Inspection on 22/09/05 for Trent House

This inspection was carried out on 22nd September 2005.

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 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

Trent House 10/10/06

Trent House 21/02/06

Trent House 12/01/05

Trent House 09/08/04

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Southfields

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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 Announced Thursday, 22 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Trent House Address Balcombe Road, Horley, Surrey, RH6 9SW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01293 785938 Ashcroft Care Services Ltd Mrs Christine Jane Brown Care Home 6 Category(ies) of Learning disability (LD) - 6 Both registration, with number of places Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: That no more than 6 male and/or female service users in the category if learning disability be accomodated. Date of last inspection 12.1.05 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. The registered manager is Mrs Christine Jane Brown. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was arranged to update assessments made at the previous inspection, and lasted 3.25 hours. The inspector interviewed three residents, two care staff, and the registered manager. The Commission also received comment cards on the service from four residents and four relatives or visitors. The inspector made a partial tour of the premises, sampled two sets of care plans and some policies and procedures including adult protection and confidentiality. What the service does well: What has improved since the last inspection? Improvements to the premises include a new carpet in the sitting room, which has also been redecorated, and redecoration and new furniture has been provided in some bedrooms. An area of the sitting room has been re-arranged to allow a resident to play puzzles and games there. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 6 Residents are being encouraged to make more decisions for themselves. More staff have been undertaking NVQ training, and training in adult protection has informed staff on how residents can be better protected and more assertive. 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 H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: None of these standards were assessed during the inspection. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9, 10 Residents have individual care plans which reflect their changing needs and ambitions. Residents are being assisted to develop their independence skills and to participate in aspects of life in the home. EVIDENCE: Two sets of individual plans were sampled, which were seen to include risk assessments, care plans, healthcare checklists, reviews, and daily records. Key worker supervision action forms have been introduced as part of the care planning process. Interviews with residents and staff indicated that residents are being encouraged to make choices in an increasing number of areas in their lives, and records of the monthly residents’ meeting show some of the aspects of life in the home which residents are being consulted on. Examples were provided by staff and residents of independence skills which staff were assisting individual residents to develop. The provision of a bedsit flat and independence flat on the premises is supporting residents to attain more independent lifestyles, and one resident is now being offered independent living in the community. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 10 The policy and procedures on confidentiality have been updated, and now ensure better guidance to staff on the boundaries of confidentiality to be observed. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 11, 12, 13, 14, 15, 17 Residents are being assisted to lead more full social lives, and to develop their interests and independence skills. EVIDENCE: Residents are being encouraged to develop in their individual ways, which includes for some residents being assisted towards independent living, and for others to be assisted to communicate better and develop more social skills. Residents interviewed talked about educational, social and leisure activities they did regularly, and staff accompany residents on outings and holidays. An area in the sitting room has been set up for one resident to play his games and puzzles. Residents are assisted to maintain contact with family and friends, and for one resident this includes a programme for telephoning friends and family on a regular basis. Examples were provided of facilities in the local community which are being visited by residents. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 12 Mrs Brown has advised the Commission that there is a choice of menu, and that special diets and ethnic diets are catered for. Individual menus seen for the weeks commencing 15.8.05 and 22.8.05 indicate that a varied and nutritious diet is being provided. Staff have been discussing with residents the advantages of a healthy diet. Residents interviewed said they enjoyed the meals, and were encouraged to assist with meal preparation and menu planning. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18, 19 Residents are receiving personal support in the way they prefer and require, and arrangements are in place to ensure their physical and emotional needs are being met. EVIDENCE: Residents interviewed were clear about how they wished their personal support to be provided, and indicated that the kind of staff support they wished for was being provided. Care plans seen indicated how emotional support is being provided for residents, and for one resident this includes the involvement of a visiting worker who takes on an advocacy-type role. Information on a local advocacy scheme is provided in the home. The communications book, diary, and daily records provide examples of how residents are being supported to access relevant health care services, and staff interviewed said that the key worker for the resident takes a lead role in ensuring the resident’s healthcare appointments are arranged and followed through. