Inspection on 04/10/06 for Trevithick House

This inspection was carried out on 4th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 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 10/03/06

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 Tina Maddison Unannounced Inspection 4 October 2006 10:00 th Trevithick House DS0000044476.V302641.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 Trevithick House DS0000044476.V302641.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. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 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 Ms Karen Palmer Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 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. 10th March 2006 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.V302641.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. A pre inspection questionnaire was completed by the Registered Manager and received by the Inspector prior to the inspection. The Registered Manager was present throughout the inspection and documents and records were examined in a variety of areas. A tour of both buildings was undertaken. Two service users and two members of staff were spoken with during the inspection. Three service user surveys were returned. What the service does well: What has improved since the last inspection? The Manager has worked hard to meet the requirements and recommendations made from the previous inspection. The service users guide has been produced in an audio format to ensure it is accessible to the service users at the home. Restrictions in place on individuals are now recorded as being agreed by a multi disciplinary team. Menus are now accessible to the service users. No gaps were found in the medication records, and guidance is now provided to Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 6 staff in relation when to administer “as required” medication. Infection Control policies and procedures have been reviewed and improved particularly in relation to the management of soiled laundry. A quality assurance system is now in place for the home. A risk assessment for hot water delivered at the showers has now been completed. 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.V302641.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good because service users receive sufficient information about the homes prior to their admission that will help them decide whether the home will meet their care needs. This judgement was made using available evidence including a visit to the service. EVIDENCE: Trevithick and Reed House offer prospective service users information about the homes in a recently updated statement of purpose and a service users guide. The service users guide is available in an audio version, suitable for people who have a learning disability. Prior to admission to both houses, the Manager, Karen Palmer, will visit the prospective service user and their family and care manager to undertake an assessment of their care needs. These assessments were available for inspection, and contained comprehensive information regarding the individual service users. Prospective service users are invited for a meal or overnight stay prior to their admission. Service users spoken with confirmed that they had a visit before they moved in. Copies of terms and conditions were contained in service users files, and service users had signed to say that they were aware of the conditions of their stay at the homes. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is adequate because while service users are supported to take risks and make choices about their lives, care plans must be more detailed to ensure staff are clear about exactly what support is needed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: All of the service users living in both of the houses had a care plan on file. Four of these were examined in detail. It was not made clear in these plans what actions staff needed to take to meet these needs. The Registered Manager has done a lot of work recently updating these plans and since the last inspection has now recorded the restrictions placed on individuals and evidenced that these are reasonable and have been agreed with a multi disciplinary team, such as the Learning Disability challenging behaviour service. The Registered Manager is currently reviewing risk assessments in relation to the service users, and understands that the risk assessments should be specific with regard to actions to be taken to ensure a reduction in risk, and that these risk assessments should be signed, dated and regularly reviewed. The inspector spoke with service users and they confirmed that they are able to choose when they get up and go to bed, and what leisure activities they Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 10 wish to undertake. One service user said that he was happy for staff to help him make choices, and this made him feel supported and sure that he would make good choices. The service users also choose their own meals and are to some extent involved in chores such as cleaning their own bedrooms. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good because service users enjoy a range of activities and are given support to make positive decisions about their daily lives. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The two service users who were spoken with during the inspection told the inspector that they had taken part in activities with support from the staff including computer courses, holidays to Butlins, shopping trips to the city centre and visits to the cinema. The manager said that there are good relationships between themselves and the neighbours, and the service users are regularly invited in for coffee at one of the neighbours houses. From discussion with the Manager and service users, and from service users records, it was evident that most of the service users have families and friends that visit regularly. Some of the service users visit their families, and these visits are supported by staff. The daily routines are, for certain service users, displayed in symbol form so that the service users understand what activity is happening on which days. It was observed during the inspection that staff knocked on bedroom doors Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 12 before entering and interacted with the service users in a respectful and enabling manner. Keys to the front door are available where appropriate and bedroom doors can be locked from the inside and the outside. The two service users spoken with during the inspection both said that they enjoyed the meals available. A choice of healthy meals was evidenced in records, and a lunch time meal was observed. This was a relaxed and unhurried occasion that the service user said they enjoyed. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good because service users physical and emotional health needs are met at Trevithick and Reed House. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Details of service users health care needs are detailed in their individual care plans. These include guidelines for staff for specific medical conditions such as epilepsy. It was recorded that staff had attended training to further their knowledge of epilepsy. The homes use the Boots monitored system for administering medication. Records were found to be accurate and up to date. There is information about the different tablets taken on each service users files. There is a system for managing controlled drugs. Medication was found to be safely stored. Staff that administer the medication have received appropriate training. All of the service users are registered with General Practitioners in the area, and records evidenced that they access health services in the community such as dentists, Optician, and chiropody. Referrals to specialist health services had been made where necessary, and behavioural support from the Challenging behaviour service had been sought recently for one service user. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good because service users complaints are listened to and acted upon, and there are systems in place to protect the service users from abuse. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Both of the houses had a complaints procedure displayed in a clear symbol form, and the two service users spoken with were aware of whom to speak to if they were unhappy with something in the home. Complaints and concerns are recorded with actions taken to resolve the complaint or concern. The Commission for Social Care Inspection had not received any complaints regarding the homes in the last twelve months. Staff were aware of the whistleblowing policy and procedure. It was clear from discussion with the Manager and staff that verbal and physical aggression from the service users is understood and dealt with in an appropriate manner. Physical interventions have been used with one service user, but only as a last resort when distraction techniques have failed. Staff are trained in physical intervention and were clear about when it was appropriate to use it. Any physical interventions used were recorded in the daily records, and following discussion with the Manager it was agreed that physical interventions will be recorded separately so that it would be apparent if there were any emerging patterns of behaviour that could be addressed. As has already been noted, there were guidelines in service users files, where appropriate, on how to manage risks and how to avoid incidents of self harm. There was evidence in staff files that they had received training in relation to the protection of vulnerable adults. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30. Quality in this outcome area is good because both houses are comfortable and suited to the service users individual needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Both Reed House and Trevithick are Victorian terraced houses situated in the same street in a residential area near to the centre of Plymouth and provide a homely environment. Service users from both houses said that they thought the houses were nice and that they liked their bedrooms. The stair and Hall carpet in Reed House should be replaced as it is very worn and stained. The exterior of Trevithick House would benefit from being re painted. A tour of both houses was undertaken by the Inspector, and all bedrooms were seen. Bedrooms were personalised and comfortable, and reflected individual tastes and interests. All of the bedrooms are single rooms. One of the bedrooms in Trevithick House is self contained at the top of the house and has its own kitchen and bathroom for a service user who is more independent. Both houses have a small courtyard area to the rear that service users said they used in the summer. Both houses have a maintenance and renewal programme. The houses were free from offensive odours on the day of the inspection. The Manager has recently reviewed the infection control policy and implemented a Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 16 new system for dealing with soiled laundry that controls the possible spread of any infections. There are pleasant dining rooms and lounge areas in both houses that are spacious and contain good quality furniture. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 17 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): 32,34,35. Quality in this outcome area is good because service users benefit from and are supported by a competent and skilled staff team. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Staff rotas were examined, and evidenced that both houses are appropriately staffed to meet the care needs of the service users who live there. Most of the service users are staffed on a 1:1 basis due to the complexity of their needs and to ensure that their behaviour that challenges the service is managed safely. There is a stable staff team with little turnover that has ensured a consistent approach recently. Staff confirmed that they are able to access training in a variety of areas, including health and safety, first aid, fire safety, physical interventions, and food hygiene. Most staff were qualified to at least NVQ level 2. Service users said that they thought the staff nice and always helpful. Staff files were examined, and evidenced a thorough recruitment procedure was in place. All current staff had clear CRB checks, and files contained two references. Staff have a three monthly probation period following appointment, and receive an induction in a variety of areas from the Manager. There is a training plan in place. It was evident from observations made during the inspection that the service users and staff enjoy good relationships and mutual respect. This was evident Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 18 when a service user was getting ready to go out for the day and care staff were encouraging the service user to organise themselves in a positive and enabling manner with the use of appropriate humour. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 19 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): 37,39,42 Quality in this outcome area is good, because service users benefit from living in a safe, well run home where their views are taken into account and acted upon. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Registered Manager, Karen Palmer has completed the NVQ4 in management and care and is currently working toward her Registered Managers Award. Ms Palmer became the Registered manager in March 2006, and has worked effectively to establish positive relationships with the staff and service users. A quality assurance system is in place at the home, and evidence of questionnaires regarding the quality of care in the home being sent to service users and their representatives were seen. The manager aims to assimilate these returns and action the outcomes. The Regard Partnership employs a quality assurance manager who visits the home. Monthly monitoring reports are completed by the company quality assurance manager. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 20 Fire prevention logs were checked, and evidenced that fire prevention equipment is regularly serviced, and staff have received appropriate training. Portable appliance testing was last completed in September 2005, and is planned to be completed for this year. Records evidenced that gas and electrical systems are regularly serviced. The home has appropriate liability insurance in place. Radiators are covered and a risk assessment for hot water delivered at the showers has been completed. Hot water outlets are fitted with temperature restrictors. The home has the use of a vehicle, and records evidenced that this is appropriately insured, serviced and has a current MOT certificate in place. Risk assessments are in place for all safe working practice topics. There was a record of accidents kept. Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Trevithick House DS0000044476.V302641.R01.S.doc Version 5.2 Page 22 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 YA6 Regulation 15 Requirement Service User Plans must contain detailed information about what an individuals needs are and how they are to be met. Timescale for action 01/12/06 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. 3. Refer to Standard YA23 YA24 YA24 Good Practice Recommendations A record of physical interventions should be kept in a separate book that has numbered pages. The exterior of Trevithick House should be re painted. Consideration should be given to replacing the stair and hall carpet in Reed House as it is very worn and stained. 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