Inspection on 19/07/05 for Trevone

This inspection was carried out on 19th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Trevone 27/11/06

Trevone 07/02/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Trevone 22 Denmark Road Gloucester GL1 3HZ Lead Inspector Ruth Wilcox Announced 19 July 2005, 09:00am 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. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Trevone Address 22 Denmark Road Gloucester GL1 3HZ 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) 01452 529072 01452 380829 The Order of St John Care Trust Mr Richard Bruce Terry Care Home 47 Category(ies) of OP old age (47) registration, with number of places Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) Temporary Variation to client category - one named service user under the age of 65 years. 2) The manager is to complete the N.V.Q.4 Registered Managers Award by the end of December 2005. Date of last inspection 8/2/05 Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Trevone is a care home providing nursing care and personal care for fortyseven older people, over the age of 65 years. It is managed by The Orders of St. John Care Trust, and is situated a short distance from the town centre in a residential area of Gloucester. A registered nurse is on duty 24 hours a day. All health care services are accessible from community resources, and residents can register with a General Practitioner of their choice as far as practicable. The accommodation is purpose built, and is provided on three floors. A staircase and a shaft lift provide access to the first and second floors. Residents private accommodation is provided in single rooms on all three floors. Each room has a wash hand basin. There is a combined lounge and dining room on the ground and first floors, two very small lounges and two even smaller quiet rooms on the first and second floors. In addition to this there is another ground floor communal room, which is used primarily for those choosing to smoke. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this announced inspection over six hours on one day in July. The Registered Manager was present throughout the inspection, providing assistance where needed. Six other members of staff were spoken to during this visit, who were most helpful and were open to the inspection process. There was direct contact with fifteen residents and two visitors. The care of six residents in particular was closely looked at. Care records were inspected, as were the systems for the provision and recruitment of staff, their supervision and direction. The standard of meals, and the opportunities for social activities for the residents were inspected. A tour of the premises took place, with particular attention to the standard of maintenance and environmental safety issues. Staff were observed going about their duties whilst interacting with the residents. Since the last inspection a complaint investigation has been completed by the CSCI, which looked into concerns raised by a resident’s family, regarding: 1. The standard of care being received - upheld 2. The use of sedating medication – not upheld 3. The unsatisfactory conduct of one nurse – upheld. What the service does well: The home provides an adequately safe and comfortable environment for those living there. Prospective residents have access to a good deal of information about the home before making their choice about it, and are admitted on the basis that an assessment of their health and personal needs shows that the home can meet the needs. Residents were generally happy with the way in which their care was delivered. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 7 Residents have the option of joining in with the programme of social activities, which is provided by the home on a regular basis. There is a good standard of meals provided here, with a very good degree of choice available; residents’ levels of satisfaction were high. The menus here have recently been under review, and new ones show a wellbalanced selection of foods, with references made to different dietary requirements. Staff are recruited to the home following very good pre-employment checks, and are routinely supervised to ensure working practices are monitored. What has improved since the last inspection? What they could do better: It is unfortunate that, given that staff generally are mindful of residents’ privacy and dignity, on the day of this inspection an agency carer had neglected to close the bedroom door whilst providing personal care to a resident; this resulted in the resident’s privacy and dignity being compromised on this occasion. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 8 Although the environment is generally safe for residents, the manager must review the quality of lighting in the corridors as residents use these areas, and one area in particular appeared quite dim in comparison to others. There are currently only two members of staff who are qualified in First Aid, though there are qualified nurses on duty at all times. Additional staff must receive formal training in First Aid. Following two recent serious medication errors in this home, the Commission Pharmacist is going to conduct a full inspection of the management of medications here soon. 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. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 9 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 Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 10 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) 1 & 3. The home’s Statement of Purpose and Service User Guide provide prospective residents with details of the services the home provides, enabling them to make an informed decision about the home. The home’s admission procedure ensures that all residents are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: A number of additions have been made to the Statement of Purpose and Service User Guide, in order that the new management under The Orders of St John Care Trust is now reflected therein. Copies of these documents are sited conveniently and accessibly in the entrance hall, with a copy of the home’s guide issued to each resident. The revised Service User Guide has been supplied to the CSCI. Residents are admitted to the home on the basis of a fully documented assessment of their personal needs, which can be performed in hospital or in the person’s own home, as appropriate; the assessment tool used for those Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 11 residents forming part of the case tracking exercise was seen, and in the main was adequately comprehensive; one assessment conducted some time ago under different management was at best minimalist. Trevone does not provide Intermediate care. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 12 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. There is a care planning system in place, which in the main adequately provides staff with the information they need to satisfactorily meet residents’ health and personal needs; fuller recording in some cases would further improve this. Care and support is generally offered in such a way as to promote the privacy and dignity of the individual, but the omission by some staff to close bedroom doors will compromise this. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of all their needs; six were selected as part of the case tracking exercise. In the main care plans are well written, with clearly recorded health care interventions, and are regularly reviewed. Review documentation was minimal and uninformative in some cases. There were isolated instances of where care plan recording could have been more fully detailed; this was with particular reference to one person’s continence needs and one person’s wound management needs. Despite this case tracking revealed that there was very clear evidence of residents’ health Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 13 needs being met appropriately, with good multidisciplinary working with community health care services and external agencies. Appropriate support equipment was provided to residents where needed, on the basis of assessments. Care plans are written in a sensitive way, and show due regard for the privacy and dignity of the individual. Residents spoken to were generally satisfied with the care they receive, confirming that staff are kind and respectful to their needs. One person said that ‘the staff are wonderful, and work so hard’. This person also said that this was the third care home they had been in, and wished that they had ‘found this one first’. Another said that the staff were ‘very respectful regarding her privacy when helping her with some intimate personal care’. One person commented on how glad he was to have his key worker to support him. Staff were seen to be attentive and respectful during their contact with the residents. However, unfortunately an agency carer neglected to close the bedroom door when helping a resident to wash, resulting in a breach of his privacy and dignity on this occasion. Standard 9 was not inspected during this visit, as two recent serious medication errors have necessitated a full inspection of management of medications by the CSCI Pharmacist, which will take place in the near future. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 14 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 & 15. An activities and entertainments programme is offered, in order that residents are provided with regular and varied opportunities for social activity. Dietary needs of the residents are well catered for, with a balanced and varied selection of food available that meets residents’ tastes and preferences. EVIDENCE: The home has a designated activities coordinator, though in her absence on the day of this visit, another carer was taking responsibility for leading the day’s planned activity. Residents are consulted about their ideas and preferences for social activity, and a record of activities undertaken with those participating is maintained. A weekly programme is displayed on the notice board, and on this day a large number of residents were very evidently enjoying a lively and interactive game of bingo. Some gentlemen in the first floor lounge indicated that they were ‘doing bits of the puzzle on the table’ occasionally, which was proving a challenge. One lady said that she ‘would like someone to play dominoes with her’, and that she helped out with certain light chores in the dining room, as she really liked doing this. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 15 New menus show a good range of varied and nutritious meals available for residents, with due regard for special diets. Observation of the breakfast and lunch arrangements confirmed that they are offered a very good degree of choice with their meals. The lunch looked wholesome, nutritious and well cooked; residents, without exception, confirmed their complete satisfaction and enjoyment of the meals. Some comments indicated that the food was ‘very good and plentiful’. Staff were assisting residents where necessary with their meals, with a range of eating and drinking aids provided where needed to meet the needs of that person. Case tracking confirmed support was being given to residents regarding their dietary needs during lunch, in accordance with their plan of care. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 16 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. The home has a satisfactory complaints system, with evidence that residents feel that any concerns they may have are listened to and acted upon. EVIDENCE: The written Complaints procedure was not displayed on the notice board, though was accessible in the Statement of Purpose and a copy of the Service User Guide, which were placed on the table in the entrance hall. Residents confirmed that staff were attentive to them, with some saying that staff will do what they can to help them. Visitors also confirmed their satisfaction with the manner in which staff responded to them. The home maintains a record of complaints and concerns received; there has been one complaint since the last inspection, which is summarised at the front of this report. This was inspected by the CSCI due to the complainant’s concerns about the manner in which her complaints would be dealt with by the home at the time; the positive comments heard from residents and visitors at this inspection show the positive impact that the current manager has had in terms of addressing people’s concerns more effectively. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 17 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 & 25. The standard of the environment within this home is satisfactory, and provides residents with a comfortable and safe place to live. EVIDENCE: The home is generally well maintained and decorated. Some redecoration and re-carpeting has taken place since the last inspection, with more planned for the near future. The carpet in the smokers’ lounge appears worn and old, though remains safe and serviceable. A maintenance person is employed, and a record of all maintenance undertaken is kept. Radiators throughout the home are of a low surface temperature design to ensure safety. Hot water is blended at outlets, to provide a safe temperature for residents. The maintenance person carries out random checks of this system, though a hand check on some of these outlets indicated that they might be slightly in excess of the recommended safe temperatures at the time Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 18 of this inspection. The Orders of St John Care Trust have made arrangements to employ an external contractor to perform Legionella checks on the water system, and to check and maintain the hot water temperatures at outlets. Windows on the upper floor have a restricted opening. Rooms are well lit, and appeared reasonably light and airy. The lighting in the corridors must be reviewed, as one particular area leading to some residents’ rooms was quite dimly lit. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 19 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 & 29. Staffing provision is only just adequate to meet the needs of the residents currently living in the home. Recruitment procedures ensure that full and appropriate safeguards are in place to ensure the protection of residents. EVIDENCE: The home has been working towards establishing a more cohesive staff team, as previously there have been divisions within the team, which have impacted on the smooth running of the home; a good deal of focus has been applied in this regard, in an effort to resolve it. There remains a loyal core team following the departure of a number of staff; in part this has enabled the manager to review the staffing arrangements, with consideration to the current level of staff’s ability to fully meet residents’ needs in a timely way. Trevone is a large home with accommodation on three floors for 47 dependent residents, and safe and appropriate deployment of staff is crucial to the safety and welfare of the residents. There has been significant agency staff usage over recent months; a recruitment drive is planned in the near future. Ancillary staff are provided, though there are occasions when non-care tasks, such as laundry, are performed by care staff. Residents spoke well of the staff, some saying that they work extremely hard, and that there is not enough of them; one person said that she could be kept waiting sometimes for a response to her call bell. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 20 A selection of staff files was chosen for inspection on the basis of their recent recruitment to the home. Each record contained application forms, including a full employment history. Records of interviews were seen. Full and complete evidence of all the required pre-employment checks was seen. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 21 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) 31, 32, 34, 36 & 38. The Manager has a supportive, open and inclusive management approach, which benefits all living and working in the home. Good management systems are in place to ensure that the health, safety and welfare of the residents are safeguarded. EVIDENCE: The Manager is a registered nurse, is registered with the Commission for Social Care Inspection, and has commenced the Registered Manager Award. Progress with this award has been slow due to the demands placed upon him since coming to Trevone, as he has had a number of problem areas to address; it is to his credit that he has done this methodically and consistently, whilst remaining very accessible to all in the home. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 22 He demonstrates positive and supportive leadership; residents, visitors and staff alike have the opportunity to discuss ideas and views freely, with the assurance that their views will be taken into account. The overall management of Trevone is now provided by The Orders of St John Care Trust, and evidence of robust financial and business management systems was inspected as part of the recent registration process. The home’s administrator was extremely helpful and supportive to residents, and was very organised and informed to assist with various parts of the inspection process. A formally recorded staff supervision programme has been successfully implemented; an audit tool shows that most staff will be receiving the recommended minimum number of six sessions during the current twelvemonth period. Agency staff on this day confirmed that they were working in a supervised capacity, and that they felt well supported in the home. There was evidence that health and safety issues are addressed satisfactorily in this home, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. There are just two staff who are currently qualified to provide First Aid; additional training is required in order for the number of staff appropriately skilled to be increased. All necessary safety checks and maintenance of equipment is undertaken in a timely fashion. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 23 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 2 x STAFFING Standard No Score 27 3 28 x 29 3 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 3 4 x 3 x 3 x 2 Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement Staff must ensure that all elements of care planning are fully detailed, in order to clearly demonstrate how residents needs are to be met; this is with particular reference to continence and wound management on this occasion. Staff must ensure that care plan reviews are documented more fully, in order that the outcome is made clear. Staff must ensure that they are consistently mindful of residents privacy and dignity during the delivery of care. The Manager must audit the standard of lighting in the corridors, increasing levels of brightness in any dim locations identified. Staff must receive training in First Aid. Timescale for action 31/8/05 2. 7 15(2.b) 31/8/05 3. 10 12(4.a) 31/8/05 4. 25 23(2.p) 30/9/05 5. 38 13(4.c) 31/12/05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 25 No. 1. 2. 3. Refer to Standard 16 19 38 Good Practice Recommendations The home should display the Complaints Procedure in a more acessible and prominent position. The carpet in the smoking lounge should be replaced. A person qualified in First Aid should be provided on each shift. Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Unit 1210 Lansdown Court Gloucester Business Park Brockworth Gloucester G1 3HZ 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 Trevone D51_D03_64614_Trevone_190705_v233626_UI_stage 4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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