Inspection on 16/01/07 for Trewartha House

This inspection was carried out on 16th January 2007.

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

The inspector 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

Trewartha House 18/11/05

Trewartha House 18/05/05

Trewartha House 03/02/05

Trewartha House 01/09/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE Trewartha House Trewartha Estate Carbis Bay St Ives Cornwall TR26 2TQ Lead Inspector Richard Coates Key Unannounced Inspection 16th January 2007 09:00 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 Trewartha House DS0000009134.V315375.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. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trewartha House Address Trewartha Estate Carbis Bay St Ives Cornwall TR26 2TQ 01736 797183 01736 797287 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) Cornwall Care Limited Mrs Christine Muxlow Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40) Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18th November 2005 Brief Description of the Service: Trewartha House is one of eighteen homes for which Cornwall Care Ltd is the registered provider. It is registered to accommodate and provide personal care for forty older people with dementia and mental illness. The provider endeavours to plan all admissions, and to avoid emergency admissions whenever possible. The accommodation for residents at Trewartha House is on one floor with four wings radiating out from a central communal area. Each wing has its own bedrooms, toilets and bathrooms and is decorated in a distinctive colour scheme. The wings are arranged in pairs, each pair with a shared dining area and sitting rooms. The garden area is secure with a large paved area, seating and a wooden summerhouse. The majority of residents’ bedrooms are single. There are four shared bedrooms. Trewartha House is accessible for people who have mobility difficulties or use a wheelchair. The home is close to community facilities in the immediate area and is a short distance from St Ives. Trewartha House has developed relationships with local agencies including the Alzheimers Society. The fees were given at November 2006 as from £350.40 to £460.00 Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned unannounced key inspection. The purpose of the inspection was to focus on the key national minimum standards as identified by the commission and review progress on the two recommendations set in the report for the last inspection dated 18 November 2005. The inspector was on the premises during two days. A second inspector joined for the second day. The methods used were discussion with the manager, staff, residents, and their relatives, inspection of records and documents, observation of the daily life of the home and inspection of the premises. This included case tracking the records for three residents selected using the criteria of their age, disability, and gender. The Registered Manager submitted a pre-inspection questionnaire with supplementary material. What the service does well: Trewartha House provides a safe and comfortable home for older people. Service users and their representatives reported that Trewartha House provides good quality care and accommodation. Comments made by residents included ‘they listen to me’ and ‘good as gold’. Residents and their representatives felt that that their health needs were well monitored and appropriate assistance sought when required. The managers ensure that they have obtained a sufficiently detailed assessment to determine if the home can meet the prospective resident’s needs. Residents felt that they were supported to follow their preferred daily routine. They reported that there were sufficient activities and enough to do. The home has a recently appointed activities worker. Residents felt their visitors were welcomed to the home. Residents, relatives and staff said that they were confident that they could approach the registered manager with any concerns and issues. Residents expressed satisfaction with the quality and quantities of the meals provided. The home is well maintained, generally tidily decorated and clean and hygienic. Residents made positive comments about the staff’s kindness and caring qualities. Staff stated that the informal and formal supervision supported them to do their jobs well. Cornwall Care has a well-established training programme for staff which covers required areas. The company supports staff in their training and development so that residents and their representatives can have confidence in a well trained and supervised staff team. Staff were satisfied with the training they receive and with the support from the management team. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 7 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 Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 8 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): 3 and 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The needs of prospective service users are assessed so that they can be assured that the home can provide adequate care. EVIDENCE: Managers visit prospective residents and complete a needs assessment. Cornwall Care Ltd uses a standard format for assessment and care planning. When completed in sufficient detail, this record covers the assessment issues specified in the standard and the diverse needs of prospective residents. The residents’ records case tracked contained completed needs assessments. The home staff carry out an assessment for both private purchasers and those commissioned by the local authority. All the residents’ records case tracked Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 9 contained a written assessment and care plan. The home’s assessments state who was present at the assessment. This provides evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. The records for a resident case tracked included the assessment and commissioning documents from the local authority. The assessment part of the care planning records were completed in reasonable detail. