CARE HOMES FOR OLDER PEOPLE
Trevern 72 Melville Road Falmouth Cornwall TR11 4DD Lead Inspector
Lynda Kirtland Unannounced 4 July 2005 11.00 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Trevern Address 72 Melville Road Falmouth Cornwall TR11 4DD 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) 01326 312833 01326 210196 Cornwall Care Limited Mrs Bridget Varney Care Home 24 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11), Old age, not falling within any other category (13) Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 13 adults of old age (OP) Service users to include up to 11 adults over 65 with dementia (DE(E)) Service users to include up to 11 Adults over 65 with a mental disorder (MD(E)) Service users to include one named person only outside of the normal age category of the home Total number of service users not to exceed a maximum of 24 Date of last inspection 20 January 2005 Brief Description of the Service: Trevern is one of eighteen care homes owned by Cornwall Care Ltd. It is situated on the outskirts of Falmouth. The home offers residential care for up to twenty-four elderly people, nine of whom may be suffering from a degree of dementia. Trevern has commenced building works to enable an increase in the provision of the care and accommodation it can provide to future service users. Admissions are on a planned bases and emergency admissions are avoided whenever possible.The premises have been adapted and offer a number of flatlets for the more able and independent service user. Bedrooms are on the ground and first floors with a lift at each end of the building. All rooms have call bells. There is a day care facility provided with a maximum of two service users attending each day.Meals are prepared in a well-equipped kitchen on the ground floor and served in two ground floor dining rooms, accessible to all service users. A hair dressing service is provded on site.The grounds are kept tidy and there is a patio with seating and tables, easily accessed by service users. Limited car parking space is provided at the front of the home.Suitably qualified care staff provides personal care within a relaxed, friendly atmosphere. There are opportunities for socialising and visitors are openly encouraged. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Trevern on the 4 July 2005 and spent six hours at the home. This was an unannounced visit. On the day of inspection 22 service users were resident in Trevern. The inspector met with 11 service users, a number of staff and the registered manager to gain their views on the service that Trevern provide. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. Trevern has planning permission to extend the home facilities to provide accommodation for a further 16 residents. This is in the process of being built. The majority of residents felt that the building works had not had any personal impact on them, all stated that there had been no impact on the care they received from staff at the home. Staff are enthusiastic about the extension to the home. The registered manager aims for the extension to be ready for use around October 2005, dependent on the approval and registration by the relevant authorities and with CSCI. What the service does well:
Residents commented that Trevern provides good quality care and accommodation. In the main residents made various comments about staff such as, they are ‘kind’ and ‘caring’. All residents said that they felt that they were consulted about their care needs which staff met. Residents commented that they have access to health care and felt that all their health needs were met to a ‘good’ standard. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. Residents were ‘very satisfied’ with the quality and provision of food. Cornwall Care prioritises staff training and is keen to continue to develop staff skills. Staff are positive about the training that they have received and how it is relevant to their every day work. Cornwall Care Ltd is keen to continue to provide good quality training to its entire staff. The majority of residents and staff stated that if there were any issues they felt able to approach the management team directly and that their ideas would be listened too and where appropriate acted on. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 6 This inspection was positive and the inspector would comment that Cornwall Care Ltd is an organisation that wants to achieve a high standard of care to all its residents and provide appropriate training and support to its staff group. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5 Prior to admission, residents and their representatives participate in a pre admission assessment with members from the management team to identify individual care needs. Trevern provide a planned trail period of stay at the home. Emergency admissions are avoided wherever possible Staffs are experienced and competent to meet resident’s needs. EVIDENCE: From discussion with residents, plus inspection of two residents files it was evident that they are consulted in Trevern pre admission assessment. Care needs identified by the referring professional assessments were incorporated in the assessment process and transferred to care plans This assessment is detailed and identifies the residents individual physical, emotional, social, educational and leisure needs and how the home would aim to address them. A months trail period is offered to all new residents after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. From records inspected and in discussion with residents they commented that the preadmission and ‘moving in period’ are carried out sensitively by staff and could not see how this process could be improved. They also stated that this
Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 9 was undertaken with their participation and that their care needs were identified accurately. From observations of staff, plus inspection of training records it was evident that the staff team are experienced in the area of older peoples care and receive regular training to update their knowledge in this area. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to residents. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Residents and their representatives are consulted in the implementation and subsequent reviews of their individual care plans. The staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. Health care needs are met to a good standard. EVIDENCE: From discussion with residents, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of residents files, and in discussions it is evident that Trevern encourage residents and their representatives to express their views in the formation of their care plans. The care plans are detailed documents, which clearly identify resident’s skills and where assistance is needed. From this the care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. Monthly reviews of the care plans were evident. Residents commented that health needs are met by the staff at the home and by external professionals to a good standard. Detailed records of all health professional visits to individual residents further evidenced this.
Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 11 Trevern outlines in its statement of purpose and service users guide its philosophy on promoting resident’s rights, privacy and dignity. Inspectors noted that the atmosphere of the home and residents appeared to be relaxed. Residents commented staff ’ were ‘kind’. From inspectors observations of staff throughout the inspection it was noted that staff approached and interacted with residents in a professional yet sensitive manner. Residents confirmed that they have a choice as to when to rise/ retire to bed, receive their mail unopened, have access to a private phone and can receive visitors in private. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 Trevern provides a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. EVIDENCE: From discussions with residents the majority commented that there is ‘enough to do’ during the day. The inspector noted on the day of inspection a variety of activities taking place; walks out, socialising, music and receiving visitors. Trevern keep a record of individual pursuits and try to encourage residents to participate in activities that are on at the home. Individual interests are recorded in service user care plans and their ‘life story book’. There is a flexible visiting policy and residents determine where they meet with their guests. Residents felt their visitors were welcomed to the home positively and could not think of improvements in this area. Residents made positive comments to the inspector in the variety and quality of food provided. As the food project has been implemented recently this will be inspected on the next visit. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Cornwall care Ltd has a corporate complaints and whistle blowing policy. The complaint policy is on display and the management team encourage residents and their representatives and staff to voice any concerns so that they can be addressed EVIDENCE: Cornwall Care Ltd has completed policies in respect of the complaints procedures. Trevern and CSCI have not received any complaints about the home. From the inspectors discussions with residents all stated that they had no concerns about the care or facilities that were provided by the home. Staff likewise commented they had no current concerns. The majority felt able to approach the management team if they had any concerns. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Trevern provide a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. EVIDENCE: Trevern is in the midst of a planned extension to the home. Despite this the staff are to be congratulated on the hard work they have undertaken to ensure that the home remains clean and tidy throughout. The décor and furnishings were attractive in appearance and residents stated they felt happy with the homes general appearance. A redecoration programme of the home is currently in progress. The registered manager acknowledged that the day care room and one bathroom is in need of redecoration and has planned for this work to be undertaken. Residents stated they were ‘happy’ or ‘pleased’ with their single rooms and felt that all the furnishings they needed were provided and that they are encouraged to personalise their rooms. Residents stated that they are ‘happy’ with the homes facilities and did not feel any further improvements to the home are needed.
Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 15 The home layout is arranged as the main home and the ‘flats’. In both of theses areas residents have access to ground floor lounges and dining areas, single bedrooms and sufficient toilet/bathing facilities are on both floors. In the main building there is also a day care and quiet room. A garden area is accessible for all residents. All parts of the home are accessible to residents with a lift allowing access to the first floor. There is limited parking due in part to the current building works. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Trevern ensure that suitable trained staffs are employed in sufficient numbers at all times EVIDENCE: On the day of inspection four-care staff, plus domestics, handyperson, kitchen staffs, laundress, administrator and managers were on duty. Staffing ratio during waking hours is aimed to be 1:6. At night there are two waking night staff plus a manager who is on call. The registered manager stated that the home has not needed to employ agency workers. The assistant manager stated that there is a 20-hour night carer vacancy in the home, which has been advertised. Residents were complimentary about the care and approach they receive from the staff team. The inspector observed staffs that were competent in their work. From discussion with staff in the main they all commented that they felt that there is sufficient staff on duty. This area will be reviewed in line with the proposed extension of the home as staffing levels will need to increase to staff the new unit. The registered manager is currently working on this. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 Resident’s financial interests are safeguarded. The home is maintained to ensure the health and safety for all who reside, work or visit the home. EVIDENCE: Cornwall Care Ltd have cooperate policies in the management of residents monies. Residents are encouraged to manage their own monies and hold their own accounts. However they can sign an agreement to request that Cornwall Care assist them in the management of a small amount of their monies. From inspection of residents monies records were accurate and tallied. The inspector recommended that there was clear evidence of auditing of residents monies, as this has not occurred for some time. The administrator and registered manager agreed this has not occurred due to the extra commitments in managing the extension plans of the home. They agreed to reinstate this. The inspector recommended that the home keep an inventory of what is stored in the homes safe as this is not current practice and includes items used by the Domiciliary Agency as well as the home. This will assist in identifying
Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 18 belongings for individuals and for insurance purposes. The administrator agreed to action this. Trevern undertakes regular health and safety checks in the home i.e. fire drills, Legionella, emergency lighting, training of staff in the areas of COSHH, moving and handling and first aid. In addition inspections from other authorities occur and no issues have arisen form these inspections. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x 3 Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 20 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 Regulation Requirement Timescale for action 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. 2. Refer to Standard OP35 OP35 Good Practice Recommendations The registerd manager should ensure that a inventory of service users belongings being stored by the home is kept. A audit of service users monies by a manager should be undertaken on a regular bases. Trevern D52-D04 S8922 Trevern V227140 040705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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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