The visitors interviewed gave very positive feedback about the management and staff. One relative said, “This is the second time a family member has moved into this home because of the excellent staff and care given.” The lunch served on the day included a hot dish of meatballs and spaghetti. One service user remarked that “it looks good and it tastes good” Others had alternative dishes as requested. Lunchtime was unhurried. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 13 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. The home has a robust Complaints Policy and Procedure. Service users’ legal rights are protected. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Registered Manager investigates any complaints or concerns raised by service users, relatives and others. Immediate action is taken to resolve any issues raised. Staff have training on issues concerning the protection of vulnerable adults. They are aware of the Whistle-Blowing Policy. The home follows the Adult Protection Procedure of Hertfordshire Social Services Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 14 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, 20, 22, 23, 24, 25, 26. The interior décor and furnishings do not have a homely and comfortable appearance. Some of the bathrooms have no assisted facilities for service users with restricted mobility. The dining room lacks space for the current number of service users and is accessible with difficulty for wheelchair users. The interior and the surrounding grounds have hazards to safety. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: On the day of the inspection, the dining room was packed with 35 service users, including wheelchair users, relatives and staff. Members of staff have to squeeze in between the back of the chairs and the wheelchair to serve the meals. Relatives were left standing around. The entrance from the dining room door to the patio was partially blocked by chairs and wheelchairs. These are hazards to safety for service users, relatives and staff as hot meals are being served. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 15 In addition, the entrance to the dining room seemed narrow as a member of staff struggled to manoeuvre a wheelchair user into the dining room. The door was kept ajar at a 90 degrees angle. The service user was not able to place her feet on the footstool because of restricted mobility. This daily performance is a risk to safety for both the wheelchair user and the staff. The patio itself has objects that are tripping hazards. The entrance to the French door appeared unsafe. The sloping pavement is slippery. Again, a member of staff had difficulty pushing a wheelchair user into the dining room from the patio end. On the day of the inspection several doors were kept open manually with chairs. All doors must be kept open with automatic hold-open door devices approved by the Fire Authority. The décor in the entrance hall gave a very positive impression about the environment the service users live in. However, the décor in the corridors and some communal rooms gave the place a dreary look. The brown coloured handrails may blend-in with the wallpaper and the dark coloured carpet but it does not aid the service users with sight impairment. A contrasting colour would be more appropriate and practical. The ‘dirty’ appearance of the carpet does not help the appearance of the place. It would benefit the service users if the décor could be changed to a brighter colour scheme. Some of the bathrooms and shower rooms are not used to their full potential because they have no assisted facilities to aid service users with restricted mobility. Staff tend to use the remaining 2 bathrooms that have assisted facilities. It is recommended that the provider and management review the premises and the facilities provided to ensure that service users live in a safer, more homely and more comfortable environment. (See Statutory Requirements and Recommendations). Since the inspection, the manager has made alternative arrangements for some service users to have their lunch in one of the 3 lounges, which has been transformed into a lounge-diner as suggested. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 16 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, 29, 30. Service users are supported and protected by the home’s recruitment policy and practices. The number and skill mix of staff ensure that the care needs of the service users are being met adequately. The staff training programme has been updated. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Registered Manager ensures that the interview and selection process will identify experienced and quality staff. The recent advertisement has resulted in the employment of 4 senior carers who will soon commence working in the home. The management aims to increase the number of bank staff over the next few months. There are a number of applicants going through the interview and selection process. The training programme for staff is being updated. Staff are trained in relevant topics to ensure that the changing care needs of the service users are being met. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 17 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): 32, 33, 34, 35, 37, 38. The administration and management of the service have improved since the appointment of the current manager. In general, the health and welfare of the service users are promoted and protected. However, the manager must ensure that service users are not exposed to unnecessary risk. The home’s record keeping, policies and procedures have been updated. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The registered manager must ensure safe working practices. On the day of the inspection, the surrounding ground appeared untidy and there were tripping hazards in the premises both internally and externally. Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 18 The personal allowance for the service users were properly recorded and accounted for. The home has a current Liability Insurance Certificate and the CSCI Registration Certificate was on display. The quality monitoring system includes written survey questionnaires. Data has been collected and the management is in the process of correlating the data to produce a report, a copy of which will be forwarded to CSCI. (See Statutory Requirements and Recommendations). Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 19 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x 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 2 x 2 2 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 3 3 X 3 2 Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No 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) 17(1)(a) Sch.3(i) (a) Requirement Changes or additions to instructions on the MAR charts must be signed and dated by the author. A 3 month printed MAR chart should be obtained from the supplying Pharmacist for one service user. All prescribed medicines that are no longer required should be reviewed and returned regularly to the pharmacy. The registered manager must ensure that unnecessary risks to the safety of the service users are identified and as far as possible eliminated. All doors must be held open only with automatic hold-open door device approved by the Fire Authority. (Rectified) Timescale for action 15/08/06 (b) 2. OP19OP38 13 (4)(c) (a) 08/08/06 23(4) (c)(i) (b) Tremona DS0000019597.V306531.R02.S.doc Version 5.2 Page 21 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 OP19 Good Practice Recommendations It is recommended that the provider and management review the premises and the facilities provided to ensure that service users live in a safer, more homely and more comfortable environment. It is recommended that the number of assisted bathrooms be reviewed to ensure that they are sufficient in numbers to meet the needs of the service users. 2. 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