Inspection on 14/05/07 for Trenant House

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Trenant House 24/01/06

Trenant House 12/04/05

Trenant House 25/01/05

Trenant House 24/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Trenant House Queens Road Lipson Plymouth Devon PL4 7PJ Lead Inspector Anita Sutcliffe Unannounced Inspection 14th May 2007 09:15 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 Trenant House DS0000003517.V334345.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. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trenant House Address Queens Road Lipson Plymouth Devon PL4 7PJ 01752 663879 F/P 01752 663879 trenantpl4@btopenworld.com 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 Julie Lynn Franks Mr Peter John Woodworth Franks Mrs Julie Lynn Franks Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number disorder, excluding learning disability or of places dementia (24), Old age, not falling within any other category (24) Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents in the category MD to be 60 years of age or over at time of admission. 24th February 2006 Date of last inspection Brief Description of the Service: Trenant House is registered to provide residential accommodation with personal care to a maximum of 24 service users over the age of 65 who may have conditions associated with older age or dementia. They may also admit people over the age of 60 who have a mental disorder. Health care/nursing needs are met through community nursing services who visit as required. The home is privately owned. Trenent House is a large, detached house, which stands in its own grounds and is situated in the Lipson area of Plymouth, close to local amenities, the park and public transport links. The accommodation for service users occupies two floors, with access assisted by the use of stair lifts as well as a shaft lift. The Home has 22 bedrooms, 20 single and 2 double rooms, with 12 of the single rooms and both double rooms having en-suite facilities. Ten rooms have en suite shower facilities. The home has 4 bathrooms, 2 of which have baths fitted with hoists. The Home offers two lounges, one with access to a conservatory area, and a dining room with a bar area. There is a call bell system throughout the Home and due to the layout and size of the building staff carry an intercom system to support the call system. A covered area is provided outside of the main house for service users who may wish to smoke. The current scale of fees at the home, May 2007 is £285 - £480. Additional charge is made for hairdressing, chiropody/podiatry and reflexology. The most recent inspection report, and current information about the home, is displayed on the entrance notice board. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was to check the home’s compliance with the National Minimum Standards for Older People. Prior to the inspection the home provided current information on the service it provides. The care of two residents was examined in detail and specific additional information sought regarding two others. Most residents were met, some during lunch, some in their rooms, some during a morning quiz. Two family representatives provided information during the inspection visit. Others were contacted after the visit. Staff were spoken with and observed working. Records connected with care, staff, complaints, quality auditing and medication were examined. Both owners/registered manager and the person employed to manage day to day care were present throughout the inspection. What the service does well: What has improved since the last inspection? The laundry floor is now sealed so that cleaning is more effective. A more accurate fridge temperature can now be gauged to ensure foods will be properly stored. There is ongoing investment and a programme of upgrading at the home, with regular redecoration and improvement. This includes new electrical and gas Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 6 installations to improve comfort and safety. There are imminent plans for a specialist bath for the first floor. This should be more pleasant and safer for resident and staff alike. 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. The summary of this inspection report can be made available in other formats on request. Trenant House DS0000003517.V334345.R01.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 Trenant House DS0000003517.V334345.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5 (Standard 6 does not apply to Trenant House) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Potential residents are encouraged and supported to make a positive choice about moving into Trenant House. Assessment of their needs is thorough, so that their wishes, needs and aspirations are recorded and understood. EVIDENCE: The care of a recently admitted resident was examined in detail. A second also gave their opinion. On the day of the inspection visit a potential resident spent time at the home to ‘try it out’. The manager tries hard to ensure every new resident has had the opportunity to make a positive choice about moving in. Potential residents are visited in their home, or in hospital, and invited to spend time at Trenent House. They may have a meal, join other residents for activities and look at vacant rooms. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 9 Record of pre admission assessment was detailed and informative. It included every aspects of health, physical and emotional needs, abilities, preferences, social interests and history. Individual risk was well considered and important health observations were recorded. From this information staff can plan how to provide the support and care wanted and needed; one resident, identified with a high risk of falling, received hip protectors to prevent hip fracture. Another, with compromised circulation, had NHS chiropody arranged. Where additional information is necessary, staff ensure this is sought. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are well met although some changes in the handling of medication would make this safer. Residents are treated with respect and their dignity and privacy is upheld. EVIDENCE: Residents and their family said they have complete confidence in the care provided at Trenant House. Staff are considered to be very good, kind and caring. They approach their work in a professional way, with good leadership from the care manager. Staff felt that good care is what they do best, one rating their achievement as ‘9 out of 10’ adding: “Staff share the same values”. The standard of care planning is very high and staff said how much they use and are informed by the detailed, up to date information this provides. The home achieves close monitoring of health and good management of risk, whilst understanding people as individuals. Family said they are kept informed, although residents are helped to make decisions for themselves. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 11 A resident spoke of regular district nurse visits. The manager spoke of seeking appropriate podiatry/chiropody services. Health care referrals are made appropriately because staff are competent to judge when they are necessary. Residents say they are treated with respect. Staff were observed being polite, unhurried treating each resident as individual. Privacy is upheld. Shared rooms have screens for privacy and each resident in the home is offered a key to their room, with any associated risk considered and managed. The handling of medicines is approached in a professional and organised way and residents are enabled to look after their own medicines whenever possible. Where this is not possible it should be clear that the resident, or their representative, has consented to staff doing this for them. Most medicines were securely kept, either within the main home or lockable bedroom cupboards. Medicines, which need refrigeration, currently ointments only, were stored in the food fridge. The temperature of a food fridge is not suitable for all medication, which should also be stored securely in a locked container, or ideally, a fridge designed for the purpose. Stock control of medicines needs to be better planned. Three separate tubes of ointment were in use for one resident. There was no record of when each had been opened. There were also some tablets mixed together with tablets for a different use, introducing an unnecessary risk. The medicine administration records were orderly and complete. Medicines are properly checked in and out of the home so that a full audit can be achieved, and safety promoted. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices, express individuality and lead fulfilled lives. EVIDENCE: Information on individual preference is sought, recorded and part of the planned care. Twice daily activities are organised by the home’s Activity Coordinator: these are planned in advance with the residents. Two residents who remained in their room confirmed that was their choice and preference. One to one time is spent with residents that might otherwise feel isolated. At the time of the inspection some residents were engaged in a quiz. There is a monthly slide show of local places and a theatre group visits twice a year. Spiritual needs are met through arrangements with local clergy/organisations. Staff said that shortly daily outings would be started again and that all would have this opportunity to go out locally. A relative confirmed: “Residents are taken out in the summer”. There is a seated patio area and lawns for residents’ use. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 13 The home works hard to provide genuine choice and meet personal preference. There us always a second choice of main meal, as well as breakfast and tea. Staffing arrangements enable residents to take the lead on when they rise in the morning and go to bed at night, as there are sufficient staff to be flexible. Relatives are made welcome at the home and may visit at any time. Residents are supported to look after their own finances. Safe storage in their room, or the option for staff to hold money for them, enables them to retain this personal control. Residents have the opportunity to influence the menu at the home. Records were seen of a meeting where this was discussed. There were no complaints on record about the food. However, opinion on the food was mixed, but with the majority of responses negative. Three of the four family members reported that their relative did not like it with comments including: “Initially the food was very good, but now I get comments that he’s not very impressed with it” and “It’s not very adventuresome or appealing”. Residents’ comments ranged from “Good” to “Grotty”. Staff fully understand the importance of a nutritious diet but, as the enjoyment of food is so important, the provision of food at the home must to be reviewed. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are well managed once they have been identified as such and residents are protected from abuse. EVIDENCE: The managers and staff are happy to receive any complaints or concerns which residents or family might have. The home have recorded two complaints, each fully investigated and acted upon. However, it is clear that people are not happy with the food provided (See Standard 15). We conclude that either people chose not to make a complaint although they have one, or a complaint may not be interpreted as such. Either way, this current dissatisfaction is not being investigated. Residents said they felt safe at the home and have confidence in the manager and staff. Staff receive training in how to protect residents from abuse and spoke with conviction about what they would do if they had any concerns. Both the owners and the care staff have demonstrated their responsibilities relating to the protection of vulnerable adults. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 15 Trenant House DS0000003517.V334345.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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, well equipped, comfortable and well maintained environment, but improvements in hygiene would make the home more pleasant and reduce the risk of cross infection. EVIDENCE: Residents said they were happy with their rooms. They confirmed that the home was warm enough and they were comfortable. Effort is made to ensure that the most suitable and desirable room is available to meet a person’s preference and needs. Some rooms were very personalised, full of items of importance and personal interest. Where a room is shared privacy is assured through the use of screens. