CARE HOMES FOR OLDER PEOPLE
Trevone 22 Denmark Road Gloucester Glos GL1 3HZ Lead Inspector
Mrs Ruth Wilcox Unannounced Inspection 09:00 7 February 2006
th 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.V249980.R01.S.doc Version 5.0 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.V249980.R01.S.doc Version 5.0 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 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.V249980.R01.S.doc Version 5.0 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. The manager is to complete the NVQ 4 Registered Manager`s Award by the end of December 2005 29 July 2005 2. 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 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 DS0000064614.V249980.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over 5 hours on one day in February 2006. The Registered Manager and the Deputy Manager were present, providing information and assistance as requested. Both were open and cooperative with the inspection process. Care records were inspected, with the care of two residents closely looked at in particular. There was direct contact with a large number of residents, with twelve being spoken to directly to gauge their views regarding the standards of services and care at the home. Following the specialist inspection carried out in July 2005 by the CSCI Pharmacist, the management of medications in respect of the requirements issued for improvements were inspected to assess the home’s compliance. The arrangements for visitors, and for residents to make and pursue personal choices in respect of their daily lives were considered. The provision of staff and the way in which they are trained was inspected. The systems for monitoring and ensuring quality of the service, and the policies and procedures for protecting vulnerable residents were looked at; this included the safeguards for those choosing to place money or valuables with the home for safekeeping. A tour of the premises took place, with particular attention to the standard of maintenance and cleanliness. Staff were observed at various times throughout the day, whilst going about their duties and interacting with the residents. As well as the manager and deputy, five other staff were spoken to directly. What the service does well:
Trevone provides a well maintained and very clean and hygienic home for the residents living there. Residents are generally very satisfied with the standards of care and attention they receive, saying that in the main the staff are very helpful, kind and caring. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 6 Each resident’s health and personal care needs are adequately met, with each having their own individually drafted plan of care, which is well written and informative about the kind of care, attention and treatment they require. Staff carry out regular reviews of these care plans, ensuring that all staff have access to up to date and relevant information about each resident. There is a very committed and effective registered manager at this home, who has ensured a capable and effective supporting management structure with a deputy manager and senior care leaders. There are good systems for monitoring the quality of the service provided at Trevone, with residents and their families having opportunities to give feedback on their views and ideas. Visitors are welcomed into the life of the home, and residents are well supported to maintain their close contacts with family and friends. The home has established a safe and transparent system to allow residents to place money or valuables in the main safe, keeping good clear records. What has improved since the last inspection?
Senior staff have worked hard to make improvements in respect of the systems for managing residents’ medications. There are very significant improvements in aspects of associated storage and recording, making systems much safer and more comprehensive. The home has improved some of the facilities for the residents with the purchase of some new wheelchairs and bedside tables, new lighting in some areas, and new curtains in the lounge. The ground floor corridor and lounge/dining room has been redecorated, and the resident call bell system has been replaced with a new one. There is now a greater consistency and cohesiveness among the staff group, with a reduction in the use of agency staff. Staffing levels have been reviewed and increased at certain times, in order that residents’ needs can be met in as timely a way as possible. The new management structure among senior staff is now benefiting all who live and work at Trevone, in terms of guidance, supervision, and consistency. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 7 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. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 8 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.V249980.R01.S.doc Version 5.0 Page 9 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): EVIDENCE: None of the standards were assessed in this section on this occasion. Trevone does not provide intermediate care. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 10 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. There is a consistent care planning system in place, which provides staff with the information they need to satisfactorily meet residents’ health and personal needs. The systems for the management and administration of medications are much improved, with arrangements in place to ensure that residents’ medication needs are appropriately met. In the main, care and support is offered in such a way as to promote the privacy and dignity of the individual, though the insensitive action by one member of staff did compromise this for at least one resident. EVIDENCE: Each resident has a personal plan of care, which is directly linked to their needs assessment; two plans were chosen as part of a case tracking exercise. Care plans are well written, with clear instructions for staff to follow. Reviews of plans are carried out regularly, and each review seen contained very detailed and comprehensive information.
Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 11 Records contained evidence of how residents’ health needs are met, through sourcing the appropriate health care services in the community and through good multidisciplinary working. Interventions of other health care professionals are well documented. Appropriate risk assessments are documented, with recorded risk reducing actions for staff to follow. Care plans contained records of residents’ general condition and health, vital signs and weights. Staff have made very good progress regarding improvements to the management of medications, following the requirements issued by the CSCI Pharmacist. All have been addressed satisfactorily, ensuring safer management, storage and recording in general. The home has changed its pharmacy supplier, in order that it remains compliant regarding the disposal of waste medicines, in accordance with the Special Waste Regulations 1996. Care was being delivered in the privacy of individuals’ rooms throughout the visit. Residents spoken to confirm their satisfaction with their care, saying that staff in the main are polite, kind and caring. Individual care plans were also reflective of individual’s privacy and dignity, and also their levels of independence to be respected. Two residents made the point that the staff are very busy, and that they sometimes go for a while without seeing a member of staff whilst in the lounge. Throughout this visit the residents’ call bell was heard ringing for prolonged periods. One member of staff was observed helping and speaking to a resident in a less than sensitive manner, which was addressed at the time, and subsequently referred to the manager for action. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 12 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): 13 & 14. The visiting arrangements at the home ensure that residents can keep close contact with their families and friends in accordance with their wishes. In the main, consideration and respect is shown towards residents exercising control and choice in their daily lives. However, there are some whose higher dependency levels have resulted in them being more restricted in this regard. EVIDENCE: The home provides a relaxed environment for visitors, and does not place any restrictions on them. Some of the residents themselves confirmed their close contact with their relatives and friends. Visitors are encouraged to join in the life of the home, and are always invited to any of the home’s social events; a notice board helps to keep visitors informed about news and events in the home. Trevone has limited links within the community, which includes local churches. Some residents go out with their families and friends, and one resident said that she regularly goes out to a day centre. Residents are able to pursue choices in many regards, with this being evident at meal times, in the way residents’ rooms appear personalised, and in the way that some residents were spending their time how and where they chose.
Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 13 However, there were some, because of their physical limitations and their greater dependency on staff, who seemed to have less opportunity for choice whilst waiting for staff to come into the lounge to attend to them; two people indicated that there are times when there are no staff present in the lounge area to respond to them. One resident was heard to ask a carer if she could sit in another place for her lunch; the carer denied her this, saying that she would have to sit where she put her. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 14 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): 18. Although the home has very clear policies regarding the protection of vulnerable residents, the failure to provide all staff with adequate training in adult protection procedures could compromise their ability to consistently protect residents from risk of abuse. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults, and has copies of other relevant documents and information available. Some of the staff have received training in abuse either during induction or as part of the NVQ programme. However, this training is not being delivered at the present time, and therefore there are some staff who have not received training in recognition of abuse and in adult protection procedures. Staff spoken to were very clear about adult protection issues, and were concerned that there was no training available for those staff needing it at the present time, though were hopeful that the training department was addressing this. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 15 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. The standard of the environment within this home is satisfactory, and provides residents 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, and a rolling programme of redecoration is carried out, with the ground floor corridor and dining room having been done since the last inspection. Lighting has been checked in the corridor also, to ensure that it is sufficiently bright for the residents using the area. Lighting is also being replaced in the smokers’ lounge and the lounge/dining room. New curtains have been fitted in the lounge/dining room, and there are proposals to replace the carpet in here and in the smokers’ lounge as well. A new call bell system has been installed for the residents. Some new wheelchairs and a number of ‘over bed’ style tables have been purchased.
Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 16 There is a large crack in the wall of one of the bedrooms on the ground floor, which has been surveyed by the property department for action. The home was very clean and fresh, with no unpleasant odours anywhere. One resident was particularly impressed by the standards of cleanliness and hygiene maintained by the staff. Gloves and aprons, liquid soap, hand cleansing gels and paper towels are provided throughout the home. The home has a contract for the correct management of clinical waste. The laundry room provides appropriate facilities for the sluicing and disinfection of any foul or infected laundry. A recent illness in the home has been correctly managed and treated by staff, using strict infection control procedures. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 17 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 & 30. Staffing levels are reviewed appropriately and provided in sufficient numbers to meet the needs of the residents. The slow progress to provide an adequate training programme for staff has meant that it is only the in-house training from more experienced staff that is providing them with the knowledge to provide adequate care for the residents. EVIDENCE: There has been greater consistency achieved recently within the staff group, with more contracted staff and less agency usage. A strong commitment is evident among senior staff to provide strong leadership to the team, and help them to function more cohesively. Trevone is a very busy home, and staffing levels have been increased slightly to cope with this, to one nurse and eight carers during the morning. Staff report that this has made a very positive difference in the home. During the afternoon and evening there is one nurse and six, sometimes seven, carers, with one nurse and two carers overnight. The night time provision is being monitored, as this is the absolutely bare minimum of staff. The manager has carried out night monitoring visits, and at present is satisfied that this level is currently adequate to meet the needs of the residents. The senior care leaders are now allocated supernumerary time, with a view to extend this to the deputy manager, to address their additional responsibilities. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 18 Residents themselves were generally very positive about the staff, saying that they are kind and caring. One person did say however, that ‘some are better than others’. There are six care staff who are qualified to at least NVQ level 2 standard, with one of these being at level 3, and another undertaking the level 3 award at the present time. There are five staff who are part way through the NVQ level 2 training, with another two on an apprenticeship scheme. It is unfortunate that, despite a reported eagerness and enthusiasm regarding training among staff, there is limited progress with this training due to The Orders of St John Care Trust making changes to its training provider; there has been a very slow response from the college concerned, and staff are becoming disheartened whilst still waiting to get support to restart their programmes. There is a similar situation in respect of other training also, with a new training programme being devised, which is not yet available. Whilst awaiting this there is very little training being provided, with staff just receiving the minimum in fire safety, manual handling and health and safety. First aid training has not taken place as was required. Despite care staff sometimes having to undertake a small degree of catering duties, there has been no basic food hygiene training for them. The manager has made attempts to resolve this situation by making regular enquiries of the training manager at The Orders of St John Care Trust, but with little resolved to date. Staff regularly ask about any new training opportunities, and demonstrate a commitment to their professional development. Induction training is carried out for any new staff, using an in-house programme specific to Trevone. New staff have not been able to attend the structured induction at the county office within the six week timescale. New staff work under the supervision of the senior care leaders during their induction. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 19 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): 33 & 35. 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. There are good management systems in place to ensure that the financial interests of the residents are safeguarded. EVIDENCE: The manager is very approachable to residents and visitors, ensuring that he remains accessible for them to discuss any issues they might have. Residents and their relatives are invited to attend regular meetings, at which they have the opportunity to voice their opinions and ideas about the home. ‘Suggestions and Feedback’ forms are situated in the hall for anyone choosing to give comments about the home in this way. The manager and other senior staff conduct internal quality audits in a number of areas, such as the environment and assorted record keeping.
Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 20 A six monthly ‘Resident’s Review’ survey is just being introduced, in order to establish that the service is meeting the resident’s needs and expectations, and meal monitoring forms have been introduced on a frequent basis, in order that residents’ views about the quality of the food can be obtained. A report has not yet been produced on the basis of all the quality monitoring work that is being carried out, but this is being addressed by The Orders of St John Care Trust. 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, are kept. Residents or their representative sign to acknowledge some transactions, but where this is not possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 21 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP10 Regulation 12(4.a) Requirement The Registered Manager must take any actions necessary to ensure that all staff are consistently respectful and mindful of each residents privacy and dignity. (previous timescale of 31/08/05 not met in full) The Registered Manager must ensure that all staff take into account the wishes and feelings of each resident. The Registered Persons must ensure that all staff are trained in the recognition of abuse and adult protection procedures. Staff must receive training in First Aid. (Previous timescale of 31/12/05 not met) The Registered Persons must implement a training programme for staff, which is appropriate for the work they are to perform. Timescale for action 31/03/06 2 OP14 12(3) 31/03/06 3 OP18 13(6) 31/05/06 4 OP30 13(4.c) 31/05/06 5 OP30 18(1.c.i) 31/05/06 Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 23 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 OP28 OP30 OP30 Good Practice Recommendations A minimum ratio of 50 of care staff qualified to NVQ level 2 should be achieved in the home. The structured induction for new staff, which is held at the county office, should take place within six weeks of the start of their employment. A person qualified in First Aid should be provided on each shift. Trevone DS0000064614.V249980.R01.S.doc Version 5.0 Page 24 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
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