Inspection on 29/09/05 for Trevithick House

This inspection was carried out on 29th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 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 10/03/06

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 29 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Trevithick House Address 18 Nelson Street, Plymouth, Devon, PL4 8ND and 24 Nelson Street, Plymouth, Devon, PL4 8ND 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) 01752 269431 01752 269431 john@the regardpartnership.com The Regard Partnership Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 1st March 05 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 homes service has as yet not been clearly defined within the LD category. 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 D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between 12.30pm and 6.30pm on 29th September 05. The inspection included a tour of both Trevithick House and Reed House. Time was spent talking to three of the Service Users during this visit. Records were examined and the inspector discussed a number of issues with the manager. What the service does well: What has improved since the last inspection? What they could do better: Many of the requirements made at the last inspection are still outstanding. Improvements need to be made in relation to risk assessments and particularly fire safety in the home, this could mean service users are put at risk. Staffing levels that had been agreed with purchasers (Social Services Departments) had been reduced, and meant that opportunities to go out and about more limited. Improvements were also required in relation to the recruitment and induction of new staff. This is of particular importance in such a service where service users can exhibit challenging behaviour. Competent staff are essential to ensure that service users, and other people who are in contact, are kept safe. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 6 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 D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2, and 5 There is poor provision of information to prospective and existing Service Users about what they can expect from the service. Service Users can be confident that all efforts are made to find out about their needs. EVIDENCE: No current Statement of Purpose or Service User Plan were available. These documents should provide prospective and existing Service Users with information about the home. None of the people who had moved to the home in previous months had been provided with this information, or with a set of terms and conditions that explain what the home provides and what they can expect. The manager said that staff had explained to new service users what the terms and conditions, however this was not based on any agreement. Two service user assessments were looked at, considerable information was on file about individuals needs so that staff would have a considerable information as a basis for providing care. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9,10 There are comprehensive Service User Plans for each Service User, however these need to be more specific, so that staff can work consistently. EVIDENCE: Service User had Plans and “Behavioural Guidance” which explained how each individuals needs are to be met. In the two files that were looked at during this inspection the information was comprehensive but not specific. For example it noted that staff were to: educate a service user in relation to dietary needs. It did not say how staff were to do this. Behavioural Guidance and Service User Plans should be specific about the actions to be taken. If staff are expected to sit with a service user during a meal and to ensure that they eat slowly, then this should be specific. There are risk assessments on file, however again these are not specific. Both the Service User Plans and Risk Assessment were not signed, dated and there were no review dates for these. Individual files and daily records are kept in locked cupboards in the dining rooms of both houses. There is an office/sleep in room in Reed House, but no Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 10 office in Trevithick House. Staff sit at the dining table, in both houses, to complete records. Whilst it is recognised that this is convenient this practice needs to be reviewed. The dining room is space is for use of Service Users and confidentiality of records. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,and 13 Service Users are given the support to participate in a range of activities that they enjoy or find worthwhile. EVIDENCE: Individual files contained information about the plans for the week. One person told the inspector that he had recently started a numeracy and literacy course, another person described how she was able to go to work part time. Four of the five Service Users had recently been on holiday together and from the account given enjoyed themselves. The other Service User had chosen not to go away but was enjoying local trips out. From talking to Service Users and from the information on file, Service Users had full and active lives. Reed and Trevithick House have no garden as such, Ms Palmer said that Service Users went out frequently and enjoyed walks on Plymouth Hoe and in the surrounding area. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 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 standard(s) None of these standards were inspected at this inspection. EVIDENCE: Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 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 standard(s) None of these standards were inspected at this inspection. EVIDENCE: Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 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 standard(s) 24 and 30 The home is clean, comfortable and suited to individuals needs, however aspects of fire safety need urgent attention. EVIDENCE: Both houses were clean and generally in good order. Individual bedrooms varied in tidiness reflecting individual preferences and moods. All of the Service Users are able to tidy and clean their own rooms and do so with support from staff. Communal areas were well decorated and the inspector was told that there were plans to replace a soiled lounge carpet in Trevithick House. Concerns relating to safety, particularly fire safety, were identified and these are raised later in this report. