Inspection on 09/11/07 for Tresleigh

This inspection was carried out on 9th November 2007.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tresleigh 03/11/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Tresleigh Fore Street Grampound Road Truro Cornwall TR2 4DU Lead Inspector Lynda Kirtland Unannounced Inspection 9 November 2007 9:15 Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 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 Tresleigh DS0000070068.V349975.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 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. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tresleigh Address Fore Street Grampound Road Truro Cornwall TR2 4DU 01726 883431 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) Spectrum Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) - maximum 5 places The maximum number of service users who can be accommodated is 5. Date of last inspection New service – first inspection Brief Description of the Service: Tresleigh is a care home providing accommodation and care for up to five adults, of either gender, with a learning disability. The registered provider is Spectrum, an organisation that provides specialist services for people with Autistic Spectrum disorders. Tresleigh offers care and accommodation to service users who already have a reasonable level of independence and a facility where they can continue to develop their personal and social skills. Spectrum currently employs an acting manager and a team of staff to run the home on a day-to-day basis. External, on-call managers are available to provide specialist input, support and advice where necessary. Tresleigh is a former small farmhouse in the village of Grampound Road. The village offers limited facilities such as a shop, park and pub. St Austell & Truro are approx ten miles away. The home has an accessible garden in safe surroundings with limited car parking for the home’s vehicles and some staff cars. The home has a vehicle to provide transport for service users who need to access resources in the wider community. The home is a two-storey building. All the bedrooms have en suite bathroom facilities and the people who use the service choose décor. The majority of bedrooms are on the first floor. Service users must be able to negotiate stairs. There are facilities for staff sleeping in and the home has a dedicated office on the ground floor. The home has two lounge areas, separate dining area, and gardens, There is a communal kitchen, laundry facilities are located in a separate area to the kitchen. On the 9 November 2007 the current fees for this service ranged from £1759.74 to £3256.72 per week. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Tresleigh was registered with the commission transferring from a children’s to adult service in June 2007. This was the first unannounced key inspection under adult regulations, which took place on 9 November 2007 and lasted for approximately seven hours. The purpose of the inspection was to ensure that service users (residents) needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents’ placements in the home result in good outcomes for them. Information received from and about the home since it’s opening has also been taken into consideration in making judgements about the quality of outcomes for the residents living there. The people who use the service were at their daily activities (school/ college) during the inspection and therefore there was limited time to be able to meet with them and gain their views. The inspection included a tour of the premises, examination of care, safety and employment records and discussion with the acting manager. We talked to staff about particular people’s needs and their care plans, medical records and daily notes for two people. This is called case tracking. There were some opportunities to directly observe aspects of residents’ daily lives in the home and staff interaction with them. The Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the acting manager completed. The AQAA describes the services and facilities that Tresleigh provide and identifies what areas they do well in and where they want to make further improvements. What the service does well: Some of the residents had lived together previously and therefore knew each other well. With new residents it was evident from looking at documentation, and a tour of the home that there was a planned moving in period to Tresleigh. The manager said that residents choose the décor of their rooms, which were also personalised to the individuals taste. Assessments prior to moving into Tresleigh are undertaken and based on the individuals health, social and personal care needs, including needs relating to their religious, ethnic and cultural backgrounds, to ensure they can be met in the homes setting. Residents are encouraged and supported to develop their skills and independence in many ways. They are involved in developing their own care plans with assistance and support from staff. Residents attend reviews regularly, so that they know why they are placed at the home and via their person centred planning (PCP) process identify what aspirations they are Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 6 aiming to achieve e.g. developing a particular element of self-care to promote their skills and independence. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Residents are encouraged to maintain valued relationships with their families and friends, with staff support as necessary. Residents have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. There is good access to health agencies and from documentation inspected it was evident that access to specialist services is also available. The home has a robust medication process and procedure, which promotes the safe administration of medicines to residents in the home. Residents participate in the planning of the menus and help staff to prepare meals. They have free access to the kitchen so that they can make drinks and snacks for themselves when they wish and are encouraged to live and eat healthily. Residents are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist them with their needs quietly and unobtrusively. There are adult protection policies and procedures in place to safeguard residents. These are shared with staff so that they are aware of what to do if they have any concerns in this area. Tresleigh environment is suitable for the residents living there. Resident areas were clean and tidy throughout at the time of the unannounced inspection. Residents are consulted about the décor and furnishings of their bedrooms. The staff team demonstrated throughout the inspection positive interactions with residents and assisted them with personal care needs in a discrete manner. Staff confirmed access to training is available. The inspector was welcomed to the home in a friendly manner by staff and residents. All were aware of the reason of the inspection. What has improved since the last inspection? This is the first inspection Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 7 What they could do better: As this is the first inspection a number of statutory requirements and recommendations were identified to further improve the service that Tresleigh provides. The manager agreed that the Statement of Purpose and Service Users Guide needs to be reviewed, updated and made more personalised so that they accurately reflect the services that are provided at Tresleigh as this is currently lacking. This includes clarity on management arrangements and what staffing levels are present in the home at all times to ensure that they can meet individual’s needs as specified in their care plans and risk assessments. These numbers must be reviewed taking into account residents individual and group risk assessments to ensure there is sufficient competent staff on duty at all times. Contracts in relation to the placement clearly identify residents’ rights and what services they will be provided with. It should clarify what costs the resident needs to pay and identify their benefit entitlements. It is recommended that the staff record resident’s views so that they are aware of the purpose of their placements in the home and are able to contribute to the ongoing care planning process. The manager did not have a disposal of medication record but will introduce this The manager agreed to gain a copy of the latest medicine guidelines for care homes, for reference. It is recommended that the manager attend the Multi Disciplinary Adult Protection course and gains a copy of the Cornwall Multi agency adult protection procedure. There are many areas for improvement in respect of the environment both internally and externally. These are detailed in the report but to summarise certain areas of the home internally needs replacement carpets, decoration, furnishings to be replaced, a review of the kitchen area and more emphasis placed on the importance of infection control. The external parts of the home also need to be risk assessed to ensure that the areas that are currently accessible to Service users, staff and visitors are made safe. Due to the number of areas identified these have been summarised into three requirements and must be addressed. The staff team are below the national minimum standard of 50 qualified at minimum of NVQ level 2. The manager said this is being addressed. The homes manager is aware that staff need to attend specific training courses to assist them in their daily work and is arranging for them to attend such courses i.e. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 8 medication, infection control, health and safety, manual handling, infection control, food hygiene and positive behavioural management. Elizabeth Howarth the current manager has been in post for 4 months. The Commission has accepted Ms Howarth application that is being processed. Ms Howarth confirmed that she has gained her NVQ 4 in management and is nearing completion of her NVQ 4 in care. In the New Year she aims to attend the Registered Managers Award course. The Manager should attend the Multi Disciplinary Adult Protection training. Ms Howarth has five hours dedicated administration time. It needs to be reviewed if this is sufficient time to undertake the management roles that she needs to achieve. All notifications under regulation 37 should be forwarded to the Commission. The manager should ensure that up to date policy and procedures are available in the home and accessible for all staff. As the service is new a quality assurance process has not commenced. Ms Howarth will implement this and send a copy of the quality assurance findings when completed. The fire risk assessment must be reviewed to ensure that it meets new legislation. It was observed that some doors were wedged open, this poses a health and safety risks especially in the event if a fire and should not occur. The inspector would like to thank residents, staff and acting Manager for their cooperation and assistance throughout this inspection. 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. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 9 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 Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information provided to service users needs to be updated and more individualised so that Service users are aware of what facilities and services they will be provided at Tresleigh. Service users’ needs are assessed with a planned transitional programme occurring so that Service users are consulted before moving to a new home. Service users contracts should identify what financial costs are involved in the placement. EVIDENCE: The manager agreed that the Statement of Purpose and Service Users Guide needs to be reviewed, updated and made more personalised so that they accurately reflect the services that are provided at Tresleigh as this is currently lacking. Managers of Spectrum homes undertake assessments and seek professionals’ views that are involved in the individuals care. From this a decision is made as to the suitability of Tresleigh being able to meet the individual’s needs. It is evident from documentation seen that prospective residents to the home were consulted through their transitional programme about their wishes to reside at Tresleigh. Contracts in relation to the placement clearly identify residents’ rights and what services they will be provided with. It should clarify what costs the resident needs to pay and identify their benefit entitlements. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users care plans address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. EVIDENCE: Residents, their family, advocate and relevant professionals are involved in the development of individual care plans and their subsequent reviews. Monthly reviews are held and it is recommended that the staff record resident’s views so that they are aware of the purpose of their placements in the home and are able to contribute to the ongoing care planning process. The care plan has specific headings to address their health, personal and social care needs, including their individual and diverse needs. These are in written form plus in Widget (pictorial) form. Care plans provide residents with specific goals to work towards, and inform and direct staff in how to support the resident to achieve this goal to encourage them to fully maximise their skills for Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 12 independent living. As the care plan documentation can be lengthy the introduction of ‘micro care plans’ summaries particular aspects of care and details what specific staff interaction is needed are now available. Residents participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. Staff were observed supporting residents who required it, to make decisions about what to do during the day. Residents written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. Residents can choose the level of privacy they wish to enjoy in their private accommodation. Residents are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. Resident’s monies are audited on a monthly base at Spectrum headquarters. They were not inspected on this occasion. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. EVIDENCE: Residents care plans and daily care records provide good evidence that their interests and abilities are fully considered in planning their daily activities, which are planned with them individually. This is then displayed in either word or symbol format as a “daily activity rota” so that residents can follow their routine more easily. Some activities include assisting them to access school/college and involved in variety of sports for example. At the time of the inspection residents were engaged in a variety of different and appropriate activities in and out of the home, with staff support provided as necessary. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 14 Residents are encouraged to maintain valued relationships with their families and friends, with staff support as necessary, which their daily care records confirmed. They are able to make telephone calls in private if they wish. Residents are supported and encouraged to eat healthily. They undertake shopping, planning for and preparing meals with assistance from staff. Nutritional needs and preferences are considered as part of the care planning process. Resident’s views are sought in the weekly menu planning. All the residents looked healthy and well nourished. The home has an ordinary, domestic kitchen, which they can access freely, to prepare drinks and snacks when they want them. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems are in place to ensure that Service users are not placed at risk. EVIDENCE: Residents individual care plans address their personal care needs. Residents appeared to be attractively and fashionably dressed and were well groomed so that they can comfortably take part in community life. The home has suitable bathroom facilities so that they can attend to their personal care in private. Resident’s healthcare needs are considered as part of the care planning process and regularly reviewed. Documentation showed that people who use the service have access to external healthcare providers, including specialists, when they need to. There are suitable medication storage facilities. Residents do not currently selfadminister medication. Spectrum has a medication policy that was present in the home. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 16 Tresleigh uses the Monitored Dose System (MDS) so that medication in the main is received in blister packs. From inspecting the medication process it was evident that staff receive and administer medication safely. MAR sheets recorded medication the home had received, and when administered. An audit of loose medication showed that the numbers recorded as present in the home tallied with the tablets stored in the cabinet. The manager did not have a disposal of medication record but will introduce this. It was observed that Tresleigh has a lockable medication cabinet fixed to the wall and then PRN medication is kept in lockable tins in a locked filing cabinet. We recommend that the storage of the later medication is reviewed and risk assessed as to the appropriateness of storing medication in this manner The manager agreed to gain a copy of the latest medicine guidelines for care homes, for reference, by the Royal pharmaceutical company. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: Residents are provided with written and pictorial copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. The home has received no complaints. The home has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Residents are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Spectrum has a whistle blowing policy. It is recommended that the acting manager attend the Multi Disciplinary Adult Protection course and gains a copy of the Cornwall Multi agency adult protection procedure. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s internal environment provides service users with an ordinary, domestic setting so that they can develop their skills and independence in a non-institutional setting. Consultation with Service users has led to private space being furnished to a comfortable standard. Improvements are needed to protect service users from risks of cross-infection. The outer buildings are unsafe and some improvements to the home are needed. EVIDENCE: The home looks like an ordinary, domestic dwelling. It was evident form a tour of the home that the people who use the service have been consulted on the décor of their bedrooms and some had recently chosen furnishings for their rooms. The communal lounge areas and dining area are also attractively furnished. People who use the service need to be able to negotiate stairs to access the upper part of the home. From a tour of the home it was observed that Tresleigh aims to provide comfortable surroundings to the people who live there. However there were Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 19 some areas of improvement, which need to be addressed. They are: the carpet in the main lounge is badly stained and needs replacing: the carpet in the smaller lounge needs cleaning or replacing: the walls in the smaller lounge needed to be washed; one of the residents rooms and parts of the landing has holes in the walls, which need to be repaired: a resident w=room was identified as needing redecoration which CSCI supports: two en suite baths have cracks in them and need repair/ replacing: a radiator in one of the en suites had rust on it and this can cause a infection control risk and therefore needs addressing: staff toilet needs redecorating as tiles are missing and again can cause a infection control risk. In respect of the kitchen area this is accessible at all times to the people who use the service. It is noted that due to the height of the kitchen cupboards that these were not easily accessible to anyone in the home, which staff agreed. The manager stated that all equipment works and that the kitchen is ‘function able’ but agreed that the practical design of the kitchen so that residents can access the kitchen easier and participate more in meal preparation would benefit from redesign/ refurbishment. It was also observed that there were infection control risks here that need to be addressed: broken tiles, parts of the flooring had become unstuck and the kitchen walls needed cleaning. The manager was unaware of the last environmental health inspection and it is recommended that this be arranged It was noted that the freezers are in the basement. Due to the building being a farm house access to this area is down steep uneven concrete stairs. The manager needs to risk assess the safety of carrying frozen food to/from this area and consider relocating the freezers due to the current high risks this poses. It is noted that people who use the service do not access this area. From a tour of the external parts of the property a secure garden is accessible to People who use the service. One part of the fence has a hole in it, which needs repair. Staff said that external security lights are not currently working and these need to be repaired. Tresleigh has a cottage attached to the main home. This is not accessible for residents due to the current risks that are evident in this area and is therefore used as a storage facility. The laundry facility is located in one of the outbuildings. This area needs to be cleaned as the current amount of ‘fluff’ from the cleaning of clothes could pose a fire hazard. All outbuildings are in a poor condition and are not able to be used for residents due to the risks they could pose. The manager agreed that residents can access these areas and that she would risk assess these areas and ensure that all precautions are taken to ensure the health and safety of all those who live, work or visit the home. The coal cupboard should be locked shut. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Currently there are sufficient numbers of staff on duty so that service users can have confidence in their competence and skills. Staff training needs to be reviewed and any gaps in training identified and addressed. The home’s recruitment policies and practices are fair, safe and effective so that service users can be assured that staff are suitable to work in a care setting. Staff supervision has commenced. EVIDENCE: The staff rota showed that six or seven care staff were on duty during the day, four or five in the evenings (but on a Wednesday this is increased to six due to a particular activity) with one sleeping in and one waking night staff member on shift. Staff felt that the staffing numbers were sufficient. On the day of inspection there was 8 care staff on duty. The homes Statement Of Purpose (04/10/07) and staffing policy (23/04/07) contradicted each other in identifying how many staff should be on duty – the manager agreed to review both of these documents. In addition from individual risk assessments the home concluded that there should be eight care staff on duty at all times, therefore the manger needs to review the risks in the home and how many staff should be on duty at all times. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 21 The manager stated that they have two and a half care staff post vacant, which will be advertised. The current staff team undertake extra shifts so that the residents have the same carers at all times which provides consistent care. Care staff undertakes all personal care duties plus with residents assistance cleaning and cooking tasks. From observations of staff interaction with residents it was evident that they communicate with residents in a competent, fair, patient manner and work with them at their pace. Staff commented that they enjoy working at Tresleigh with the current resident group, feel they work together well as a team and that they have good management support. The homes manager has arranged for staff to commence or are progressing towards achieving NVQ level 2 training. The staff team are below the national minimum standard of 50 qualified at minimum of NVQ level 2. The homes manager is aware that staff need to attend specific training courses to assist them in their daily work and is arranging for them to attend such courses i.e. medication, infection control, health and safety, manual handling, infection control, food hygiene and positive behavioural management. The home’s staff recruitment records indicate that staff are appointed on the basis of written application forms and equal opportunities interviews. Appropriate checks are made of their suitability to work with vulnerable adults in a care setting. It was noted that residents are not currently involved in the recruitment process but newly appointed staff felt that residents views were being sought during their probationary period of work. Due to the recent appointment of the manager supervision is commencing of all staff and states she aims to provide six weekly supervision. