Inspection on 10/03/06 for Trevithick House

This inspection was carried out on 10th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trevithick House 03/10/08

Trevithick House 04/10/06

Trevithick House 29/09/05

Trevithick House 01/03/05

Trevithick House 05/10/04

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 Trevithick House 18 Nelson Street Plymouth Devon PL4 8ND Lead Inspector Helen Tworkowski Unannounced Inspection 10th March 2006 10:10 Trevithick House DS0000044476.V284147.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 Trevithick House DS0000044476.V284147.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. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Trevithick House Address 18 Nelson Street Plymouth Devon PL4 8ND 01752 269431 01752 269431 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) The Regard Partnership Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home is registered as a Care Home only (PC) providing care for people with learning disabilities. The home may accommodate up to a maximum of 6 service users at any one time Reed House to provide a service for a maximum of two service users to ensure night care staff have a specified sleeping in room and specified office from which to administer the home. 29th September 2005 Date of last inspection Brief Description of the Service: This service consists of two houses Trevithick House and Reed House, which are a few doors away from each other in Nelson Street, Plymouth. The Care Homes are situated within walking distance of Mutley Plain shopping precinct and the centre of Plymouth. The two houses are mid terrace houses with no external spaces except small yard to the rear of the building. The home has the category of LD (Learning Disability) and is registered to accommodate six service users, two in Reed House and four in Trevithick. The home specifically accommodates people with challenging behaviour. The accommodation is unsuitable for persons with significant mobility difficulties. The home is owned by The Regard Partnership Ltd. Both houses are staffed 24 hours per day, and each has waking night staff. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started at 10.10am and finished at 3.10pm. The Inspection included discussion with the manager and deputy manager, and time was spend with the two service users. The inspector looked around all of Reed House and much of Trevithick House. What the service does well: 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. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 6 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 Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 7 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 and 5 Information is available to Service Users about what to expect from living at Trevithick. EVIDENCE: The Manager, Karen Palmer, said that the Statement of Purpose and Service User Guide had been revised, these revised documents need to be sent to the Commission. Ms Palmer said that it was planned that the documents would be provided in an audio format so that they would be more accessible to Service Users. There were copies of terms and condition of accommodation on two files looked at. Service Users had signed to say that they were aware of the conditions. No Service User had moved to the homes since the last inspection. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 8 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, and 9 Service User Plans, which exist for each individual, need to be more specific so that staff can work consistently. Service Users are supported to take risks and to make some choices about their lives, however again the details of what is to happen needs to be improved. EVIDENCE: Three Service User files were looked at during this inspection, two were examined in detail. Each Service User should have information on file that explains in detail how assessed needs will be met, with the details of the actions staff are to take. The information on file about how needs were to be met was mainly in the form of Risk Assessments. The information was not presented in an easily accessible format, and it was difficult to get an understanding of needs that did not present a risk or were not related to behavioural difficulties. A number of areas of identified as “risks” were not in effect risk for example doing household chores. Risk assessments did not have review dates. Where it was specified what staff should do to meet needs the information was vague, for example staff were required to model appropriate behaviour at meal times, given that the Service Users at the home have challenging behaviour, the directions to staff must be more specific. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 9 One service user has epilepsy, and whilst there was some information in the form of a risk assessment, it was not comprehensive and did not provide sufficient information about how the condition is to be managed. There should be a comprehensive plan that is agreed with relevant medical professionals. A listening device is used in relation to one Service User, to assure his well being at night. The use of such devices or any restriction on liberty, including locking doors must be recorded in the Service User Plan and must be following consultation with a multidisciplinary team. The Inspector spoke with Service Users about choices and those spoken with confirmed that they were able to choose when they get up and go to bed. Restrictions are placed on certain aspects of life in the home for some individuals, for example in relation to access to food. This is recorded on the file however it was not clear if this restriction had been agreed. Service Users explained to the Inspector that they are involved in choosing the meals in the home, and to some extent involved in chores such as cleaning their own bedrooms. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16, and 17 Service Users are supported to maintain relationships with friends and family. Service Users are given support to make decisions about their daily lives but the information is not always presented in an appropriate way. EVIDENCE: The manager, Karen Palmer, explained that all of the Service Users have friends or relatives who visit regularly. Some of the Service User visit their relatives, and are supported to do this by staff. Karen Palmer said that there were no restrictions on visiting and where Service Users need support and advice regarding relationships this is sought. As has already been noted Service Users rights are to some extent restricted, for example in relation to access to food. In some circumstances this may be appropriate, however there must be a record of this and that it has been agreed at a multi-disciplinary team meeting. Service users are involved in choosing meals and there is a menu that contains a variety of meals. The menu is in a written format, which is not necessarily Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 11 understood by all Service Users. Menus and other information about what happens should be provided in a format that is accessible. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, and 20 The medication is generally well managed though improvements can be made to improve consistency in relation to administering as required medication or in meeting specific needs. EVIDENCE: Trevithick uses a monitored dose system provided by Boots. There is information about the different tablets taken on each person’s files. There is a system for managing controlled drugs. Medication is recorded when it is administered, however on one occasion in February it was apparently administered but not recorded. On occasions “p.r.n” or as required medication is given. There was no information on record to define under what circumstance this medication could be given. The Inspector spoke with two Service User about the help they received. One was able to confirm that staff were supportive and met their needs. As has already been identified some of the information on file does not contain sufficient detail about how staff are to meet needs, and whilst there is no indication that needs are not met it could lead to a degree of inconsistency. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There are systems in place to ensure that Service Users or their representatives are able to complain, and that Service Users are protected from abuse. EVIDENCE: There is a complaints system, which is available to all Service Users in a symbol format. There was a copy of the complaints procedure on the Service uses notice board. Karen Palmer, Manager, said that no complaints have been received since the last inspection. The Commission has received no complaints. There was evidence in staff files of receiving training in relation to the protection of vulnerable adults. As has already been noted there was guidelines on Service Users files, where appropriate, on how to manage risks and how to avoid incidents of self-harm. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 14 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 and 30 The home is comfortable and suited to individual needs. The way the laundry is done in the home and the way staff keep the houses clean needs to be reviewed so that everyone avoids unnecessary infections. EVIDENCE: Both Trevithick and Reed House were clean and tidy, taking into account a new carpet was being in one of the bedrooms at Trevithick. The washing machine in both houses is in the kitchen at the rear of the house. Soil washing is therefore taken into the kitchen to be washed. Advice must be sought from the Control of Infection Service to review current practice and to consider the use of dissolving laundry bags, disposable aprons when dealing with soiled linen and the use of alcohol gels to clean hands. The Fire Log book in Reed House was checked, this indicated that staff had received regular training in relation to fire and that regular checks had been made on the system to ensure that it was working. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 15 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, 34 and 35 Services users are supported by a competent staff team. EVIDENCE: The manager, Karen Palmer, said that staffing levels had been increased since the last inspection in accordance with what had been agreed with funders. Service User are generally provided with one to one staffing throughout the day, and two to one where required. There is waking night staff in both houses. No new staff have been appointed since the last inspection, one new member of staff was in the process of being appointed, and there was evidence that appropriate checks were being made. As no new staff has started at the home no one has been inducted, however the manager, Karen Palmer, had a copy of Regard Partnerships Induction Booklet to be used for the next person appointed. Karen Palmer stated that every member of staff was involved in completing an National Vocational Qualification at some level. No member of staff was currently being trained in relation to the Learning Disability Awards Framework, however this would be consider once staff had completed their NVQs. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 16 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 and 42 Service Users views have been taken into account by the wider organisation but not yet at a local level. Appropriate checks are made to ensure fire safety. EVIDENCE: The Regard Partnership has completed a Quality Assurance survey across all of it’s homes. Karen Palmer, manager, said that a system was to be developed for local use, and this would need to be in a suitable format to be used by Service Users. The Fire Log was checked at Reed House, this indicated that regular checks had been made of the system. A requirement was made that at the last inspection that a risk assessment is made of hot water delivered to showers. This was not inspected at this inspection, but will be looked at during the next inspection. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 17 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 x 3 x 4 x 5 3 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X X X 2 X X 3 X Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 18 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 statement of purpose must be updated to be compliant with Schedule 1 of the Care Homes Regulations. The statement of purpose must be available in the home. This requirement was originally made on the 7/1/04. A copy of this document must be supplied to the Commission. The service users guide must be updated to be compliant with standard 1.2 of the National Minimum Standards. The service users guide must be available in the home, in an appropriate format for Service Users. This requirement was originally made on the 7/1/04. A copy of this document must be supplied to the Commission. Specific health care needs, for example in relation to epilepsy, should be identified and a comprehensive plan drawn up, agreed with relevant medical professionals as to how these needs will be met. This must include an individual record of any staff training. Each Service User must have a DS0000044476.V284147.R01.S.doc Timescale for action 01/05/06 2. YA1 5 01/05/06 3. YA6 15 01/06/06 4. YA16YA7 15 01/06/06 Page 19 Trevithick House Version 5.1 5. YA18YA6 15 6. YA9 13 7. YA16 12 8. YA20 13 9. YA30 23 10. YA39 35 11. YA42 13 plan that specifies in detail how assessed needs are to be met. Where restrictions are placed on an individual these must be reasonable, recorded and agreed by a multi-disciplinary team. Service User Plans must contain detailed information about what an individuals needs are and how they are to be met. All risk assessments should be specific with regard to actions to be taken to ensure a reduction in risk, be signed and dated, and have set periods of review. Menu’s and other documents must be available to service users in a format they can understand so that they understand and participate in what is happening. Guidance must be provided to staff in relation when to administer “as required” medication. No gaps should be left in medication administration records. Control of infection policies and practices must be reviewed particularly in relation to washing soiled laundry in the kitchen. A quality assurance system, as described in the regulations, must be developed and implemented. A risk assessment for hot water delivered at the showers must be completed 01/06/06 01/11/05 01/08/06 01/06/06 01/06/06 01/06/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 20 No. Refer to Standard Good Practice Recommendations Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trevithick House DS0000044476.V284147.R01.S.doc Version 5.1 Page 22 - 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. 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