Inspection on 04/05/05 for Tremona

This inspection was carried out on 4th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 15/11/05

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 Name Tremona 18 Alexandra Road Watford Hertfordshire WD17 4QY Lead Inspector Marian Byrne Unannounced 4th May 2005 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 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. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tremona Address 18 Alexandra Road, Watford, Hertfordshire, WD17 4QY Telephone number Fax number Email 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 228211 01923 226982 B&M Investments Ltd (Trading as B&M Care) Care Home, P C Care Home only 39 DE(E) Dementia over 65: 12 Category(ies) of OP Old age: 39, registration, with number of places Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/11/2004 Brief Description of the Service: Tremona is a three-storey detached building that offers 37 single occupancy 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. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried in response to complaints made by two staff members regarding the management of the home. The manager in question had left the home at the time of the inspection and had been replaced in the previous week by a new manager. In the past two and a half years there have been five managers in the home none of whom were registered with this commission. The inspection was carried out by interviewing service users and staff, by observing the delivery of care and by inspecting records and the environment. This was not a positive inspection. The lack of a stable management team was evident. One service user had been admitted to the home, the home could not meet her needs. The home was unable to keep her safe and she had left the home without the staff being aware on several occasions. On one occasion, she, was returned to the home by the police. This Commission was not informed of these incidents. Other service users were not safe as her challenging behaviour was unmanaged. Employment records were not complete in regard to the security check that must be made on staff. The dining room was used as the smoking room. This was very smoky at times and could cause problems for service users who don’t smoke. Service users themselves said they were well looked after. Door wedges were in use to keep fire doors open in the home. Care plans lacked the detail necessary to manage the care of service users. There was an odour that could be associated with incontinence in some of the bedrooms. What the service does well: Service users reported that the food is always good on the day of the inspection lunch was eaten with enjoyment. Staff are very keen to ensure the home provides a good service to the service users and stated that they are very keen to support the new manager. The new manager is keen to make the service work for the service users. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 6 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. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 standard(s) These standards were not inspected. EVIDENCE: Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10. Service users’ welfare was not protected, nor was the health care of one service user fully met. Care Plans and risk assessments were not comprehensive enough. Medication is not administered and recorded in accordance with approved guidelines. Interaction where observed between staff and service users was good. EVIDENCE: Inspectors witnessed one service user upset others. There were no effective measures in place to ensure this service user was protected from gaining access to outside dangers. One service user had bruises, there were no notes of this bruise in the daily notes or on her care plan. Medication were stored haphazardly, insulin was not stored in a refrigerated space. There were gaps on the MAR charts. There was medication left in containers with no explanation as to why it had not being administered. There was no letter from the GP or the service users’ family regarding the administration of Risperidone. The medication trolley was stored next to a radiator. Medication must be stored at no more than 25 degrees Centigrade to maintain its quality and potency. Where observed, staff treated service users with respect and dignity. Service users reported that staff were kind. At one point during the inspection the inspector could not find one member of staff on the ground floor where the Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 10 majority of the service users were. One service user who was very thin weighed 5 stone 3 lbs but her nutrition was not being monitored. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 15. On the day of the inspection there were no activities in the home. The food was of good quality and of good appearance and the service users appeared to enjoy lunch. There was a steady stream of visitors to the home during the inspection. EVIDENCE: There is an activities organiser in the home, she was not present on the day of the inspection. No alternative plans were in place in her absence. Care plans inspected did not contain enough information on the service user to ensure that the expectations, preferences, cultural, religious and recreational needs of the service users are being met. There were no restrictions on visiting. Lunch was observed and all service users appeared to enjoy their meal. Alternative main courses were available. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 standard(s) 18. The home does not follow a robust policy on the Protection of Vulnerable Adults. EVIDENCE: One staff member has a conviction on his CRB clearance. This was not followed up to gain full details to ensure that he posed no risk to the safety of service users. A staff member informed the inspector that she had concerns regarding the behaviour of a fellow staff member towards the service users. She reported this to her senior management. There was no evidence available that this was investigated under Hertfordshire’s Protection of Vulnerable Adults Policy. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 standard(s) 19, 20,25,26. The environment in Tremona does not ensure the safety of service users It fails through the use of door wedges and the inspectors found four exits from the home un-alarmed. The décor of the home was in the main of an acceptable standard. There were odours that could be associated with incontinence in several rooms in the home. The home lacked cleanliness. The dining room was very ‘hazy’ with cigarette smoke. Radiators were not made safe. EVIDENCE: One service user who has dementia found her way out of the home on several occasions. The inspectors found four exits from the home that were unalarmed. Service users could make their way out of the grounds of the home in this way. Door wedges were found in use in the home. There was faeces on the stairwell near room 20. The dining room is used as a smoking room, on the day of the inspection the room was ‘hazy’ with smoke. No risk assessment was available on how this environment effects the health of other service users. Radiators must have covers that protect service users from burning their very delicate skins. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29,30 None of these standards were met. The home fails to protect service users in its recruitment practices. The home fails to provide staff who are appropriately trained to do their jobs. EVIDENCE: One member of staff whose CRB check showed convictions had not had those convictions explored to ascertain if there was any risk to the service users. The home must ensure that all staff have up to date training and on moving and handling, food hygiene, and infection control. Staff must be monitored to ensure that this training is incorporated into their day to day working practices. This was not evident at this inspection. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,38. This home has had five managers appointed in the last two and a half years. None of these have been registered with the NCSC in the past or with CSCI now. On the day of the inspection yet another manager had been appointed the previous week. The Registered Providers B&M must ensure that Tremona is effectively managed and that the present Manager is registered with CSCI. It is not possible to state what the ethos of the home is. Staff displayed little regard for the welfare of service users or safe working practices by leaving the floor unattended. EVIDENCE: Staff spoken with were unhappy about the way they had been managed in the past. They informed the inspectors that the home was not managed in a way that was open or transparent. One member of staff informed the inspector that she had made a complaint to senior management about the way one of her colleagues spoke to service users. There was no evidence available that this was investigated under Hertfordshire’s Protection of Vulnerable Adults policy. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 16 Regulation 37 reports regarding the safety of one of the service users was not sent to this Commission (CSCI). Two members of staff approached this Commission with their concerns regarding the management of the home. Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 x x x x 2 2 STAFFING Standard No Score 27 x 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 1 1 1 x x x x x Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 18 Yes 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. 2. Standard 7 8 Regulation 15 (1) 14(1)(a) Requirement The Registered Provider must ensure that care plans reflect the needs of service users. The Registered Provider must ensure that the home can meet the needs of the service user admitted to the home. The Registered Provide must ensure that service users lifestyles satisfy their cultural and social needs. 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 unser section 37 of the Care Standard Act must be reported to this Commission. The Registered Provider must ensure that the safety of service users within the home is ensured. The Registered Provider must ensure that the home free from odours that could be associated incontinence. The Registered Provider must ensure that staffs training is up Timescale for action 30/06/05 Immediate and ongoing 30/06/05 3. 12 14(1)(a) 4. 18 37(1)(e) Immediate ando ongoing 5. 19 23(2)(a) Immediate and ongoing Immediate and ongoing 30/06/05 Page 19 6. 26 23(2)(d) 7. 30 18(1) Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 to date. 8. 31 8(1)(b)(i) The Registered Provider must ensure the home has a registered Manaager and is managed in a manner that meets the requirements of the Care Standards Act 2000. 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. The use of door wedges must cease failure to comply this requirement will lead to a Notice of lllllll Immediate and ongoing. 9. 9 13(2) Immediate and ongoing 10. 19 23(4)(a) Immediate and ongoing 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 Good Practice Recommendations Name Tremona I52 S19597 Tremona V224518 040505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 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. 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