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The homes manager is applying to the Commission to be registered so that an assessment of her fitness to provide this role is assessed. The home is mainly well managed for the benefit of service users. Service users and their representative’s views need to be gained regarding the day-to-day running and ongoing development of the home. Risk assessments and notifications of incidents to Service users need to be followed to protect service users from avoidable harm and injury. EVIDENCE: On registration of this home a different manager was appointed to be the registered manager of Tresleigh. This manager has since left and Elizabeth Howarth the current manager has been in post for 4 months. The Commission has accepted Ms Howarth application that is being processed. Ms Howarth confirmed that she has gained her NVQ 4 in management and is nearing Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 23 completion of her NVQ 4 in care. In the New Year she aims to attend the Registered Managers Award course. Staff spoke highly of Ms Howarth’s skills and felt that she was approachable and listened to their ideas or concerns. From observations staff and residents communicated with her in a relaxed manner. Ms Howarth has five hours dedicated administration time. It needs to be reviewed if this is sufficient time to undertake the management roles that she needs to achieve. As the service is new a quality assurance process has not commenced. Ms Howarth will implement this and send a copy of the quality assurance findings when completed. However she is monitoring the care planning, medication, and monitoring staff practices. Regulation 26 visits occur which she says she finds useful especially as the home is in the early stages of its development. Records are stored confidentially, staff need to be conscious of their recordings to ensure that it adheres to the data protection act i.e. communications book. As detailed in the environment section areas of improvement need to be addressed to ensure the health, safety and well being for all these who live, work and visit the home. The manager is also aware that the fire risk assessment needs to be reviewed. Fire training occurs and regular fire tests are carried out. The manger was informed that fire doors should not be wedged open as was observed during this inspection, as this poses a health and safety and fire risk. The manger was made aware that some of the policies and procedures that were available in the home appeared to be out of date (majority dated 2003or before). These need to be reviewed and updated. Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 24 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 2 X 2 X Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4 Requirement The homes Statement Of Purpose and Service Users guide must be reviewed to accurately reflect the services that Tresleigh provide. The manager must undertake an internal environmental audit of the home and ensure action is taken so that the premises are kept reasonably decorated and all furnishings are in working order. The manager must undertake a external environmental audit of the home to ensure that Service users, staff and visitors are not placed in unnecessary dangers and identify what action will be taken to ensure there safety at all times. The manager must ensure that the kitchen area is kept clean and that furnishings are repaired to promote infection control. All events notifable under regulation 37 of the care Standards Act 2000 must be DS0000070068.V349975.R01.S.doc Timescale for action 31/01/08 2 YA24 23 (2) (b) (c) 31/03/08 3 YA24 23 (2)(a)(b) (o) 31/03/08 4 YA30 13(3) 31/01/08 5 YA42 37 31/12/07 Tresleigh Version 5.2 Page 26 reported to the Commission 6 7 YA37 YA42 8(1)(2) 23(4)(b) (c)(iii)(d) (e) The homes manager application for the registered manager post must be processed. The fire risk assessment must be reviewed to ensure that it meets new legislation. In addition fire doors must not be wedged open as this posses a health and safety risk. 31/12/07 31/12/07 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 YA5 Good Practice Recommendations Service users should be provided with clear information about the costs of their placements, including more detailed and accurate information on how their personal contributions are calculated Care plans are reviewed monthly and it is recommended that the staff record resident’s views in this process A copy of the Royal pharmaceutical guidelines should be gained, as should a medication disposal book. Staff and managers should undergo multi-agency training in the protection of vulnerable adults from abuse to enhance their knowledge and skills of working together with key agencies involved in this. 50 of the staff team should be qualified at minimum of NVQ level 2. The mangers administrative hours should be reviewed to ensure that she has sufficient time to fulfil her management role and responsibilities. A quality assurance process should be implemented and its findings with any actions the home intends to take should be sent to the Commission. The manager should ensure that up to date policy and procedures are available in the home and accessible for all staff. DS0000070068.V349975.R01.S.doc Version 5.2 Page 27 2 3 4 YA6 YA20 YA23 5 6 7 8 YA32 YA37 YA39 YA40 Tresleigh Commission for Social Care Inspection Devon Area 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 Tresleigh DS0000070068.V349975.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!