CARE HOME ADULTS 18-65
Treseder House 111 Moresk Road Truro Cornwall TR1 1BP Lead Inspector
Ian Wright Announced Inspection 2nd March 2006 14:00 Treseder House DS0000009138.V276782.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 Treseder House DS0000009138.V276782.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. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Treseder House Address 111 Moresk Road Truro Cornwall TR1 1BP 01872 274172 01872 274172 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) www.mencap.org.uk Royal Mencap Society Ms Lesley Saunders Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 3rd October 2005 Brief Description of the Service: Treseder is situated in a pleasant residential area close to the city of Truro. The home provides care and support for 8 adults with learning disabilities. The home is a large detached property. All service users have their own bedrooms. The home has a large lounge / dining room, kitchen, and appropriate bathroom and toilet facilities. The home has spacious grounds, which are well maintained and there is a patio with seating. The present service users can access all parts of the home and garden, however the home would not be suitable for wheelchair users. Car parking space is available at the front of the home. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over six and a quarter hours. The inspector was able to speak to the majority of service users, the registered manager and the staff members on duty. The inspector examined care and service records, and inspected the building. What the service does well: What has improved since the last inspection? What they could do better:
This inspection produced a total of five statutory requirements, which the registered persons must address. Currently staff look after the majority of service users moneys. Arrangements regarding the management of service user finances must be risk assessed and regularly reviewed, with the objective of increasing service user independence where this is appropriate.
Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 6 Mencap needs to review its complaints procedure. Service users need to be aware they can contact the Commission, at any stage, when they have a complaint. The current procedure implies the Commission should only be contacted as a last resort if someone has a complaint. The registered manager however has provided details for service users to contact the local commission office. Training needs some improvement. For example there are some gaps in training received by staff as required by law such as food handling. Additional training specific to the needs of service users at Treseder is also required; i.e. training to meet the needs of people with either autism and dementia, and training to care for people with epilepsy (e.g. how to care for a service user who has had a seizure). If staff do not have training regarding epilepsy this could put service users at risk. Medication training needs to be improved by Mencap, for example to ascertain staff competence in administering medication. 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. Treseder House DS0000009138.V276782.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 Treseder House DS0000009138.V276782.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, 3 The registered provider provides suitable information to assist service users and their representatives, to know what services are provided. Suitable links are maintained between staff and other external professionals so service user needs are met. EVIDENCE: A suitable statement of purpose, and service user guide were inspected. The manager said the service user guide is issued to service users, and where appropriate to their next of kin / representative. The registered manager said the staff team have developed suitable links with external professionals such as community nurses, general practitioners, chiropodists, dentists and social workers. The manager said staff have access to comprehensive training provided by Mencap, for example to National Vocational Qualifications. Treseder House DS0000009138.V276782.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 Appropriate policies and procedures and documentation, are in place regarding care planning and risk assessment. Care plans are reviewed and updated regularly. Service users receive support to develop their skills and take appropriate risks. Service users are consulted about major and day-to-day decisions. EVIDENCE: A copy of a care plan is contained in each service user’s file. Service users have at least an annual review meeting. Service users stated they are enabled to make decisions e.g. regarding day activities and major life events. Service users said there are regular residents meetings, which enable them to make comments about life in the home. Minutes are kept of these meetings. CSCI comment cards received from service users were positive regarding the service provided, although some service users wrote they would like to be more involved in decision-making. The registered manager said there are currently no advocacy services involved with service users. Service users said they are encouraged to take appropriate risks e.g. go out on their own. Suitable risk assessments are maintained on each service user’s file, and these are reviewed.
Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 10 Staff look after the majority of service users’ moneys. Records for service user moneys were inspected and were satisfactory. Receipts are obtained for expenditure where service users lack the capacity to make decisions regarding how moneys are spent. Risk assessments need to be developed for individual service users where the control and management of their individual money is carried out by staff. For example the Mencap service user risk assessment procedure could be used. Risk assessments must be regularly reviewed. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 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 the following standard(s): 11, 13, 14, 17 Service users are encouraged to develop their skills and abilities. Service users have suitable opportunities to be part of the local community and have a range of day activities. Arrangements for meals are to a good standard. EVIDENCE: The registered manager said service users are encouraged to develop their skills to be more independent. For example service users are encouraged to participate in household tasks such as cooking and shopping. Service users can participate in religious services if they wish. Service users said they have suitable opportunities to participate in the community for example using local facilities such as leisure centres, cinema and the local theatre. Service users have opportunity to attend work placements and attend further education. All service users have comprehensive day activity plans. Mencap supports service users to have an annual holiday. Some service users said they were looking forward to go to the United States of America later in the year. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 12 Daily routines are flexible and tailored according to individual needs. Independence and choices are encouraged. Service users stated they feel very much at home and are well supported by staff. The registered manager said service users receive varying degrees of support to prepare their breakfast and lunch. Service users take turns to cook the evening meal with staff support. Service users special diets due to health, cultural or religious needs can be catered for. The inspector shared a meal with service users, which was to a good standard. Staff also ate with service users and everybody discussed what had happened during the day. The meal was unrushed and relaxed, and service users received appropriate support where this was required. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 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 the following standard(s): 20, 21 Arrangements regarding the management of service users medication is satisfactory although staff training needs to be more comprehensive in this area. There is a suitable policy regarding ageing, illness and death of service users. EVIDENCE: The registered provider has a suitable policy regarding the storage and handling of medication. The medication system was inspected. Storage and records of medication is satisfactory. In regard to the medication training offered, coverage of issues of administration and record keeping is very basic. There also is no practical assessment of staff skills after completion of the course to verify staff competence. Mencap must address these matters. The registered provider has developed a policy regarding ageing, illness, death and dying. Although basic, this is satisfactory. Care plans and practices need to demonstrate how the registered persons will meet the changing needs of service users-when this is applicable- as they get older and/ or become unwell. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 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 the following standard(s): 22, 23 The registered provider must review its complaints procedure so it meets the national minimum standard and gives service users appropriate information. The registered provider has a suitable adult protection policy, which is effectively implemented. EVIDENCE: The registered provider has developed a complaints procedure. The registered manager has included a summary of this in the service user guide. Information regarding the complaints system has been issued to service users. For example service users receive a prepaid postcard, which they can send to the organisation if they have a concern or a complaint. The complaints procedure is regularly discussed in residents’ meetings. The inspector read the organisation’s complaints policy in the ‘Operations Manual.’ This requires updating, for example the organisational policy refers to the National Care Standards Commission, which has now been superseded by the Commission for Social Care Inspection. The policy also regards the complainant’s right to contact the Commission as the last stage of the procedure, rather than stating complainants can contact the Commission at any time as outlined in NMS 22.3. The registered manager said the Complaints Procedure is also discussed regularly in residents’ meetings. Mencap has an appropriate adult protection policy. Most staff have attended Mencap training regarding abuse (Protect Me). The ‘Protect Me’ training is mandatory for all staff as part of the organisation’s induction and foundation training. Some staff have also attended social services training regarding protecting service users from abuse. All staff have a Criminal Records Bureau (CRB) check and (where applicable) a Protection of Vulnerable Adults (POVA) check.
