Inspection on 27/11/06 for Trevone

This inspection was carried out on 27th November 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 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 07/02/06

Trevone 19/07/05

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 Glos GL1 3HZ Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 27th November 2006 08:45 X10015.doc Version 1.40 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 Trevone DS0000064614.V310105.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 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 DS0000064614.V310105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trevone Address 22 Denmark Road Gloucester Glos GL1 3HZ 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) 01452 529072 01452 380829 manager.trevone@osjctglos.co.uk The Orders of St John Care Trust Mr Richard Bruce Terry Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary Variation to client category - 1 (one) named service user under the age of 65 years. The Home will revert to the original client category when this service user either reaches the age of 65 years or leaves the Home. 7th February 2006 Date of last inspection 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 city 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 was originally 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, one of which provides a smoking area, and two even smaller quiet rooms on the first and second floors. There is also another communal room adjacent to the large lounge diner on the ground floor. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Trevone range from £460.00 to £637.00 per week. Hairdressing, Chiropody, Newspapers, Opticians and Toiletries are charged at individual extra costs. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over two days in November 2006. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. As part of this unannounced inspection the quality of information given to people about the care home was looked at. The information included the service user’s guide (sometimes called a brochure), statement of terms and conditions (also known as contracts of care) and the complaints procedure. As well as inclusion in this report, these findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Trevone. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. 60 of resident and 70 of relatives’ surveys were returned; none of the staff surveys were returned. Some of the survey comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 6 Trevone is generally a well managed home, and provides a safe, clean, comfortable and adequately maintained environment for the residents living there. The home has a welcoming atmosphere for visitors, and relatives confirmed that they felt comfortable here, and that they were consulted and kept appropriately informed. Prospective residents are provided with an information brochure about the home, and also receive a good amount of information in relation to financial and fee arrangements, which is helpful in terms of enabling an informed choice about Trevone; any delays in the provision of contracts and fee information for residents whose care was funded by the local authority seemed to be beyond the home’s control, with the delays being the responsibility of the authority. Residents are admitted on the basis of a full assessment, so that they can be assured the home can meet their individual needs. In the main, residents were generally satisfied with the care they received from staff, with their families echoing this view, and many of the staff were seen as attentive and caring. Residents confirmed that respect was shown towards their privacy, personal choices and preferences in the majority of instances, and there was evidence that residents were enabled to participate in a programme of social activities. Staff had made good efforts to accommodate the diverse needs of residents. The food served was of a good standard, and residents said that they had plenty of choice, and that they enjoyed their meals very much. Residents and their families can be assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is regularly reviewed as part of good quality monitoring systems. The home has policies and procedures for the protection of vulnerable residents, and staff have attended adult protection training. The home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Staff have good access to training opportunities, and are making good progress with the National Vocational Qualification (NVQ) training programme. Recruitment is carried out using rigorous employment procedures, with new staff appropriately supervised. What has improved since the last inspection? Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 7 Since the last inspection there has been an ongoing programme of redecoration, and a new assisted bath has been installed into one of the bathrooms. A new electronic induction-training package is being introduced for new workers, which is innovative and engaging. A new deputy manager has recently been appointed, although has yet to actually start work in the home. There is a reduction in the amount of agency staff used at Trevone, with a more regular and flexible staff now employed. What they could do better: There are a number of shortfalls in care plan documentation, which could pose a degree of risk to residents in terms of meeting individual needs entirely appropriately, and which now require improvement. In many regards there is a good system for the management of medications, but on this occasion there were some shortfalls in areas pertaining to aspects of recording and to stock balances, which require attention. There were instances when isolated staff members’ attitudes and approaches towards residents were observed as being ‘casual’, and could have been more attentive and sensitive. There is also some concern about certain aspects of training competencies and development of qualified staff, which should now be addressed. A small number of residents and visitors did comment that staff could be slow to respond to them on occasions, as they perceived the home to be short of staff. Until recently retention of a cohesive nursing team has been problematic, though this is now beginning to show signs of improvement. The manager has had little support in terms of managing and supervising the staff team from a committed deputy manager, but the recent appointment of a new deputy should help resolve this. Although generally maintained, there are very isolated areas in the environment that would benefit from some decorative attention, and these are already recognised by the home, and are under consideration. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 8 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 DS0000064614.V310105.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Trevone DS0000064614.V310105.R01.S.doc Version 5.2 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 the following standard(s): 1, 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough assessment process, the provision of an information brochure, (now requiring a small degree of revision), and financial information about the home, enables prospective residents to make an informed decision regarding their admission and gives them assurances that their needs will be met. Residents are also provided with a written contract of their terms and conditions. EVIDENCE: Trevone’s Statement of Purpose and Service User Guide (The Residents’ Handbook) has recently undergone a major review under The Orders of St John Care Trust; a copy of each is readily available and easily accessible in the home. The new guide conformed to the revised regulations in most regards, but did not contain a standard copy of a contract, or a statement in relation to whether costs would be the same for services, the total fee payable and additional Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 11 charges for all residents, regardless of whether their care was funded for them or not. Information regarding the home’s overall fee range and Registered Nurse Care contribution (RNCC) was included in the guide, and the manager was also heard discussing this with an interested party, who was enquiring about the home during the course of this visit. Information regarding the assessment process, the RNCC, the Local Authority Financial Assessment Bureau was also shared with the enquirer. In each of the three cases looked at, the resident or their representative had been provided with a copy of the home’s guide; one particular relative commented on the good degree of information they had received upon enquiry. Each person had received a contract for their accommodation and care; in two of the cases their representative had signed on their behalf, having been unable to do so themselves, and in the third case the home had not issued the Local Authority contract in a timely way for the resident or their representative to sign, and was about to rectify this lapse. The home’s own Accommodation Charter had been issued for information to supplement the contracts, in these cases. Examples of letters were on file to advise residents (though not in these three cases, as it had not applied to them at this stage) of when there were to be changes to fees; letters contained a good period of advanced notice and the reason for the increase, as is required. In cases where the Local Authority funds care, there are delays for residents receiving their contract and even longer delays for receiving an accurate breakdown of their fees and contributions; this is not under the home’s control however. There can also be delays under these care arrangements, when there are changes to funding and contracts. In two instances the home had issued a breakdown of RNCC payments, showing how they were taken into account as part of the fees, being relevant in these cases. Copies of pre-admission assessments carried out on these three residents, plus a number of others, confirmed that the assessment had been conducted and recorded in full before their admission to the home was agreed. The home was beginning to adopt the practice of providing written confirmation of placement offers following assessment, as is required. Appropriate care assessments and health information from other health and social care professionals involved in each case were also on file where applicable. Trevone does not provide intermediate care. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal needs were being satisfactorily met in most cases, however failure to record certain aspects of care plans are posing risks in this regard. Failure to observe the home’s safe medication procedures consistently could pose risks to the residents. Efforts are made to observe residents’ privacy and dignity. EVIDENCE: All residents have a recorded plan of care that is based on an individual assessment of their health and personal needs. In most cases plans are regularly reviewed, although in one case reviews had only been conducted very infrequently. Four were chosen for closer scrutiny as part of the case tracking exercise. Although plans largely recorded the care and support needed, shortfalls were identified in each case. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 13 In one case there was a plan for managing a catheter, which was no longer relevant. The manual handling risk assessment was incomplete, and there was no nutritional risk assessment, despite some weight loss, with these circumstances not being reflected in the dietary care plan. The plan to manage a wound was reasonably informative, although did not record the frequency of dressing changes needed. In the second case the person’s assessment showed they had continence needs, and support and equipment had been provided; however this was not recorded in a plan of care. This person was at significant risk of falling, and despite medical interventions establishing that the person had a low blood pressure and dizzy spells, this had not been taken into account for planning care around the risks of falling. A nutritional risk assessment showed some good measures in place for the risks