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 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 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Care plans and risk assessments do not consistently set out the residents’ health, personal and social care needs and do not consistently provide clear directions and information for staff. The healthcare needs of residents are monitored and addressed so that prompt attention is sought when required. The arrangements for the management of medicines protect service users. EVIDENCE: All the residents case tracked had written care plans made up of a number of documents. Cornwall Care Ltd has a standard single format for assessment and initial care planning. These records were dated and signed, with dated records of regular reviews. The records for most residents include a written life story, but this had not been completed for one of the residents case Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 11 tracked. The care plans did not consistently direct and inform care staff in sufficient detail in meeting the health, personal and social care needs of residents. The home uses a ‘care profile’ as a working document for staff to summarise the care and support that the residents need. The care profiles were not signed or dated, which would demonstrate the accountability of the writer and that they are up to date. The records for one of the residents sampled did not include a care profile. Some areas of the care plans are rather generalised, lacking clear and specific directions for staff about the actions that they should take and not stating the desired outcomes in measurable terms. Care plans do not always make clear how staff can assist residents to maintain their independence in self-care. Information about the residents’ interests and preferred activities in the plans was limited. The registered manager reported that the home staff will be recording the preferred social activities and interests in a separate format. The Personal Routines and Preferences records detail residents’ lifestyle preferences and choices, their dietary preferences and needs, and their religious beliefs. Each resident has an identified key worker. There were regular recorded reviews of care plans. Visiting relatives felt that the home staff kept them well informed. The home staff record a moving and handling assessment for residents who require assistance with mobility and transfers. Cornwall Care Ltd uses a standard format for this. These assessments had been reviewed. A community nurse reported that co-working with the home was generally satisfactory, but there had been a recent issue, now resolved, about appropriate moving and handling techniques for a resident with more complex needs. The accident record shows a low incidence of falls. Where a resident is at risk of falling, for most residents, risk assessments direct staff in reducing the risk and safeguarding the resident. One falls risk assessment inspected did not provide clear directions for managing the risk, although from discussion with the staff and observation, appropriate action had been taken to reduce the risks. There was no falls risk assessment for one resident for whom there was a recorded incident of being found on the floor. One care plan sampled lacked a risk assessment about particular behaviours of the resident, which presented a risk to the resident herself, other residents and staff. The daily records for residents detailed the care delivered, visitors, health care matters, and activities. Consistent and informative daily records demonstrate the accountability of the provider and protect the well-being and rights of the residents. Staff keep separate records in respect of bathing, and other specific individual care needs. The contents of the residents’ records met regulatory requirements. Residents are registered with local GP practices. Residents reported that their health care needs were monitored and attention obtained promptly when needed. Care staff record each resident’s medical contacts and appointments. However, for one resident who had recent contact with a community psychiatric nurse, there were no records of contacts or advice provided. There Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 12 are written plans where required for eye care, foot care and dental and oral care. Residents are weighed regularly. One resident has pressure areas and had appropriate pressure relieving equipment and daily visits from the community nurses. A dentist visits the home weekly. An optician visited during the inspection. Staff felt that they had good working relationships with healthcare professionals. Medicines are stored in locked medicines trolleys and a locked cupboard in a secure room. There is a secure controlled drug cabinet. The cupboards are not steel medicines cabinets to the required industry standard. The cupboards and trolley were tidy and well organised. There is a small medicines refrigerator and the temperature is checked daily. The monitored dosage system is in use. Residents sign an agreement to the administration of medicines. No residents are currently assessed as safe in self administering their medicines. Cornwall Care has a corporate policy and procedure on the handling of medicines, which includes guidance on the use of homely remedies. Managers, or staff training to be managers, complete training and have responsibility for the administration of medicines. The administration