Treseder House DS0000009138.V276782.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, 30 Treseder is a suitable environment for service users living there. The home was clean and hygienic on the day of the inspection. EVIDENCE: The building was inspected. The home offers a pleasant and homely environment for service users. Bedrooms and communal areas are of suitable size to meet the needs of service users. The home was clean and hygienic on the day of the inspection. The building is well maintained. Suitable cleaning routines are in place. Treseder House DS0000009138.V276782.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): 32, 33, 34, 35 Suitable numbers of staff are employed to support service users. Information required by regulation is obtained regarding the employment of staff. This helps ensure service users are in safe hands. Training needs to improve so staff receive training to satisfactorily meet service user needs, and to adhere to legal requirements. EVIDENCE: Rotas indicate the registered persons provide appropriate staffing to meet service users needs. Service users stated they believed staffing levels to be satisfactory. There is usually two staff on duty in the evenings and at weekends, and one member of staff at other times. This level of cover is appropriate considering the number and current needs of the service users. The inspector observed information kept on staff files. The registered persons obtain suitable information regarding the recruitment of staff. This includes two references and evidence confirming the person’s identity. Evidence that staff have received a Criminal Records Bureau (CRB) check and (where applicable) a Protection of Vulnerable Adults (POVA) check is also obtained. Mencap has a suitable training programme including induction and foundation training, and other training required by regulation. Staff have suitable opportunity to obtain a National Vocational Qualification (NVQ) in care. One
Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 17 member of staff currently has an NVQ 2, and three staff are due to enrol to complete an NVQ 3 in care shortly. There are however some gaps in training received as required by regulation. This includes infection control, and food hygiene. Training records show some staff have received training required by regulation but there are no certificates to evidence this. If possible the registered manager should try and get duplicate certificates of the courses attended. Staff need to have training in dementia, epilepsy and autism. Staff need to have this training during their induction / foundation period with refresher training as appropriate. Lack of staff training in epilepsy could put service users at risk. Mencap may wish to consider delivering some of the above training at an area/ regional level as there is also a need for this training at other Mencap homes e.g. in Cornwall. Treseder House DS0000009138.V276782.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): 39, 41, 42, 43 The registered manager ensures the effective management of the home, and suitable systems are in place to evidence this. EVIDENCE: Mencap has suitable a quality assurance policy. The registered persons completed a survey of the views of various stakeholders regarding how the service is managed. The survey ascertained the views of service users, staff, external professionals etc. Responses were very positive. The survey however was completed a year ago. The registered manager said she would complete another survey shortly. A copy of Mencap’s ‘Operations Manual’ was inspected. This is comprehensive, although some policies need to be updated, for example as outlined elsewhere in this report. Records kept were inspected and found to be satisfactory. Mencap has a suitable health and safety policy. Monthly health and safety checks are carried out according to the organisation’s procedure. Suitable procedures are also in place to test gas and electrical equipment, and there is
Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 19 satisfactory evidence that testing is completed. For example portable appliance testing was completed in May 2005, and gas appliances were tested in June 2005. Mencap has a suitable system of accident / incident reporting. All accidents / incidents appear to have been dealt with appropriately. Mencap has a comprehensive policy regarding the prevention of Legionella. Checks are completed to a satisfactory standard. Testing of fire prevention equipment is satisfactory, for example in regard to emergency lighting and testing the fire alarm call points. A fire drill was completed in December 2005. The registered provider keeps suitable financial records that demonstrate the home is financially viable. Treseder House DS0000009138.V276782.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 3 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 3 X X 3 X 3 3 3 Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 21 YES 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 YA9YA7 Regulation 12, 17 Requirement Timescale for action 01/07/06 2 YA20 7, 12, 13, 19 3. YA22 22 Risk assessments must be developed for individual service users regarding the control and management of their moneys. These must be regularly reviewed. The registered provider must 01/09/06 review its medication training. Coverage of issues such as administration and record keeping should be improved. There should be a practical assessment, by a suitably qualified person, of staff skills after completion of the course to verify staff competence. The registered provider must 01/09/06 amend the homes complaints procedure to: • Include information (address, phone number etc.) how service users can contact the Commission for Social Care Inspection (CSCI) • State that complainants can contact the CSCI at any time as outlined in NMS 22. Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 22 This information must be available for inspection and issued to service users, and where appropriate, their representatives. (Previous deadline of 1/12/05 not met. Second Notification) 4 YA42YA35 12, 13, 18 The registered manager must 01/07/06 ensure staff receive training required by regulation. This must include fire training, manual handling, food handling, first aid and infection control. There must be suitable evidence of this e.g. copies of certificates of attendance. 12, 13, 18 The registered provider must provide all staff with training in dementia, epilepsy and autism, and ensure this is updated as appropriate. 01/07/06 5 YA42YA35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Treseder House DS0000009138.V276782.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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