CARE HOMES FOR OLDER PEOPLE
Trewartha House Trewartha Estate Carbis Bay St Ives Cornwall TR26 2TQ Lead Inspector
Lynda Kirtland Announced Inspection 18th November 2005 09:30 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.V258492.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. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 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.V258492.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 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 18th May 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 selfcontained 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 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 residents. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Trewartha House Residential Home on the 18 November 2005 and spent 6 hours at the home. This was an announced visit. A previous inspection occurred on the 18 May 2005 at which time no statutory requirements or recommendations were identified. In this visit the inspector focused on the following key areas of care: choice of home, care planning, health care, leisure, complaints, staffing and management areas. On the day of inspection 37 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, staff and the registered manager to gain their views on the services that Trewartha House offer. The registered manager also completed the pre inspection questionnaire, which is similar to a survey asking for information on what services/facilities the home provide. Trewartha House records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
Residents stated that Trewartha house provides ‘good care and accommodation’ and commented ‘they can’t do better’. They made various comments about staff such as; they are ‘kind’ and ‘caring’. All residents commented that they felt that they were consulted about their care needs which staff met. Residents commented that they have access to health care and felt that all their health needs were met to a ‘good’ standard. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. These were observed during the inspection. Residents felt their visitors were welcomed to the home. Residents and staff stated that if there were any issues they felt able to approach the registered manager directly and that their ideas would be listened to and where appropriate acted on. Trewartha House has a stable staff team that allows staff and residents to get to know each other well and provide consistent care to residents. Residents were complimentary about staff skill and attitude. Residents and staff commented that there are sufficient staffing levels on duty. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 6 Staff supervision occurs on a regular bases. Cornwall Care prioritises staff training and is keen to continue to develop staff skills. Staff were complimentary about the training they receive and support form the management team. This inspection was positive and the inspector would comment that Cornwall Care Ltd is an organisation that wants to achieve a high standard of care to all its service users and provide appropriate training and support to its staff group. What has improved since the last inspection?
Trewartha House continually invest in the environmental aspects of the home, so that a continual redecoration and refurbishment of the home is ongoing. Maintenance of equipment is updated and monitored to a good standard. The level of staffing in the home has increased. One of the consequences of this is that the level of activities has also increased, particularly the availability to go on weekly trips. A recent fete raised funds, which will be used for residents Christmas presnts, and the remaining amount will go towards redesigning the second part of their garden area. Trewartha House have implemented 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. Feedback from residents was that they found the experience to be positive. Residents were ‘very satisfied’ with the quality and provision of food. Observation of lunch was seen to be unrushed social occasions with choices of main meal and deserts from the menu. 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. The level of staff achieving NVQ level 2 and above has also increased. 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 is keen to develop an interactive programme, which can be shown to the public to confirm what facilities the home has to offer. Cornwall Care Ltd is continuously looking at how to develop the service they provide further. They have been changes to Cornwall Care ltd management team and the registered manager felt that this has influenced positive changes within the organisation. For example an up to date computer system will be installed in all Cornwall Care homes in the near future.
Trewartha House DS0000009134.V258492.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. Trewartha House DS0000009134.V258492.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 Trewartha House DS0000009134.V258492.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): 3,4,5 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. Staff are experienced and competent to meet resident’s needs. EVIDENCE: From discussion with residents, 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 residents 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.
Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 10 From records inspected and in discussion with residents 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 their care needs were identified accurately. From observations of staff, plus inspection of forthcoming training programme and records it was evident that the staff team are experienced in the area of older peoples care and receive training to update their knowledge in this area. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to residents. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 11 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): 7,8,10, Residents 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 residents, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of residents files, and in discussions it is evident that Trewartha House encourage them to express their views in the formation of their care plans. The care plans are detailed documents, which clearly identify resident’s 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 involved in the care planning and reviewing stages of the individuals care plan. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 12 Residents 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 accident book was inspected which demonstrated that all falls/ incidents are monitored in the home and appropriate individual risk assessments to minimise further falls are undertaken. The home also has access to relevant lifting and moving equipment that is regularly maintained. All resdients spoken with gave examples of how staff display a high standard of respect in their daily interactions. Residents 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 interacting with residents in a professional manner at all times, alongside a sense of humour when appropriate. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 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): 12,13,15 Trewartha House provide a programme of activities to promote and encourage the pursuit of residents social, educational and leisure needs. Flexible visiting arrangements are in place and visitors are welcomed at the home. A varied and nutritious diet is provided to all residents in a relaxing atmosphere. EVIDENCE: From discussions with residents they commented that there is ‘enough to do’ during the day. The inspector noted on the day of inspection a variety of activities taking place; socialising in lounges, drama therapy, music, hair dressing, a variety of newspapers available and craft work. Activities are advertised around the home so that residents can choose whether to participate. Other activities on offer are exercises, monthly communion, games, and talking books to name a few. Individual interests are recorded in resident’s pre admission information and their ‘life story book’. The registered manager stated that due to the increase in staffing hours this has provided more opportunities for weekly outings, which have been received positively. There is a flexible visiting policy and residents determine where they meet with their guests. Residents felt their visitors were welcomed to the home positively and could not think of improvements in this area.
Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 14 Residents made positive comments to the inspector in the variety and quality of food provided. Some made comments such as ‘the food is excellent’ and commented on the amount of choice. It was observed that the menu for the day was on display. They can also choose where to have their meals, either in their room or in the dining area. The dining area was observed to be a relaxed and social occasion. Cornwall Care Ltd has implemented the ‘appetite for life project’, which ensures that a varied and appealing diet is provided to residents in a relaxed atmosphere. From observations it was noted that staff verbally gave residents a choice of the main meal on offer, which is then served up and provided along with their choice of liquid refreshments. There was variety of two main meals, plus salads, and a choice of deserts. In discussion with the catering staff they felt the food project had gone well. More hours in the kitchen had been allocated to enable this new system to work efficiently plus updating some of the kitchen equipment. Training to catering staff has been provided to increase their knowledge of dietary needs. Staff commented that they felt the residents are enjoying their meals in a more pleasant environment. In the last six months an Environmental Health Inspection occurred and did not raise any issues of concern. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 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): 16,18 Trewartha House has an appropriate complaints and whistle blowing policy. Residents, their representatives and staff are confident to raise any concerns. The corporate adult protection procedure needs amending to clarify the process of investigating allegations of abuse. EVIDENCE: Cornwall Care Ltd has completed corporate policies in respect of the complaints procedures. Trewartha House and CSCI have not received any complaints about the home. From the inspectors discussions with residents all stated that they had no concerns about the care or facilities that were provided by the home. Staff likewise commented they had no current concerns. All felt able to approach the management team if they had any concerns. CSCI have met with Cornwall Care Ltd management team to discuss reviewing the adult protection policy and procedure, which they are in the process of doing. Therefore a recommendation to this effect has been made and this was not inspected further. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 16 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): EVIDENCE: This standard was inspected in detail at the previous inspection and was viewed to offer a safe and comfortable home to all who live, visit or work at the home. From a tour on this occasion this was seen to continue and it was noted that a refurbishment and maintenance programme is ongoing. Trewartha House DS0000009134.V258492.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 Suitable trained and experienced staff are employed in sufficient numbers at all times to meet residents care needs. Cornwall Care Ltd ensures that staff have access to ensure staff are trained to undertake their work. EVIDENCE: Residents and staff all commented that they felt there were sufficient staffing levels on duty at all times. The registered manager stated that the home has not needed to employ agency workers for two years and there are no staff vacancies. Residents were satisfied with the level of staffing in the home and all were complimentary about the care and approach they receive from the staff team. The inspector observed staffs that were competent in their work. Approximately eighty percent of staff has achieved a minimum of NVQ level 2 or above. Some staff is in the process of obtaining their NVQ level 2. Thirteen 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 Staff files were inspected at the previous inspection and met the requirements of the national minimum standards. As the home has not needed to employ staff since that time this was not re-inspected. The registered manager stated that all staff has relevant POVA/CRB clearance.
Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 18 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): 31,32,33,34,35,36,37,38 The registered manager is competent in her role to manage the home. The management approach creates an open, positive and inclusive atmosphere for residents and staff. Financial accounts are maintained to ensure viability of the home. The process of administering resident’s monies is robust. Satisfactory arrangements are in place to provide a safe environment for all who live, visit or work at the home EVIDENCE: The registered manager has experience in social care setting and has gained the Registered Managers Award. She has undertaken relevant training to update her knowledge in the area of older persons care. The staff team and residents spoke positively regarding the accessibility of the manager to voice any ideas as to how to improve/change the service. Some comments made Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 19 were that she is a ‘good leader’ and a ‘good listener both on work and personal issues’. Staff stated that they meet with the management team approximately bi monthly. Staff felt that these meetings were beneficial. When appropriate residents are approached individually to gain their views on the services that Trewartha House provide. The registered manager has completed a quality assurance survey with residents, and relatives, and stakeholders. The results saw an increase in overall satisfaction (now at 88.75 ) with the care provided from the previous year. Cornwall care Ltd is a not for profit charity and accounts are maintained at Cornwall care Headquarters. The registered manager stated that the home is financially viable and has relevant insurance in place. Cornwall care Ltd have cooperate policies in the management of service users monies. Residents or their representatives are encouraged to hold individual bank accounts for their use. However they can sign an agreement to request that Cornwall care assist them in the management of a small amount of their monies. From inspection of service users monies records were accurate and tallied. The inspector recommended that an inventory be kept in respect of the contents of the safe so that all personal belongings are accounted for. This will assist in identifying belongings for individuals and for insurance purposes. The administrator agreed to action this. The registered manager, confirmed by discussion with some staff stated that all staff receives at least six supervision sessions per year. Records held by the home are stored in a are in line with the Data protection Act. team, they acknowledged that there is recorded in the senior hand over book Protection Act guidance. confidential manner and in the main In discussion with the management a need to monitor the information to ensure that it adheres to Data Trewartha House undertakes regular health and safety checks in the home i.e. fire drills, Legionella, emergency lighting, training of staff in the areas of COSHH, moving and handling and first aid. In addition inspections from other authorities occur and no issues have arisen from these inspections Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 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. 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 21 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. 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 2 Refer to Standard OP18 OP35 Good Practice Recommendations The adult protection policy should be expanded to include a timetable of initiating an adult protection referral and explain what procedure should be followed. The registerd manager should ensure that a inventory of service users belongings being stored by the home is kept. Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Trewartha House DS0000009134.V258492.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
