Inspection on 09/08/07 for Tremona

This inspection was carried out on 9th August 2007.

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 31/07/06

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 9th August 2007 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.V348284.R01.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.V348284.R01.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.V348284.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: Tremona is a residential care home provided by B & M Care 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 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. The home charges £400 - £620 per week. Further information can be obtained from the Statement of Purpose and the Service User Guide. A copy of the CSCI inspection report should be available in the home. Tremona DS0000019597.V348284.R01.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 09/08/07. The Registered Manager and the Care and Development Manager were present. The home is full with 39 people in residence. The inspection began with a tour of the premises. Time was spent observing how the staff interacted with the residents. Residents and staff were interviewed. Several residents were eager to give their feedback about the care and service provided. Documents were examined. The inspection ended with a detailed discussion with the managers. To gain the views of people who use the service and those who visit socially and professionally the Commission sent survey forms to residents, relatives and health & social care workers. Their comments have been included in this report. Information received by the Commission since the last inspection has also been reviewed. This includes the Annual Quality Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how well outcomes are being met for people using the service. What the service does well: The standards of service and care are well maintained. The residents, including those with dementia, appeared content and relaxed. They live in a safe, homely and comfortable environment. Several residents were eager to share their views about their home. Comments received included: “I am very happy all round”, “It is a wonderful place. I have no complaints”, “Brilliant. Excellent food. No complaints” And “I am quite happy here”. Staff interacted well with the residents who are well informed of events in the home. In a recent CSCI survey the written comments received about the staff included: “The staff are excellent”, “The staff are always, always available” and “All the staff are always helpful and kind”. In the CSCI survey, written comments about the home received included: “The home is like a five star hotel” , “Very friendly, homely atmosphere”, “Tremona is always busy and active and the staff are friendly” and “The home is friendly, relaxed, with plenty going on to stimulate”.100 of people responding to the survey said that the staff act on things that they say. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 6 Written comments from relatives included: “I have just been to their summer fete. What a lovely time! The residents were enjoying themselves. I was so struck by the fact that the staff were enjoying themselves too. It was not a chore for them!”, “We are very pleased with the care given”, “I go weekly to see her and am always impressed by the friendliness”, “My mother enjoys living in the home and is very well treated by the staff”, “There is always someone to talk to if I have concerns”, “The manager is very good. All the staff work very long hours” and “The manager and deputy are always available”. What has improved since the last inspection? What they could do better: The management is in the process of replacing the carpet in the corridor on the ground floor to create a more homely and comfortable environment. In a recent CSCI survey comments received included: “I think they should provide more healthy meals such as brown wholemeal bread instead of white all the time” and “Communication between the home and the GP or district nurse is often ineffective. The GP’s surgery sometimes fails to respond eg to requests to make an appointment for a hearing test”. The following are the responses to the surveys although very few expressed a negative the fact that some reported that they only sometimes or usually must mean that for these people there is a perception that some improvements Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 7 could be made. 20 of people responding to the surveys stated that they had not received a contract. Although most people stated that they received enough information about the home and the services 7 said that they had not received enough information. 33 of people stated that they usually receive the care and support they need – please note that no one stated that they did not receive the care and support they needed. 40 stated that staff are usually available when they need them. 20 stated that they usually and 7 sometimes receive the medical support they need. 47 of people said that there were activities that they can take part in. 53 stated that they usually like the meals at the home but 7 stated they did not like the meals. 27 of people stated that they usually knew who to talk to if unhappy and 7 stated they did not know who to speak to. 33 of people stated that the home was usually fresh and clean. 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. The summary of this inspection report can be made available in other formats on request. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 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 Tremona DS0000019597.V348284.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 & 5. Standard 6 is not applicable. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective clients and their relatives are given the opportunity to visit and assess the facilities and suitability of the home. They have the information they need to make an informed choice. A pre-admission assessment is carried out before the prospective client is admitted to the home. EVIDENCE: The admission files examined contained pre-admission information concerning the residents. All the residents had been assessed prior to their admission. A trial period of stay is arranged and a copy of the contractual agreement is given to each resident. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 10 In a recent CSCI survey, 87 of the respondents (residents) said that they had enough information to make an informed choice. Comments received included: “Information is given and all questions answered on initial visit to the home”, “She has settled in very well. Great kindness is shown to her. I often see her being taken aside by a member of staff and reassured” and “After a few weeks, the family was very happy with the care my mother was receiving.” Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect, and their right to privacy is upheld. They have access to healthcare services, and each resident has a written care plan so that staff know what care is required and how to deliver the care to meet individual needs. EVIDENCE: Currently the written care plans are being amended using a new system called Bethel, which has been introduced in all B & M homes. Both the management and staff are getting used to the new format. During the transition, the management will ensure that each written care plan is kept up to date with an appropriate plan of care needs and risk assessments for each resident. All new admissions are processed under Bethel. All the residents share the same communal space regardless of their physical and mental health status. The home has 12 residents with dementia. All the residents have equal opportunities for recreational exercise and mental Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 12 stimulation through activities and one to one attention as required. On the day of the inspection staff were around to lend a hand to individuals, including those with dementia. A resident with dementia is given the freedom to walk the corridors, as they prefer, and the choice to have their meals wherever and whenever they like, with staff supervision. This same resident was present at the last inspection and appeared content and well cared for. In a recent CSCI survey, relatives made the following comments: “Since being in the home she has been speedily seen by a chiropodist and a doctor”, “Communication between the home and the GP or district nurse is often ineffective. The GP’s surgery sometimes fails to respond to requests to make an appointment for a hearing test.” The manager confirmed that residents are able to choose their own doctor and that the home has a good rapport with the district nurse who is currently visiting two residents with small grade one leg ulcers that require dressings. The manager said that their condition is improving. All medicines are kept in a storage room that has a cooling unit to maintain the temperature below 25 degrees centigrade. The medication trolley is kept secured in the storage room when not in use. Medicines were administered and recorded appropriately on the Medication Administration Record (MAR) charts. The member of staff spoken to said that staff have regular refresher course on medication administration. The management carry out random checks to ensure the standard is complied with. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents 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 their families and friends. The activities provided are varied and flexible to suit the lifestyles of residents. The meals provided are wholesome and nutritious. EVIDENCE: On the day of the inspection, the home seemed to be full of activities. Both the residential and dementia residents were observed to interact well with each other and with staff. There was a member of staff readily available to help or encourage a resident to participate in activities. Four residents were enjoying a game of dominoes among themselves in the lounge/diner. Others were busy walking in and out of communal rooms and corridors using their walking aids. There are planned activities every day. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 14 In a recent CSCI survey, the following comments were received: “The daily activities are excellent”, “There is enough to entertain everyone.”, “I choose to be alone most of the time, in spite of the activities” and “I have just been to their summer fete. What a lovely time. The residents were enjoying themselves. I was so struck by the fact that the staff were enjoying themselves too. It was not a chore for them!” An individual file is kept for each service user in regards to their activities and their likes and dislikes. The activity of the day is posted on the notice board. A copy of the planned programme is kept in the record of activities. A chef is employed in the home and the meals provided are appealing and nutritious. Healthy eating is encouraged. It was noted that there are plenty of fresh fruits and drinks available to residents in all communal areas. Lunchtime was unhurried. Residents can choose to have their meals in the dining room or in the lounge/diner. The latter was set up after the last inspection to avoid overcrowding in the dining room, which has limited space. Residents interviewed said that they are very happy with the meals provided. They said that there is always a hot meal and alternative dishes. Comments received included “Food is quite nice most of the time” and “The food has been fabulous since day one!” Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 17 & 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a robust Complaints Policy and Procedure, which most people were aware of. Service users’ legal rights are protected. Residents reported that they would be listened to and action taken. EVIDENCE: The management investigate any complaints or concerns raised by residents, relatives and others. Immediate action is taken to resolve any issues raised. A recent complaint made to the Commission about the service was thoroughly investigated by the Operations and Development Manager. It was unsubstantiated. Staff have training on issues concerning safeguarding adults (the protection of vulnerable adults). They are aware of the Whistle-Blowing Policy. The home follows the Safeguarding Procedure of Hertfordshire Social Services. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 & 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and homely place. They have access to all communal facilities and have the specialist equipment they require to maximise their independence. EVIDENCE: The home appeared clean and tidy. The surrounding grounds and patio are well maintained. The bedrooms seen appeared neat and clean with personal items on display. In a recent CSCI survey, a relative commented that the resident’s bedroom is “always very clean”. There is a rolling maintenance programme. In order to improve the appearance of the home, the carpet on the ground floor corridor is to be replaced. The brown coloured handrails that blend in with the colour scheme of the wallpaper may be repainted to a colour that is more prominent for Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 17 residents with poor eyesight. All doors are held open with automatic hold-open door devices. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported and safeguarded by the recruitment policy and practices. There is an effective staff team with enough sufficiently skilled staff on duty to ensure that the care needs of the residents are met appropriately. There is a well-planned staff-training programme to ensure staff have the skills to meet the residents needs. EVIDENCE: On the day of the inspection, the residents interviewed gave very positive feedback about the staff. Comments included: “Tremona is always busy and active and the staff are friendly”, “We have very helpful staff”, “The staff are wonderful” and “I am very happy with the staff.” It was noted that the residents were well supervised. There was a member of staff readily available to lend a helping hand or to talk to or encourage a resident. The home has recruited a number of staff, including senior care workers, since the last inspection. The recruitment procedure is in accordance with legislation. All the new staff only start work after police checks and clearance including clearance from the Protection of Vulnerable Adults (POVA) list. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 19 The newly appointed Deputy Manager (formerly a Team Leader) is an assessor and trainer. She provides in-house training, including mandatory and induction training for staff. Appropriate refresher courses are held. There is a rolling training programme. Although this a residential home, arrangements have been made for the tissue viability nurse to give training on the prevention and management of wounds and pressure sores. Other topics include dementia care and falls prevention. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34, 35, 36, 37 & 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standards of care and service are well maintained to meet the statement of purpose. The health, safety and welfare of the residents are promoted and protected. EVIDENCE: The Home Manager is well supported by the Operation and Development Manager. They were both appointed over two years ago and together they have raised the standards at Tremona. The residents, who seemed very happy and content, have benefited from the proactive approach of the managers. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 21 Areas of good management practice included a thorough recruitment and selection procedure and an increased number of experienced and senior care workers. The staffing level is in accordance with the needs of the residents rather than being at the minimum level. The training programme is according to the needs of residents and refresher courses are arranged at regular intervals. The home has promoted one of its team leaders to deputy level. She is an experienced assessor and is responsible for the in-house training of staff. The supervision of staff has been maintained. The personal allowances of 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. The home has adopted a new system called Bethel and once this is fully implemented, a copy of the annual quality assurance report will be readily available for inspection. The recently introduced CSCI Annual Quality Assurance Assessment forms issued to the home for this inspection were returned on time. However, there is room for improvement in the information provided. The home manager said she will review and improve on the content for the next inspection. Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 22 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 3 8 3 9 3 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 3 3 3 3 3 3 3 3 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 4 3 3 3 3 3 3 3 Tremona DS0000019597.V348284.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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.V348284.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V348284.R01.S.doc Version 5.2 Page 25 - 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!