CARE HOME ADULTS 18-65
Tremona Care Home, 18 Parkers Cross Lane 18 Parkers Cross Lane Pinhoe Exeter Devon EX1 3TA Lead Inspector
Ms Rachel Fleet Unannounced Inspection 9th February 2006 15:10h Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 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 Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Tremona Care Home, 18 Parkers Cross Lane Address 18 Parkers Cross Lane Pinhoe Exeter Devon EX1 3TA 01392 460945 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) Mrs Melanie Louise Brunsdon Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The manager must obtain the NVQ4 in Care by 2005 Date of last inspection 25 November 2005 Brief Description of the Service: ‘Tremona’ is a care home registered to provide personal care, support and accommodation for two younger adults with learning disabilities. Mr & Mrs Brunsdon live at the premises. No other staff are employed. The home is a detached house in Pinhoe, a residential area on the outskirts of Exeter. There are 3 bedrooms, with an adjacent toilet and separate bathroom. A lounge, utility area and a shower room are accessed through the kitchen. A conservatory has been built onto the main living room, leading onto a patio with enclosed garden beyond. The home is close to a bus stop, shops, and Doctor’s surgery. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector was at the home for two hours on this unannounced inspection. Mrs Brunsdon was meeting with an NVQ assessor when the inspector arrived. The two residents had just returned from holiday, and the inspector was able to spend time with them, besides speaking with Mrs Brunsdon and looking at records - including both care plans, for case-tracking purposes. Standards that were met at the last inspection have not been re-inspected on this visit. The report from that inspection, carried out on 11 November 2005, should therefore be read along with this report, for fuller information. What the service does well: What has improved since the last inspection?
Revised care planning systems ensure individuals’ needs are clearly identified, with residents’ care plans including how the service will meet their current personal, social and healthcare needs. Risk assessments have been recorded, evidencing residents are encouraged to take appropriate risks that enrich their lives. They are protected by the home’s reviewed policies, practices and procedures for dealing with medication, including self-administered medication and regarding the use of ‘medidose’ containers. Some record-keeping practices have been amended, to better protect residents’ rights and best interests. The Health and Safety statement for the home has been reviewed. Risk assessments have been carried out for the environment (including windows). Adequate arrangements for testing fire equipment are in place, after seeking advice from the local fire authority. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 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 Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The core standard was met at the last inspection. EVIDENCE: Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Care planning systems are good, ensuring individuals’ assessed needs are clearly identified. Residents are encouraged and assisted to make choices, decisions and take appropriate risks, on a daily basis, adding to the quality of their lives. EVIDENCE: Comprehensive care plans were seen for each resident. These had been recently reviewed and updated. Abilities were noted as well as when the residents needed help. Involvement in housework was included. During the inspection, the residents were consulted by Mrs Brunsdon on various occasions – about meal choices, their views about how their time was to be spent in the next few days, etc. – discussing the various options suggested to them. Mrs Brunsdon is appointee for both residents. Personal monies records were seen for each resident. Enablers visit each week to lead different activities, besides residents having an active life with the Brunsdons (as recorded in daily notes). Risk assessments were seen relating to going out, cooking, etc. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The core standards were met at the last inspection. EVIDENCE: Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 Residents benefit from having a carer that knows and understands their individual needs and wishes, and ensures they are met. Residents are protected by the home’s practices and procedures for dealing with medication. EVIDENCE: Care records included health checks by community services, and general observation of residents’ health by Mrs Brunsdon on a regular basis; she said she would be checking when some health checks were next due – eye tests, for example – the residents having moved to the home since the checks were last done. The residents confirmed they had had flu vaccines before Christmas; they talked about their friends, their enablers, day services they attended, etc. Daily diaries showed the residents had a varied and healthy diet. Mrs Brunsdon evidenced in conversation and when talking with the residents during the inspection, that she knew each resident’s personalities and preferences very well. Appropriate records were seen for medications received into the home, and administered. Mrs Brunsdon has developed the medication policies and recordkeeping, particularly for self-administered medicines, Homely remedies, disposal of unwanted or refused medications, and action to be taken in the event of a drug error. She had also sought guidance from a pharmacist
Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 12 regarding the use of ‘medidose’ containers. She agreed to ask the residents’ GP to review the Homely remedies policy. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Appropriate action has been taken to try to ensure residents will be protected from abuse. EVIDENCE: The residents appeared very comfortable, relaxed and at ease with Mr & Mrs Brunsdon. Mrs Brunsdon had a certificate evidencing she had undertaken local social services’ training on safeguarding, in February 2005. She had a copy of their guidance (‘The Alerter’s Guide’), and described appropriate procedures for reporting suspicion of abuse. She agreed to amend the home’s written policy to reflect this. She also had the GSCC ‘Code of Conduct’. Mrs Brunsdon was confident staff at the day services the residents attended would report any concerns to her. Residents’ personal monies were checked, and tallied with balances shown on records kept. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The core standards were met at the last inspection. EVIDENCE: Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No staff are employed at the home, Mrs Brunsdon and her husband being the carers. EVIDENCE: Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41 & 42 Record-keeping practices generally protect residents’ rights and best interests, although one aspect should be reviewed to provide auditable records that ensure their interests are fully protected. Whilst health and safety matters are generally well attended to, one aspect should be addressed to ensure residents’ longer-term wellbeing. EVIDENCE: Mrs Brunsdon has been using knowledge gained through the NVQ course to improve care plans. Personal information is now kept in a way that complies with the Data Protection Act 1998. For example, separate daily diaries are kept for each resident. Personal monies records were kept for each resident, but it was difficult to match receipts available to entries made. Mrs Brunsdon had reviewed the Health and Safety statement for the home in January 2006. Risk assessments were seen for upper window. A maintenance record was seen, evidencing repairs and new fittings. A fire safety company had checked fire equipment in September 2005; smoke detectors were checked weekly by the Brunsdons, according to the fire log. Mrs Brunsdon said
Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 17 she had consulted the local fire authority about recommended frequency of testing fire equipment. Evidence that electrical hard wiring and portable electrical appliances are safe is still to be obtained. Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 N/A 32 N/A 33 N/A 34 N/A 35 N/A 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X X X X X 2 2 X Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 19 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. 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. 1. Refer to Standard YA41 Good Practice Recommendations You should develop a more auditable system where residents’ personal monies are managed on their behalf, particularly regarding paper receipts and transactions recorded. You should evidence that electrical hard wiring and portable electrical appliances are safe, to promote the health, safety and welfare of residents and staff. 2. YA42 Tremona Care Home, 18 Parkers Cross Lane DS0000039928.V274309.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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