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 17 The providers have made substantial investment in improving the environment. Expert advice has been sought to ensure the physical environment is suitable for those with mobility problems. The standard of equipment available is high, and continues to be improved; a specialist bath is soon due for delivery. No specialist adaptation was evident for residents with dementia who, through the condition, have difficulty making sense of their environment and may have difficulty finding their way around. For example, many bedroom doors look identical. However, the manager understands the needs of people with dementia and says future changes will take this into account. Residents’ have lockable storage space in their bedroom and the opportunity to lock the door should they wish. Some choose to do so. Rooms were safe, with guards to prevent contact burns from radiators, safe windows and adequately maintained fixtures and furnishings. Residents and their family said the cleanliness of the home was “OK”. However, unpleasant odour was found in two of the eight bedrooms visited; one had a soiled commode and unclean bedrail. The manager promptly addressed this lapse in practice and spoke of ways for meeting the challenge of odour prevention. Audit is undertaken regularly to check that hygiene standards are being met and staff have appropriate amounts of protective clothing. However, where soiled linen is taken to the laundry, which is near the kitchen, it could routinely be taken in a sealed (non contact) bag. Staff should not have to empty commodes in toilets and if they do they should always wear protective clothing; this was not done in the one case observed. The use of liquid soap, and the availability of hygienic hand gel, protects from cross infection, but the use of disposable hand towels would add further protection. Trenant House DS0000003517.V334345.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): 27,28,29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a skilled, knowledgeable and caring staff, recruited following the home’s robust safety procedures and employed in sufficient numbers to meet residents needs. EVIDENCE: Both residents and staff said that there is enough staff at all times. The way the rota is organised ensures that there is flexibility which enables residents personal choices to be met; for example, choosing the time to rise in the morning or go to bed at night. Where a resident is especially frail or dying, a staff member is allocated to be with them. Care staff are supported by catering, laundry and domestic staff. The majority of favourable comments received were about the care manager and staff. One said: “The girls are very kind”, another: “The care manager is excellent”. Staff training is structured and well organised. It includes all aspects of health and safety, plus care planning, dementia care, prevention of pressure sores and prevention of falls and more. Staff spoke of the provider’s commitment to good training. All staff are encouraged to undertake National Vocational Qualification (NVQ) qualifications, which is an indicator of Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 19 competence. Staff confirmed that new staff receive a thorough induction prior to working without close supervision. The recruitment records of two recently employed staff showed that recruitment is undertaken diligently. Only those suitable and safe to work with vulnerable adults are employed to do so. Trenant House DS0000003517.V334345.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): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a home which is managed by people committed to high standards and the wellbeing of residents. EVIDENCE: A manager designate (care manager) manages all aspects of the home other than the business, which is managed by the registered manager, Mrs. Franks. They are both experienced and work hard to ensure that the home is run in the best interests of residents. To this end there are meetings for residents and staff, surveys provide the opportunity for comment about the home, and there are frequent checks to ensure standards are being met. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 21 Residents know the management and say the home is well run. Other than the food, none could think of any way it could be improved. Staff said they receive regular supervision and they are well trained. One gave the standard of management ten out of ten saying: “They’re good. We feel very supported”. They also spoke of strong team work and shared values. Residents are supported to look after their own finances. Money kept by the home on their behalf is kept securely with clear records; those checked were correct. Maintenance and servicing was occurring during the inspection visit and records indicate that health and safety are properly managed. Trenant House DS0000003517.V334345.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 X X 4 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 3 Trenant House DS0000003517.V334345.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. 1 Standard OP15 Regulation 12(3) Requirement Food provided must be to the liking of residents whenever possible. Timescale for action 31/05/07 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 OP9 Good Practice Recommendations Stock control of medicines should be better managed so that: • Tablets are kept in their correct packaging • Only one tube or packet of tablets is in use at any one time This will reduce the risk from mistakes or the use of out of date medication. Medicines needing refrigeration should be kept in a locked container for their security, preferably in a specialist medicines fridge where the necessary temperature is more likely to be achieved. The way the home deals with complaints should be reviewed so that dissatisfaction is known and investigated. To promote hygiene and better reduce any risk from infection and cross infection: DS0000003517.V334345.R01.S.doc Version 5.2 Page 24 2 OP9 3 4 OP16 OP26 Trenant House • • • • A non-touch bag system should be used for soiled laundry and to prevent the need for hand sluicing. Protective clothing should always be used when emptying commodes, which should be kept clean. A sluicing facility should be available on all floors. Disposable towels should be available for staff use wherever personal care is delivered. Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Trenant House DS0000003517.V334345.R01.S.doc Version 5.2 Page 26 - 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. 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