Inspection on 21/02/06 for Trent House

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trent House 10/10/06

Trent House 22/09/05

Trent House 12/01/05

Trent House 09/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Trent House Balcombe Road Horley Surrey RH6 9SW Lead Inspector Mr E Mcleod Unannounced Inspection 21st February 2006 10:00 Trent House DS0000014804.V278024.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 Trent House DS0000014804.V278024.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. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Trent House Address Balcombe Road Horley Surrey RH6 9SW 01293 785938 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) Ashcroft Care Services Ltd Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That no more then 6 male and/or female service users in the category of learning disability be accommodated. 22nd September 2005 Date of last inspection Brief Description of the Service: Trent House is a care home registered to accommodate up to 6 service users aged 18-65 in the category of learning disability. The premises are situated in their own grounds in a rural area near Horley which comes within West Sussex. The premises include some accommodation for semi-independent living. The registered provider is Ashcroft Care Services, for whom the responsible individual is Mr Charles David Holmes. There is no registered manager at present. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was arranged to follow up recommendations and requirements made at the previous inspection, and to inspect against some standards not assessed at the previous inspection. The inspector visited the care home for three hours and forty five minutes, and spoke with two residents and two members of staff. Care plans and staff records were sampled, and a partial tour of the premises was made. The inspector would like to thank everyone who contributed to the inspection. What the service does well: Individual care plans are being reviewed and updated, and show how staff are supporting residents towards their personal goals. Residents are supported to participate in the planning of their care through the key worker support system. Independence and individual choice for residents is being promoted. The provision in the home of an independent bedsit and an independent flat are encouraging residents to develop their independence skills. The service provider has also been developing services for independent living in the community, and residents in this service are benefiting from this. Residents are being supported to increase their self confidence and to take up social, leisure, work and educational opportunities of their choosing. The premises are maintained and decorated to a high standard, and are homely and comfortable. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 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. Trent House DS0000014804.V278024.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 Trent House DS0000014804.V278024.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): 1, 2. 4 The statement of purpose and service user’s guide must be updated. Arrangements are in place for residents to visit the home and have overnight stays before making a decision on residing there. EVIDENCE: The statement of purpose and service user’s guide, which provide information on the service for residents and potential residents, were sampled. These had been updated in September 2005. It was noted that the name of the manager of the home had not been updated, and that the relevant qualifications and experience of individual staff was not included in either document. No residents have been admitted to the home since the previous inspection, no vacancies having arisen. Residents previously admitted have been assessed before admission, and residents have the opportunity to visit the home, meet residents and staff, and have overnight stays before deciding if they wish to move into the home. Trent House DS0000014804.V278024.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 Individual care plans are being reviewed and updated, and show how staff are supporting residents towards their personal goals. EVIDENCE: Two sets of care plans were sampled, which included copies of recent reviews of the care plan, medical summaries, medication reviews, activities programmes, key worker reports, and healthcare appointments. Staff interviewed had a clear view of how each resident’s personal goals will be met. Discussion with staff indicated that residents are supported to participate in the planning of their care through the key worker support system. Trent House DS0000014804.V278024.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): 16 Independence and individual choice for residents is being promoted. EVIDENCE: The two residents who spoke with the inspector are both preparing for more independent living, and both said that were looking forward to it. Examples were provided of how residents are being supported to increase their self confidence and to take up social, leisure, work and educational opportunities of their choosing. The inspector sampled the notes of the residents’ meeting of 20.2.06, which encourages residents to participate in the running of the home. Staff interviewed said that in recent months there was more emphasis on residents’ choice and involvement in their care planning. Discussion with staff indicated that new staff are bringing new ideas into the home which is developing the choices for residents. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 11 Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 12 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): 20 The provider needs to ensure that medication procedures in place are safe for residents, and that advice on this is sought from the contracted pharmacist. EVIDENCE: Medication records were sampled. Records of staff training in the administration of medicines were sampled. It was noted that there is an agreement in place for a pharmacy to visit the home twice during the year April 2005 to March 2006 to review the medication procedures in place. However, there is no record to suggest any visit from the pharmacist has been carried out during this period. Trent House DS0000014804.V278024.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): 22, 23 For the protection of residents, clear training, guidelines and procedures for staff on responding to adult protection incidents must be provided. EVIDENCE: A complaints procedure is in place. Staff advised the inspector that residents who self-advocate will generally approach their key worker to discuss concerns or disagreements they have. The residents’ meetings also give residents the opportunity to discuss concerns. Training records indicate that staff are receiving some training in adult protection issues. Adult protection procedures for the home dated October 2002 do not provide adequate guidance for staff on procedures to be followed if abuse or neglect of a resident has been identified or suspected. Manager Ms Davies said that the home followed the procedures of West Sussex County Council in this – however, no staff in the home have received training in the West Sussex procedures, and it was noted that the West Sussex procedures are dated 1997 since then important new legislation such as the introduction of the Protection of Vulnerable Adults (PoVA) register have been introduced. The home’s procedure for the protection of vulnerable adults also needs to advise staff of the provider’s responsibility to refer staff who have been deemed culpable to the PoVA register. A copy of the Department of Health’s guidelines on referrals to the PoVA register could not be located in the home at the time of the inspection – the provider should ensure that a copy of this is available to the manager. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 14 Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 15 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): 24 The premises are maintained and decorated to a high standard, and are homely and comfortable. EVIDENCE: The premises are maintained to a high standard. There are extensive gardens which are well maintained. The main communal areas are the dining room and sitting room. The premises are very homely, comfortable, and furnished and decorated to a high standard. The provision in the home of an independent bedsit and an independent flat are encouraging residents to develop their independence skills. The service provider has also been developing services for independent living in the community, and residents in this service are benefiting from this. Improvements to the premises since the previous inspection have included a new carpet and a new television in the sitting room. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 16 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): 34, 35, 36 Records for the recruitment of staff seen were incomplete, and do not ensure that residents are being adequately protected. NVQ training for staff in the home may not be LDAF-accredited. EVIDENCE: Recruitment records for two members of staff were sampled. Recruitment records seen included a photograph, two written references and information that identified the staff member. Records seen did not include the person’s application or a record of the interview held. Records seen did not include a copy of the staff member’s work visa where this is required. Copies of Criminal Records Bureau (CRB) checks are not held in the home. The manager showed a print-out for CRB checks of staff which indicated when checks had been received and whether the checks were enhanced or standard (all staff with access to vulnerable adults need enhanced checks). It was noted that some staff had only received standard checks. The manager was unable to confirm if enhanced checks had now been received for those members of staff. The print out for CRB checks of staff seen also did not indicate if the check received back was clear, and the manager was unable to confirm if checks on Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 17 current staff had come back as clear or not. The provider should ensure a risk assessment has been carried out and recorded where a check has not come back as clear but a decision has been taken to employ the person. Staff training certificates were sampled. The manager was unable to confirm if staff on NVQ training are receiving Learning Disability Award Framework (LDAF) training. Staff supervision records were sampled, and staff interviewed confirmed that regular supervision was taking place which was meeting their support needs. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 18 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): 37, 38, 39, 42 There is a relaxed and good atmosphere in the home. The provider must seek the views of residents and others on the service provided, as part of the annual review carried out on the service. There should be an annual development plan for the home. Residents may be at risk of scalding due to high hot water temperatures in the home. The provider must ensure that safe levels of hot water are being provided. EVIDENCE: The home is now managed by Ms Sharon Davies, who advised the inspector that an application to be registered with CSCI as manager of the home was being prepared. There is a relaxed and good atmosphere in the home. There is also a positive atmosphere, with two and possibly three of the residents having opportunities to live more independently. Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 19 At the previous inspection it was recommended that an annual development plan for the home be developed. No annual development plan was available at the inspection, and the manager was not aware if this was in planning. Arrangements in the home for seeking the views of residents, their friends and relatives, and stakeholders in the community do not appear to be adequately developed or operated. There is also a need to evidence how views gathered on the service provided have been assessed and what suggestions for the improvement of the service are being acted upon. A requirement was made at the previous inspection concerning hot water temperatures being recorded above the recommended 43 degrees centigrade and the need for risk assessments in this regard. No risk assessments were provided at inspection, and records of hot water temperatures seen suggest there could be a risk of residents being scalded by hot water. The provider needs to ensure that hot water temperatures for each individual outlet can be controlled (for example, through a temperature control valve on the outlet). To ensure the control of Legionella the provider needs to monitor that storage temperatures for hot water meet required levels. (Standard 42.3). Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 20 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 2 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x 3 3 2 x x 2 x Trent House DS0000014804.V278024.R01.S.doc Version 5.1 Page 21 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. Standard YA42 Regulation 13(4c) Requirement A requirement has been made that the provider carry out a risk assessment in relation to each resident and hot water outlet, and take appropriate action identified in the assessment to reduce the risk of scalding. (The previous timescale for this requirement was not met). The information in the Service User’s Guide and in the Statement of Purpose need to be reviewed and updated The registered person shall not employ a person to work in the care home unless they are fit to do so The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home, which includes consultation with service users and their representatives The registered person shall make arrangements, by training staff or by other measures, including the provision of clear procedural guidelines for staff, to prevent DS0000014804.V278024.R01.S.doc Timescale for action 16/03/06 2. YA1 6 31/03/06 3. YA34 19 31/03/06 4. YA39 24 28/04/06 5. YA23 13.6 31/03/06 Trent House Version 5.1 Page 22 service users being harmed or suffering abuse 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 YA23 Good Practice Recommendations Procedures and guidance for staff on adult protection should be extended to include the responsibility of the provider to refer staff for inclusion on the Protection of Vulnerable Adults register who have been implicated in incidents of abuse towards residents. An annual development plan for the home reflecting aims and outcomes for service users should be provided. The provider needs to ensure that medication procedures in place are safe for residents, and that advice on this is sought from the contracted pharmacist. Staff should use Learning Disability Award Framework (LDAF)-accredited training to provide underpinning knowledge for progress towards achieving NVQ’s (standard 35.8). 2. 3. YA39 YA20 4. 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