CARE HOMES FOR OLDER PEOPLE
Trewartha House Trewartha Estate Carbis Bay St Ives Cornwall TR26 2TQ Lead Inspector
Lynda Kirtland Unannounced 18 May 2005 11.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 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 Chrstine 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 D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 40 adults aged over 65 with dementia (DE(E)) Service users to include up to 40 adults aged over 65 with a mental illness (DE(E)) Total number of service users not to exceed a maximum of 40 Date of last inspection 3 February 2005 Brief Description of the Service: Trewartha House is one of eighteen homes owned by Cornwall Care Ltd. It is registered to accommodate forty older people with dementia. It provides a service to those in need of personal care and who are over retirement age. Admissions are on a planned bases and emergency admissions are avoided whenever possible. Other services that Trewartha House provides are a designated space for one intermediate care placement and day care facility for up to three service users per week. The registered manager is also responsible for supervising the domically care services from Trewartha House.Trewartha House is a single storey dwelling. It is built on a cross principal with four wings radiating out from a central communal area. Each wing is a self-contained unit with bedrooms, dining, lounge, toilets and bathroom facilities. The central communal area leads out to a landscaped sensory garden with a patio area, seating and a wooden summerhouse. The garden area is secure.The majority of service users bedrooms are for single occupancy. There are four shared bedrooms in total. Trewartha House is fully accessible for service users who have mobility difficulties or use a wheelchair.The home is close to the community facilities in the immediate area and only a short distance from St Ives town. Trewartha house has developed positive relationships with local agencies such as the Alzheimer Society, and research and training in Dementia care to strive to continue providing a high quality service to its service users. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Trewartha House on the 18 May 2005 and spent the day at the home. This was an unannounced visit. On the day of inspection 31 service users were resident in Trewartha House. The inspector met with 16 service users and a representative, a number of staff and the registered manager to gain their views on the service that Trewartha House provide. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well: What has improved since the last inspection?
Trewartha House have a stable management and staff team, which have allowed the day-to-day operations of the home to be run in a consistent manner. All service users felt that they knew staff well and that this assisted them in their care. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 6 The registered manager is keen to continue to develop and share information on the service that the home provides. She is currently attending a computer course and wants to develop an interactive programme, which can be shown to the public to confirm what facilities the home has to offer. The last inspection identified three recommendations in respect of minor alterations to environmental factors. These have been complied with. Cornwall Care Ltd is continuously looking at how to develop the service they provide further. Future training in the areas of care planning is in process. Trewartha House has piloted the ‘food project’. The aim of this project is to provide high quality nutritious food in an attractive manner and to encourage service users to maintain their self-caring skills. From discussion with service users and staff this was viewed to be a positive social experience for service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 standard(s) 3,5 Prior to admission, service users and their representatives participate in a pre admission assessment with members from the management team to identify individual care needs. Trewartha House provide a planned trail period of stay at the home. Emergency admissions are avoided wherever possible EVIDENCE: From discussion with service users and their representatives, plus inspection of two service users files it was evident that they are consulted in Trewartha House pre admission assessment. Care needs identified by the referring professional assessments were incorporated in the assessment process and transferred to care plans This assessment is detailed and identifies the service users individual physical, emotional, social, educational and leisure needs and how the home would aim to address them. A months trail period is offered to all new service users after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. From records inspected and in discussion with service users they commented that the preadmission and ‘moving in period’ are carried out sensitively by staff and could not see how this process could be improved. They also stated that
Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 9 this was undertaken with their participation and that their care needs were identified accurately. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to service users. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 standard(s) 7,8,9,10, Service users and their representatives are consulted in the implementation and subsequent reviews of their individual care plans. Care plans ensure that physical, emotional, social, educational and leisure pursuits are assessed and action to address the care needs are detailed for all staff to meet in a consistent manner. Health care needs are met to a good standard. Service users are treated with dignity and privacy at all times. EVIDENCE: From discussion with service users, their representatives, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of service users files, and in discussions it is evident that Trewartha House encourage service users and their representatives to express their views in the formation of their care plans. The care plans are detailed documents, which clearly identify service users skills and where assistance is needed. From this the care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. Staff confirmed that they are more involved in the care planning and reviewing stages of the individuals care plan. The registered manager confirmed
Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 11 corporate training is occurring in the development of care planning process, which will be cascaded to all staff. Service users commented that health needs are met by the staff at the home and by external professionals to a high standard. Detailed records of all health professional visits to individual service users further evidenced this. The inspector observed a medication round. A competent member of staff who was aware of the homes medication policy plus the Royal Pharmaceutical Guidance undertook this. All requirements to ensure that medication is stored, administered and disposed of correctly were evidenced to have occurred. The home has a positive relationship with the pharmacist and can contact her for advice if needed. All staff that administers medications attends an annual course in this area. All service users spoken with gave examples of how staff display a high standard of respect in their daily interactions. Service users commented that staffs ensure that their privacy and dignity is maintained and could not see how this area of care could be improved. In addition the inspector observed staff communicating with service users in a professional manner at all times. Cornwall Care Ltd has relevant policies on this area of care, which are incorporated, in staff’s induction process as well as through NVQ training. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 standard(s) 12,13,14 Service users social, educational and leisure needs are identified and Trewartha House aim to provide a variety of activities in the home. Service users visitors are encouraged to visit their relative. Service users are encouraged to retain links with the local community. EVIDENCE: From discussions with service users the majority commented that there is ‘enough to do’ during the day. A poster was on display with the week’s activities that included outings, sing-a-long, craftwork, drama and party night. The registered manager has also set up a ‘coffee area’ and a table for newspapers/ magazines, which is being used by some of the service users. Cornwall Care Ltd corporate policies and documentation demonstrate that they aim to encourage service users to pursue their hobbies and interests. Individual interests are recorded in service user care plans and their ‘life story book’. Service users have opportunities to access advocates and some choose to have relatives act on their behalf. Relatives and service users stated that the home is welcoming to them. Service users made positive comments to the inspector in the variety and quality of food provided. It was evident from discussions with service users,
Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 13 the representative and staff that there is a choice of main meal and that alternative meals will be provided. Kitchen staffs were aware of individual dietary needs. Cornwall Care ltd has implemented the ‘Food Project’. This has focused on the nutritional and social aspects of food. It’s aim is to provide a service users focused meal provision encouraging meal times to be social occasions whilst allowing service users the opportunity to maintain their own independence and skills i.e. encouraging self serving of food, menu cards to be introduced and to improve the presentation of meals. As this has been implemented recently this will be inspected on the next visit. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 standard(s) 16 Cornwall care Ltd has a corporate complaints and whistle blowing policy. The complaint policy is on display and the management team encourage service users and their representatives and staff to voice any concerns so that they can be addressed EVIDENCE: Cornwall Care Ltd has completed policies in respect of the complaints procedures. Trewartha House and CSCI have not received any complaints about the home. From the inspectors discussions with staff and service users and their representatives all stated that they had no concerns and that if they had they felt able to approach the management team for these to be addressed. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 standard(s) 19,20,21,22,23,24,25,26 Trewartha House provide a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. EVIDENCE: The home is well maintained. The home caters for service users with mobility difficulties and all parts within the home are accessible to service users. The home is a secure unit and has access to a secure sensory garden area. The communal areas are comfortable furnished and decorated to a good standard. Service users stated that they enjoyed these areas and that they could choose which lounge to spend time in, this was the same for the dining areas. All the bathroom facilities were inspected and some had a variety of aids and adaptations e.g. hoists, grab rails. Referrals are made to an occupational therapist when a service user needs have changed and an assessment of ability is needed. The bathroom facilities were decorated to a good standard and all were clean.
Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 16 Service users accommodation was inspected. With the exception of fours room, the rooms are for single occupancy and some had en suite facilities. All rooms were decorated to a good standard, were personalised and service users stated they were ‘happy’ with their accommodation and facilities. Communal corridors were being redecorated along with some rooms during the inspection. Previous recommendations in respect of the environmental standards have been complied with: the manager ahs reviewed the availability of electrical sockets in service users rooms, beds have been replaced and windows in the lounge areas are satisfactory. The registered manager stated that it is hoped that in the future windows in service users rooms will be replaced. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Trewartha House ensure that suitable trained staffs are employed in sufficient numbers at all times. EVIDENCE: On the day of inspection five care staff, plus domestics, handyperson, kitchen staffs, laundress, administrator and managers were on duty. Staffing ratio during waking hours is aimed to be 1:6. At night there are two waking night staff plus a manager sleeping in who is on call. The registered manager stated that the home has not needed to employ agency workers. The registered manager stated that there are no staff vacancies. Service users and their representatives were all complimentary about the care and approach they receive from the staff team. From discussion with staff they all commented that they felt that there is sufficient staff on duty and that they ‘work as a team’. The inspector observed staffs that were competent in their work. Cornwall Care Ltd ensures that staff gains NVQ certificates and the majority of staff hold a NVQ qualification. Some staff has completed first aid training. Cornwall Care Ltd prioritises staff training and from discussion with staff and inspection of staff files this demonstrated a commitment to staff updating their training. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 18 From inspection of staff files they evidenced that appropriate employment checks have been completed. Cornwall Care Ltd has detailed recruitment policies. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: This section was not inspected. Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 x x x x x x x x x x Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 Good Practice Recommendations Trewartha House D52-D04 S9134 Trewartha House V215917 180505 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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
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