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 The home’s recruitment procedures are not robust, new staff are not formally inducted, this could potentially place Service Users and staff at risk. Staffing levels are lower that those that have been agreed and funded by purchasers, potentially restricting Service User opportunities. EVIDENCE: The files of two staff who had started work at the home in the last 6 months were looked at. There were application forms for both people, and whilst two references had been taken for one person, only one reference had been taken for the other individual. There was no evidence of checks of identity on file and no photograph of the individual. Criminal Records Bureau checks had been taken prior to employment. Two written references and checks on identify must be taken prior to appointment. The manager, Karen Palmer, said that each new member of staff went through a period induction, when they were shadowed in their work. There was no record of any formal induction. Consideration should be given to using the Learning Disability Awards Framework to underpin training in the home. Staff files contained certificates of courses attended and Ms Palmer said that their were plans to keep a record of these on file. For one person who had started work at the home in April 05, they had completed a course in first aid, a course in de-escalating challenging and potentially violent behaviour, and a course in Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 16 relation to administering medication. The service offered at Trevithick and Reed House is a specialist one, and staff need a structured induction and foundation course in relation to working with a people with a learning disability. There were records of staff supervision on file. Each of the Service Users has an agreement between the Regard Partnership and their Care Manager as to the level of staffing to be provided. Karen Palmer, confirmed the evidence of the rota, that these staffing levels were not met in Reed House, and this had been on the instruction of senior managers. Service Users spoken with about the staff said that they got on well with the staff and that they felt well supported. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 42 The manager is providing a clear sense of direction in the home however the there are serious concerns regarding fire safety in the home, which could place Service Users at risk. The Regard Partnership is failing to provide proper oversight, by monthly monitoring visits. EVIDENCE: There is no Registered Manager for the service, however the Commission has received an application. The current manager, Karen Palmer, outlined the changes that had taken place in the home over the past year, and it was clear from her description, and from improvements in the behaviour of Service Users that the home had a clear sense of direction and leadership. Regulations require that a representative of Regard Partnership visits Trevithick and Reed each month, this is to ensure that the service is appropriately run. Ms Palmer said that no visit had taken place since May 05. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 18 No formal quality assurance system is in place, however from discussions with Service Users it was clear that their views were listened to. There are concerns regarding safety in the home. There were some environmental risk assessments, though these did not include a risk assessment in relation to hot water. The fire risk assessment at Reed House related to an individual who no longer lived in the service. Concerns were raised at this inspection about fire safety. The fire log at Reed House was incomplete; checks had not been made on many aspects of the fire system. At Reed House a fire extinguisher had been removed and mislaid, because of concerns regarding injuries. The front door at Trevithick is at times deadlocked and the key removed, this is for the safety of one of the Service Users. However this is a fire exit. There are also concerns that staff are receiving training in relation to fire training, which is only available to staff every three years. Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 3 x x 1 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x x x x Standard No 31 32 33 34 35 36 Score x x 1 2 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trevithick House Score x x x x Standard No 37 38 39 40 41 42 43 Score x 3 1 x x 1 x D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 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 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. It has been made at inspections since then and again at the inspection on 1/3/05. The extended time scale of 30/6/05 has not been met. 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.This requirement was originally made on the 7/1/04. It has been made at inspections since then and again at the inspection on 1/3/05. The extended time scale of 30/6/05 has not been met. A signed statement of terms and conditions must be supplied to each service user. This requirement was originally made on 23/11/04 and the time scale has been extended at subsequent inspections. The D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Timescale for action 1/12/05 2. YA1 5 1/12/05 3. YA5 5 1/12/05 Trevithick House Version 1.40 Page 21 requirement has not been met. 4. YA6 13 Service user plans including risk assessments must be detailed, and must comprehensively reflect, all the service users identified needs and the directions given to staff to meet these needs. Regulation 26 unannounced visits carried out by external management must take place and a report of each visit must be supplied to the home and the CSCI. This requirement was originally made on 23/11/04 and the time scale has been extended and subsequent inspections. The requirement has not been met. A risk assessment for hot water delivered at the showers must be completed. This requirement was originally made on 07/01/04. It has been made at subsequent inpsections and has not been met. A quality assurance system, as described in the regulations, must be developed and implemented. The staffing levels that have been agreed and funded by purchasers, must be met as a minimum. All staff must received a formal induction, that is recorded, and it is recommended that the Learning Disability Awards Framework is used. There must be a robust recruitment procedure in place that includes obtaining 2 written references and obtaining proof of identification. Immediate Requirement:The registered Provider must ensure that fire checks are completed as 1/12/05 5. YA39 26 1/11/05 6. YA42 13 1/11/05 7. YA 39 35 1/2/06 8. YA33 18 1/11/05 9. YA35 18 1/11/05 10. YA34 19 1/11/05 11. YA42 13,23 10/10/05 Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 22 12. YA42 13,23 13. YA42 13,23 14. YA9 13 15. YA10 12 per the risk assessment or as per guidance give by Devon Fire and Rescue. Immediate Requirement: The registered Provider must ensure that all staff have fire training/ instruction at regular intervals as per the risk assessment or guidance of Devon Fire and Rescue. Immediate Requirement: The Registered Provider must seek advice from Devon Fire and Rescue, and act up on this advice, in relation to dead locking the front door of Trevithick House. 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. Information relating to individual Service Users must be managed so that confidentiality is respected and service users communal space is not restricted. 10/10/05 6/10/05 1/11/05 1/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Trevithick House D52-D04 S44476 Trevithick House V237973 220905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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. 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