identified, however the planned weekly weight had not been done consistently. There were issues in relation to this person’s mental health and behaviour trends, which were being addressed, and which were to be assessed by the psychiatric services; however the plan of care did not reflect the planned psychiatric intervention. In the third case, there were very significant medical factors that had not been taken into account during the nutritional risk assessment, and had it done so, would have shown an increased level of risk to this person. In the fourth case, there were certain medical conditions that were emerging, and despite being addressed appropriately, were not featured in the related plans of care. Although there was no specific nutritional risk assessment documented in this case, the dietary care plan did show that there were some nutritional risks to be managed. For those with a risk of developing pressure sores, appropriate healthcare intervention and support equipment was in place. Records and direct observation confirmed that the residents are afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. A local general practitioner, who provides services at the home, expressed some concern about the home’s ability to address certain medical needs in relation to the skills and competencies of a small number of staff; catheter care and the use of a syringe driver were particularly mentioned. The general practitioner also expressed concern about the retention of appropriately skilled nursing staff; this is an area where there has been some concern, and is something that the manager has been endeavouring to address, having made some degree of progress, but with more work needed. Residents spoken to directly during the visit said that they were happy with the care they received, with two people saying that Trevone was much better than where they had previously lived. Most spoke well of the kind way in which staff cared for them. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 14 One particular resident was anxious about his particular medical needs, and the way in which they were being addressed at the home, and by the hospital. Three visitors spoken to directly were very satisfied with the way in which their relative was cared for here, with each saying that staff were kind and very sensitive to their relative and other residents; one commented on how staff were so respectful and mindful of her relative’s dignity. Residents surveyed said that they received good care and support at Trevone, but that the home was sometimes short staffed, meaning that some people have to wait for attention. Visitors surveyed said that they were happy with the standard of care their relative received. One visitor was particularly impressed with the way in which the staff kindly took extra time to tempt her relative’s appetite when she had been poorly. Although there is no-one currently doing so, residents are able to selfmedicate if they wish and are able, and this is done on the basis of a risk assessment. There are clearly printed Medication Administration Records from the supplying pharmacist; a small number of hand written entries on charts had been signed by the author, but there was no second signatory as a witness. In most cases there were clear instructions for the use of external preparations, with one exception to this seen; there was no plan of care to direct the usage either. There were some administration signature gaps. The exact amount of variable dosages had not been recorded consistently when administered. There were isolated instances where a medication was not being given strictly in accordance with the prescribed order, such as with pain relief, because it had not been needed; there were no coded entries to identify reasons for omission, and the instructions had not been reviewed in order to be more accurate either. Storage of medications is safe, with appropriately detailed records for receiving, disposal and management of all types of medication. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date. Random audits were carried out on three specific boxed medications, and a slight discrepancy was identified in one case. There were a small number of dosages in excess of what there should have been at that particular point in time. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 15 Care was being delivered in the privacy of residents’ own bedrooms and bathrooms throughout this visit. Some residents were able to confirm that staff knocked on their door before entering. Staff were observed whilst interacting with residents, and most were seen as polite, respectful and considerate; some in particular were extremely kind and caring, and clearly shared excellent relationships with the residents. However, there were isolated members of staff who appeared more casual and slightly less sensitive in their approach to residents. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Respect is generally shown towards individuals’ chosen and preferred lifestyles, with residents able to maintain social contacts in the home, and with their families and friends. Dietary needs are well catered for, with a selection of good food available that meets residents’ tastes and choices. EVIDENCE: Trevone employs a designated activities coordinator, who works part time on five days of the week, providing a range of social activities for the residents’ interest. Residents have been consulted about their particular interests and ideas, and a programme was being developed to suit a variety of needs; a weekly programme was displayed, which, in addition to showing the different types of activity on offer, showed that they are available at different times of the day, also to suit differing expectations. The needs of less able people had also been taken into account, and time had been spent with certain individuals in their rooms in order for them to participate in an activity. As well as physical activity, games and entertainment, there were opportunities for craft work, bulb planting, and also participation in multiTrevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 17 denominational religious services if wanted. Residents surveyed said that the home offered a social programme, but that ‘there wasn’t much’; one person actually said that they get bored; another said she would like to have trips out. Some said that ‘staff don’t have the time to spend on social activities’. Although activities were seen in progress, there were many who were sitting quietly doing nothing in the lounge; personal choice was a factor with some of them. A small number of people were pursuing their preferred interest independently, either watching television, reading or knitting. Trevone places no restrictions on visitors, and relatives and friends are free to visit at any time of theirs or their relative’s choosing. Relatives surveyed said that they were made to feel welcome in the home, were properly consulted and kept appropriately informed. Three visitors were spoken to directly, and each felt able to come when they liked, and felt comfortable with the staff and arrangements at the home. One visitor in particular, indicated that she was able to be very involved in the care of her relative, as they chose. This particular resident had an entirely different cultural background to the majority of residents, and the relative was very appreciative of the efforts staff had made to accommodate any different ideas, preferences and needs they might have. Residents were evidently spending time how and where they wanted; many more were dependent on staff however. Individual choices and preferences were respected by staff, with the manner in which they approached residents, by the personal influences noted in individual bedrooms, with the provision of different meals, and with the small number who were physically able to freely move around the home. One particular resident’s choice to have a bath or shower more regularly had not been accommodated, staff citing time factors in relation to staffing provision; the manager resolved to look into this more closely, so as to accommodate this preference as much as possible. Residents’ wish and ability to manage their own affairs is respected, and there are currently at least four people doing this, whilst others have support arrangements in place to assist them. Some residents themselves confirmed their freedom to exercise personal choice, saying things like, ‘no-one dictates to us’, and ‘we can choose what we do’. There was a wealth of information in the entrance hall regarding advocacy, advice and support services, and CSCI publication, ‘Choosing the Right Service for You’. The service of the lunchtime meal was observed. Meals were presented in reasonably calm surroundings, with a variety of choices served. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 18 Residents, with just one exception, said that the food they had was good, and that they always enjoyed their meals; they also confirmed that there was a lot of choice. The meals appeared well balanced, nutritious and fresh. Staff were available and were giving assistance where needed. Special diets were provided, with diabetic, vegetarian, soft, and gluten-free all served in addition to the standard meals. The cultural dietary needs of one particular resident had been discussed with them and their relative, and although the home was able and willing to address any specific requirements, the resident did not require this, but was grateful of the efforts made. Good catering records were maintained in the kitchen. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good system for dealing with complaints, with evidence that residents and visitors feel any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: The home has a written procedure for dealing with complaints. Records for two complaints that had been received more recently were seen, and each had been robustly addressed by the manager, with the complainants satisfied with the outcome achieved. Some of the residents surveyed said that staff could be slow to respond to concerns on occasions. Visitors surveyed were all aware of how to make complaint if they needed to, with just one exception. However, a copy of the home’s complaints procedure was contained in the home’s information brochure, and had a very high profile in a number of visible locations around the home. Residents spoken to directly during the visit, without exception, indicated their confidence in the manager and staff to listen and address any concerns they might have. Each seemed to know who to approach if necessary. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 20 One of the visitors spoken to said that she appreciated the very open lines of communication available to her for raising concerns; she also confirmed that any she had raised had been addressed promptly. One visitor said that Trevone had a warm and friendly atmosphere. The visitor said that the manager and the staff team were ‘amazing’, and that it had been the right decision coming here; they said there was always someone to speak to if they had any concerns at all. The home has written policies and procedures for the protection of the vulnerable residents, and staff have received training in recognition and how to deal with abuse this year. Abuse training is also given during induction. Staff spoken to discussed the level of training they had received, and were conversant in adult protection issues. The home has policies and procedures in relation to staff disciplinary issues, and the manager has acted appropriately when concerns have been identified, as part of the protection of vulnerable residents here. The manager is currently pursuing concerns in relation to a member of staff, no longer employed at the home, and has agreed to inform CSCI of progress and outcomes. Power of attorney arrangements were in place for more vulnerable residents where appropriate. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite isolated areas needing some decorative attention, residents are provided with a comfortable and safe place to live. The home is clean, with appropriate and full observations regarding the control of infection. EVIDENCE: A maintenance person is employed at Trevone on a full time basis, and records of all maintenance are kept. Since the last inspection maintenance and redecoration has been ongoing, with attention to, what was previously, the smoking lounge on the ground floor; this room now provides a quiet lounge, with the smoking lounge relocated on the middle floor. The main lounge and dining room has also been redecorated, and a new assisted bath has been installed in a first floor bathroom, with some refurbishment also carried out in here. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 22 The first floor lounge was in the process of redecoration, and was temporarily out of use. Many areas of corridor woodwork were damaged through wear and tear, and the painted corridor walls, particularly on the middle floor, looked patchy in places and were bare. The small end lounge on the middle floor looked bare and uninviting. The home was fresh, clean and free of odours during this visit. One relative said that she had been very impressed by the standards of cleanliness in the home, and that it was fresh and free of odours. Residents were generally happy with the standards of cleanliness maintained, with just one indicating that staff could pay closer attention to her room and bathroom sometimes. The laundry room was orderly, with items appropriately segregated and washed in accordance with infection control measures. There was a good supply of gloves, aprons, liquid soap, paper towels and sanitising hand gels for staff use. The metal cabinets used to store chemicals in the three sluices were excessively rusted through prolonged usage. All grades of clinical waste are managed safely. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 23 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to meet the needs of the residents. Robust recruitment procedures ensure that suitable staff are employed for the protection of residents. The arrangements for their induction and training are good, with the staff able to learn the skills necessary for their role. EVIDENCE: Staff rotas are recorded and allow for at least one registered nurse on duty twenty-four hours a day (this has been increased to two on at least five days out of seven), with six carers during the afternoon and evening and three overnight. An ancillary team of cleaning, laundry, catering, maintenance and administration staff ably supported the care and nursing team. The manager works in a supernumerary capacity and has not had the advantage of a reliable and committed deputy to assist him; there has been a recent appointment of a new deputy manager and her arrival is eagerly anticipated. There has been some positive recruitment recently resulting in a reduced use of agency staff; one visitor particularly commented on this. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 24 Some staff also spoke of establishing a more cohesive team. A new worker said that the staff had been very welcoming and supportive to her. One person spoke of an improving morale and flexibility amongst staff. Resident survey responses indicated that they mostly felt the staff were providing good care and support to them, but that there are occasions when they have to wait for attention, as in their opinion, the home can be short staffed. Visitor surveys also indicated the view that the home can be short staffed, with one person saying that the staff turnover can be unsettling for their relative. One particular resident and their family said that ‘staff can get diverted at times to others with more pressing needs, but on the whole Trevone got the right balance’. Others spoke of a ‘warm and friendly atmosphere’, with the manager and team being ‘amazing’. Staff were working hard to meet residents’ needs, however it was noted that some were more committed and intent on doing this in a more sensitive and efficient way than a small number of others. The home is making progress with the National Vocational Qualification (NVQ) training programme for care staff, but has not yet reached the target of 50 of care staff being qualified to NVQ level 2 standard; there were nine who were qualified to at least this level at this time, with a further seven currently on the training course. Six staff files were chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen. Full and complete evidence of the required pre-employment checks was seen in each of the files, including medical checks, proof of identity, two written references, POVA (Protection of Vulnerable Adults) checks and CRB (Criminal Records Bureau) clearances. New staff had received a structured induction training to the home, and training records for this were seen in a number of cases. Some staff spoken to directly confirmed their level of induction training, and that they had worked under supervision for that period. The home was in the process of introducing a new electronic induction-learning package for new staff. This innovative programme provides training in six modules, each of which incorporates the Common Induction Standards for care staff, including Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and Developing as a Worker. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 25 Training records demonstrated that staff have access to a variety of training that is relevant to the jobs they do. Examples included health and safety, fire safety, first aid and manual handling. Dementia care, wound management and additional first aid course are also planned. Further to concerns reported under the Health and Personal Care outcome group, (standards 7-11) regarding some registered nurse skills in certain areas of practice, there should now be additional emphasis on associated areas of training and development. Staff are issued with certificated evidence of their learning, and a copy of the General Social Care Council Code of Conduct. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 26 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some good management systems in place here to ensure that the interests, health and safety of the residents are safeguarded. The home reviews aspects of its performance through a good programme of self-review and consultations, which includes seeking the views of residents and their relatives. EVIDENCE: The manager of Trevone is an experienced registered nurse, and is registered with CSCI for his role. He is currently working towards achieving the Registered Manager’s Award. Visitors were particularly complimentary about the manager, and had great faith in his management of the home. Residents also spoke very well of him, Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 27 as did the staff, all indicating their confidence in his leadership and management. One person said that the manager was approachable, firm, but fair. Residents’ and relatives’ opinions had been sought as part of a quality monitoring process, and recently an annual quality assurance survey was distributed to them, so that they could provide feedback on their experience of the accommodation, facilities, catering, care, social activities and visiting arrangements. The manager had drafted a report on the basis of collated results, to address any issues. Comments and suggestions forms were available in the entrance hall, enabling anyone to offer their views of the service at any time if they wish. A residents’ meeting had been held, and recorded minutes of this showed that residents were able to have a say in how their home is run. The home has a system for residents to have a six monthly review of their stay, so that they can offer their views about care, services, facilities and any concerns they might have. Meal monitoring forms had been regularly issued to residents, chosen on a random basis, so that they could give feedback on their experiences of the food and drink provided for them in the home. Following assessment by the awarding body the home had done well to achieve the ISO 9001 award, for providing a ‘Quality Service for Older People in Care Homes’. Some residents have placed personal money and valuables with the home for safekeeping. Clear and transparent records for each person, which include transaction details, running totals, and receipts were kept. Two case tracking audits on residents’ monies proved to be correct, with no discrepancies seen. Residents or their representative had signed to acknowledge some transactions, but where this was not possible in the majority of cases, two staff members had signed the record to witness on behalf of the resident. There were written policies, procedures and risk assessments and provision of necessary equipment to protect and promote the health and safety of those living and working at Trevone. A small health and safety committee meets at regular intervals to risk assess the environment. Staff had received training in first aid, fire safety and health and safety. A full fire safety risk assessment throughout the whole building has been undertaken by an external assessor, with due regard to revised fire safety regulations; there were a number of issues which are to be addressed on this basis, and an action plan to address them was awaited from The Orders of St John Care Trust property department. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 28 Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply were also carried out. All necessary safety checks and maintenance of equipment was undertaken in a timely fashion, and meticulous records were kept in these areas. Accident records were maintained where appropriate. The environment was generally secure, and there were coded door entries in a number of areas. Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 5(1)(b.d) (c) Requirement Timescale for action 31/01/07 2 OP7 3 OP8 The registered manager must ensure that the following are included in the Service User Guide: • A statement of whether any of the matters in relation to sub-paragraphs (b) to (b.c) of this regulation would be different in circumstances where a service user’s care is funded in whole or part by persons other than the service user • A standard form of contract. 15(1) The registered manager must (2b) ensure that: • Care plans are more comprehensively prepared, so as to show how residents’ entire needs are to be met in respect of their health and welfare, and are regularly reviewed so as to be up to date and accurate. 13(4c) The registered manager must 12(1)(a.b) ensure that risk assessments are 17(1)(a) fully documented in relation to: DS0000064614.V310105.R01.S.doc 31/12/06 31/12/06 Trevone Version 5.2 Page 31 Sch 3(m) 4 OP8 12(1a) 5 OP9 13(2) • Nutritional risks • Falling and Handling risks. The registered manager must ensure that residents’ weights are monitored more closely in cases where a nutritional risk has been identified, and the plan of care requires it. The registered manager must ensure that: • Staff sign consistently for administration of all medications, or alternatively insert a coded reason to explain any omissions • Staff record the exact amount of a variable dosage when administered • In cases where prescribed orders for analgesia are not needed by a resident, the prescription is reviewed to reflect the ‘as required’ arrangement. 31/12/06 31/12/06 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 Refer to Standard OP7 OP9 Good Practice Recommendations Staff should record the frequency of wound dressing changes needed, as part of the associated plans of care. • A second person should sign as a witness to any handwritten amendments or additions on medication administration charts • The use of external preparations should be linked to an associated plan of care. The rusted metal storage cabinets in the sluice rooms should be replaced. There should be 50 of care staff qualified to at least NVQ level 2, or equivalent. DS0000064614.V310105.R01.S.doc Version 5.2 Page 32 3 4 OP26 OP28 Trevone Trevone DS0000064614.V310105.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000064614.V310105.R01.S.doc Version 5.2 Page 34 - 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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