records were well maintained. Two staff check in stocks of medicines delivered from the pharmacist. Two staff complete hand written medication records, for example, when residents are admitted for respite. Records of amendments to a resident’s prescription were not signed and dated by the writer on the record with a reference to the source of the change, for example the GP’s direction. The home has a controlled drug register; each administration is signed and witnessed. A check of stocks of one drug against the record showed this to be accurate. A record of medicines returned to the pharmacist is kept on the pharmacy standard format. The pharmacist last made a visit for advice on 5 June 2006. Residents made positive comments on the skills and caring qualities of staff. They felt very well cared for and reported that staff delivered care sensitively and respected their privacy and dignity. Residents made statements like, “good as gold” and “they listen to me ”. Residents felt safe when, for example, staff were transferring them and providing personal care in the assisted baths. Examples of staff providing skilled and sensitive care were observed during the inspection. Residents found it difficult to identify any area where the home could improve. The families of residents expressed satisfaction with the skills and kindness of staff. The registered manager and assistant managers work with the staff in care delivery and monitor the quality of care delivered. It should be noted that there are four shared rooms at the home which provide each occupant with limited space and potentially restrict their privacy. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 13 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, and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are supported in a lifestyle which accords as far as possible with their own expectations and preferences. A range of activities takes place and meets residents’ social and recreational interests. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: Residents felt that they were helped to make choices about their daily lives and routines. One resident said that she liked to be independent and do things herself, and the staff were always on hand to assist her. They felt that there was enough to do. There is a notice board displaying information and a recently introduced newsletter. The home provides a range of planned activities, including a regular daily activity worker. During the inspection, an organist provided a lively afternoon session with dancing and singing. During Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 14 the second morning of the inspection residents were engaged in making cards, reading books and the daily papers, knitting, receiving nail care, conversing and enjoying their morning drinks and biscuits. Residents and visitors reported that they found the visiting arrangements open and flexible. They felt that visitors were made welcome and they were offered a drink. Residents choose where they meet their guests. The Registered Manager reported that she is not appointee for any residents for their benefits. A minority of residents manage their own finances. Relatives or representatives manage other residents’ finances, a high proportion being recorded as through Power of Attorney arrangements. Residents can bring in possessions and furniture at admission by agreement with the provider. The staff record an inventory of belongings at admission. Many residents and their families had personalised their bedrooms to a high degree. Cornwall Care has introduced the ‘appetite for life’ initiative for residents to receive a varied and appealing diet in a relaxed atmosphere. Each resident’s preferences and choices are recorded. There are two dining areas. In addition to the main kitchen, each pair of wings shares a small kitchen for serving breakfast and drinks. Residents were positive about the quality of food provided, reporting that the meals were very good with appetising choices and sufficient portions. Residents have their breakfast, with a hot choice available, in one of the dining areas or in the resident’s room. The cooks have approached residents about their choices and preferences, and are introducing a new four-week rotating menu for lunch. There are two main choices each day for lunch, with further individual choices available. Tea is a choice of savouries and home made cakes. The daily menu is displayed in each dining room. The inspector joined residents for lunch. The main choices were lamb steaks and chicken pie with a choice of potatoes and fresh vegetables. There was a wide choice of puddings. The food was appetising and well presented. Residents were relaxed and unrushed with staff providing appropriate support to residents to make choices and eat their meals. Hot and cold drinks are served between meals. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. The provider has arrangements to protect service users from abuse. EVIDENCE: Cornwall Care Ltd has a corporate complaints procedure that complies with the standard and regulation. Trewartha has received no formal complaints since the last inspection. There is a record for complaints and compliments containing a number of expressions of appreciation and thanks. Residents and representatives had confidence that they could approach the managers and they would listen to any concerns. Cornwall Care Ltd has a corporate adult protection policy and procedure. The policy and procedure have been revised since the last inspection to comply with the Cornwall Multi-Agency Adult Protection Code of Practice. Staff receive training in adult protection following their induction and as part of their NVQ level 2. Cornwall Care is introducing a programme to provide staff with refresher training in safeguarding vulnerable adults. The registered manager intends to nominate staff for the Cornwall multi-agency adult protection Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 16 training. The home had a copy of the Cornwall Multi-Agency Adult Protection Guidance and the Alerters’ Guidance. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is accessible, generally well maintained and safe. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: Trewartha is situated in a residential area of Carbis Bay in its own grounds. The main entrance is accessible for wheelchair users. The residents’ accommodation is on one level. One area of the building has further floors used as offices, training room and a sleeping-in room for duty managers. The entrance hall leads to a central activity and sitting area. The four wings are arranged in two pairs, each pair with their own dining and sitting areas. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 18 Cornwall Care Ltd continues to maintain and refurbish the home’s décor and furnishings. Most areas of the home are in good decorative order, although there is wear and tear on walls and paintwork in the central sitting area. The paintwork of the outside of the metal window frames is peeling and scruffy, and needs attention. The insides of these window frames in residents’ rooms are marked and stained. Their appearance may be improved with the use of a suitable cleaner. Furniture is of good quality and in good condition. Residents and their representatives commented that the home is kept clean and fresh. The garden is accessed through two sets of doors. One of these is a new set of patio doors leading to an extensive paved area with garden furniture. The grounds were tidy and appeared safe. Residents reported that their rooms were comfortable and pleasant, and kept clean and hygienic. Residents cannot currently lock their rooms from inside, but rooms can be secured if the occupant is away from the home. The provider should review providing residents with the choice and ability to lock their rooms from inside. The heating and lighting appeared satisfactory. The air filters in the overhead heating units in the wing corridors may need attention. The home has two sterilising sluices which appear to be rather old. Given the demands set by the level of the continence needs of residents, the provider needs to review these sluices and the general condition of the sluice rooms. The home has two laundries. A domestic scale laundry deals with the household linen such as tablecloths. The main laundry complies with the standard. The washing machines and tumbler driers are industrial standard. Clothes and linen for laundry is transported through the home in sealed red bags or covered containers. Residents and their representatives were satisfied with the laundry service. Residents’ clothes appeared well cared for. The bathing and toileting facilities in the home comply with the standard. There are five assisted baths and one level entry shower. The toilet and bathroom doors have clear signs and suitable locks. Hot water was supplied at a safe temperature. Toilets are situated throughout the home. All the bathrooms and toilets inspected were fully tiled, and clean and hygienic. Facilities for staff hand washing, with hand wash and paper towels, were situated throughout the home. Staff reported that there were good supplies of gloves and aprons. Equipment and adaptations were in place to assist with mobility and transfers. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 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 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 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing and training arrangements ensure that the needs of residents are met. There is a good level of qualified staff. Recruitment procedures support and safeguard the residents. EVIDENCE: A written roster details the deployment of staff. Generally five care staff are on duty during the day; the domestic staff assist with meals and drinks. There are two cooks and ancillary kitchen staff. An assistant manager is on duty during the day and on call at night. At night there are 2 waking care staff. Residents were positive about the staff’s kindness and caring qualities. Cornwall Care Ltd has standard corporate recruitment procedures including an equal opportunities policy and procedure. Posts are advertised through the Job Centre and local press. Two people interview applicants and use a recording and rating system. The records for two recently recruited members of staff showed that the required employment checks had been properly completed. Staff records for established staff contained the required documents and Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 20 information. The company issues staff with a statement of terms and conditions of employment. Cornwall Care Ltd provides a structured training programme for staff which covers induction, NVQ and other required training. Staff and the employer sign up to a Contract for Training and Development. Records for recently appointed staff detailed planned inductions to the Skills for Care standard. Staff had individual well maintained training records which showed that staff had completed training in moving and handling, first aid, dementia care, health and safety and other training courses. Staff reported that there had been recent training on equality and diversity. Cornwall Care Ltd ensures that all new staff are registered promptly for their NVQ training. Currently 75 staff have completed their NVQ in care at level 2, with other staff working towards their qualification. The cook has a City and Guilds qualification and an NVQ level 3 qualification, and an intermediate food hygiene certificate. Staff said that access to training was good. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 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 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, 36 and 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an experienced and qualified registered manager who has a clear understanding of her responsibilities. The provider provides a safe system for managing residents’ spending money. The health and safety of residents and staff are promoted and protected. EVIDENCE: The registered manager, Mrs Christine Muxlow, exceeds the experience requirement in caring for older persons and has completed her registered Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 22 manager’s qualification. Mrs Muxlow has attended recent courses to update her knowledge and skills. There are lines of accountability from the manager through the assistant managers, who have identified areas of responsibility. Managers and staff were positive about the support and supervision that they received from the registered manager. Residents had confidence in the registered manager and felt that she would listen to and address any concerns that they might have. The registered manager does not act as agent or appointee for any resident in the collection of benefits. Cornwall Care Ltd has a corporate policy and procedure for the safekeeping of small amounts of residents’ money. The person managing the resident’s finances pays in money for the resident to spend. A standard record for each resident details the payments in and out, and a running balance, with receipts for all expenditures. Each resident’s balance is not held as an individual amount of cash as this would amount to a large sum to retain. The home runs a specific bank account, with a float available for daily transactions. The administrator has systems in place for reconciling the cash held, the bank account balance, and the residents’ individual recorded balances. The registered manager carries out regular checks on these records. Cornwall Care Ltd has obtained the views of residents and their representatives, and other stakeholders through questionnaires. An external organisation has carried out annual quality assurance survey this year and analysed the results. The overall outcomes of the survey for all Cornwall Care Ltd homes are now available to residents and their representatives. The registered manager said that the outcomes for individual homes would be available at a later date. The registered manager felt that the supervision structure with each assistant manager having an identified team of staff contributed to quality assurance. There are regular management team meetings and training days. The manager has found that discussions with small groups of residents are effective in gaining their views. There are regular staff meetings. The handy person carries out regular planned checks of the building and facilities. The records showed that staff receive regular supervision, although one formal supervision record sampled was not completely up to date. Staff reported that informal and formal supervision supported them to do their jobs well and they had confidence in the management. Staff felt that the home provided a high quality of care and they worked well as a team to achieve this. Cornwall Care Ltd has comprehensive policies for health and safety. The preinspection questionnaire detailed required maintenance and safety records. A sample were checked against the original records and found to be accurate. Staff have attended relevant health and safety training. The accident record for residents was inspected. This does not record a high level of incidents. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 23 The environmental health officer visited during the commission inspection to inspect the food hygiene arrangements. The report set no requirements and stated, “High standards continue to be maintained”. The records showed regular tests of the fire alarm system and the emergency lighting. The fire procedure is displayed at strategic points in the home. The home’s fire risk assessment has been completed. There are records of regular fire drills and fire safety training for staff. Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 24 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 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 Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Timescale for action Unless it is impracticable to carry 30/04/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (2) The registered person shall— (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 26 Requirement user’s plan; and (c) notify the service user of any such revision. Care plans and risk assessments must set out in detail the actions which needs to be taken by care staff to meet all aspects of the health, personal and social care needs of service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Risk assessments should be drawn up for all areas of unreasonable risks to residents. This should include the risk of falls and the effects of service users’ behaviour. Risk assessment should record the controls in place and provide staff with specific practical guidance on reducing the risks. The registered person should review the condition of the metal-framed windows and plan for their redecoration. The registered person should review the unsuitability of the current door locks for residents to secure their rooms from inside. The registered person should review the condition of the sterilising sluices and the fitness for purpose of the sluice rooms. 2 3 4 OP19 OP19 OP26 Trewartha House DS0000009134.V315375.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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