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 23 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. EVIDENCE: Policies and procedures are in place for the protection of residents from abuse, and staff training is being provided in this. Registered manager Mrs Brown said that the training had changed the staff team’s approach, in that they were now more aware of abuse and the importance of offering residents more choice. Guidance for staff on adult protection did not include reference to the Protection of Vulnerable Adults (PoVA) register which was introduced in July 2004, or to the provider’s responsibility to refer staff for inclusion on the register who have been implicated in incidents of abuse towards residents. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 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 standard(s) 24, 25, 26, 28, 30 Residents live in a homely, comfortable and safe environment, which is well maintained. Residents have personalised their bedrooms, which reflect their interests and lifestyle. EVIDENCE: Since the previous inspection, the patio door and the carpet in the sitting room have been replaced. The sitting room has been repainted, and some bedrooms have been redecorated and provided with new furniture. A new bed has been provided for one resident, and a new fridge and new freezer bought. The house and the garden and grounds are being well maintained, and the furnishings and decoration are of good quality, and are homely, comfortable, bright and cheerful. Staff said that when repairs are arranged and carried out this is recorded in the communications book. The premises include an independence flat and a bedsit flat which each accommodate one resident. The main communal areas are the dining room, the sitting room, and an outdoor patio area. Part of the dining room has been re-arranged to provide the space for one resident to do games and puzzles. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 16 The bedrooms of three residents were seen, and these had been personalised by the resident and reflected their interests and lifestyle. All areas of the home visited were clean and hygienic. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 Residents benefit from there being an experienced and competent staff team who are meeting their individual and joint needs. EVIDENCE: Staff interviewed were capable and experienced, and discussed with the inspector how the team ensure that the needs and wishes of residents are allimportant. Each resident has a key worker, who will plan activities with the resident, arrange reviews of the care plan and health appointments, and discuss care issues with the resident. The home has a clear management structure. Mrs Brown has advised that two care staff have the National Vocational Qualification (NVQ) in care at level 2 or above, and that four care staff are presently undertaking NVQ training. A range of core training, including training in the protection of residents from abuse, are being provided for staff. Staff rotas for 4 weeks in July and August 2005 were sampled by the inspector, which indicate that staffing levels are consistent. Mrs Brown has advised that over an eight week period in July and August 2005 two individual shifts were covered by agency staff. Care records seen indicate that staffing is sufficient to ensure staff are available to accompany individual residents on outings and to assist residents with individual activities. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 18 Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42 The home operates has a resident centred approach, and has a relaxed and friendly atmosphere. 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. EVIDENCE: Mrs Brown said she had now achieved the NVQ4 in care management, and was continuing to update her skills and knowledge through training and other resources. The clients are benefiting from Mrs Brown’s resident-centred approach to running the home, and examples of this were noted during the inspection. Mrs Brown said she felt well-supported by the clinical team and company partners in providing the service to residents. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 20 The home has a relaxed and friendly atmosphere, and records indicate that staff deal with difficult situations in a calm and helpful way. One relative has commented in writing to the Commission that without the environment that the home provides the resident “would be a lot less stable and happy”. A business plan is in place for the home, but an annual development plan has not yet been provided. Mrs Brown has advised the Commission in writing of fire drills, tests and training which are taking place, and of electrical wiring, lighting, and equipment checks and replacement which have been carried out. The home has a policy of providing hot water in taps and in baths at 50 degrees centigrade, rather than the recommended 43 degrees centigrade. The inspector hand tested the hot water in the upstairs bathroom, and considered that the temperature of the hot water could present a scalding risk to residents. Mrs Brown has advised the Commission in writing of policies and procedures required and when these have been last updated. Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trent House Score x x x x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 2 x H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 22 no 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 42 Regulation 13.4 c. 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. Timescale for action 16.12.05 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 23 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. 2. 39 Trent House H60-H11 S14804 Trent House V242560 220905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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