Inspection on 18/11/08 for Trewiston Lodge

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Trewiston Lodge 23/01/08

Trewiston Lodge 14/11/06

Trewiston Lodge 31/07/06

Similar services:

The Vicarage

Fairfields Country Rest Home

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5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Trewiston Lodge Trewiston Lodge St Minver Wadebridge Cornwall PL27 6PU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Trewiston Lodge St Minver Trewiston Lodge Wadebridge Cornwall PL27 6PU 01208863488 01208862438 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Tracey Anne Broad Type of registration: Number of places registered: Blakeshields Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 30 people may be accommodated whilst rooms 25 and 26 are used together as bedroom and living room, but room 26 may not be used as a bedroom whilst the fire exit is within the room. The maximum number of service users who can be accommodated is 30. The registered person may provide the following category of service only: Care home providing nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability- Code PD- maximum 30 places Old age, not falling within any other category- Code OPmaximum 30 places Date of last inspection 0 30 Over 65 30 0 Care Homes for Older People Page 4 of 27 Brief description of the care home Trewiston Lodge is a registered care home providing accommodation, personal and nursing care for up to 30 older persons. Service Users who require Terminal Care or have a Physical Disability can also be cared for, in this home. Trewiston Lodge is in North Cornwall between St Minver and Polzeath, situated near the villages of St.Minver Lowlands and Tredrizzick. The home is a large property with a purpose built extension that provides spacious accommodation. There are well-maintained gardens with far reaching countryside views. There is a car park to the rear and emergency parking to the front of the building. Accommodation for service users is provided on the ground and first floor with a stair lift provided to assist service users. The Registered Provider, is Blakeshields Ltd. The home does have a registered manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection at Trewiston Lodge took place on the 18th November 2008. The inspector looked at records, toured the building, and spoke to staff and residents. Where possible evidence was cross-referenced to other sources (e.g. training records supported by staff comments). Observations of care delivery took place during the course of the inspection. The registered manager was not available at this inspection. The home is operating at a current maximum occupancy of 29 residents as the laundry has been relocated, and the new bedroom is not yet ready. Care Homes for Older People Page 6 of 27 The number of requirements and recommendations has reduced since the previous inspection. Overall, outcomes for residents are good, though the home is not always best able to demonstrate this as the care records do not reflect the efforts made, particularly in respect of lifestyle. The range of fees charged is 466-630 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who are thinking about a move to Trewiston Lodge are provided with good information to help inform them about their choice of home. Evidence: The deputy manager confirmed that copies of the Statement of Purpose and Service User Guide (documents that tell a person about the home) are given to prospective and current residents. This also includes the Complaints Procedure. The Statement of Purpose and Service User Guide were last reviewed in 2008. The Statement of Purpose is also displayed in the entrance to the home. The deputy manager confirmed that everyone had a contract and this was supported by the care documentation seen at the time of the inspection. The inspector was advised that the registered manager was addressing the recommendation from the last inspection regarding the frequency of review of fees. Care Homes for Older People Page 10 of 27 Evidence: As part of this inspection we looked at the assessments that were carried out prior to a person moving to Trewiston Lodge. The care documentation of the person most recently admitted to the home showed that a proper pre-admission assessment had take place. The same form is used for assessments following admission and care should be taken to ensure it is clear that the assessment carried out was done preadmission, providing date, place of assessment, and the name of the assessor on the front page. The home does not provide intermediate care, though respite care is offered. Comments received from residents at the time of the inspection, and provided by the quality assurance surveys sent out prior to the inspection were positive, and confirmed that people feel they receive the information they need. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comments received from the people who live at Trewiston Lodge were positive. Surveys sent to the people that live there and their relatives indicated that that people are happy with the service provided and peoples health care needs are well met. Residents are protected by the homes medication procedures. Evidence: The care documentation for residents was seen to include: admission details; property details; care needs assessment; social history; and risk-assessments. Three care plans were inspected, two of which showed evidence of resident/family involvement in the development and review of the care. One was a recent admission and had yet to be reviewed. The care plans are generally well written and informative, but care must be taken to ensure that they include clear direction for staff (e.g. check pressure points regularly - define regularly). This was discussed with the deputy manager. The care plans are written in plain language, are easy to understand and consider all areas of the individuals life including health, personal and social care needs. The care plan also includes a risk assessment. The home ensures that each residents plan is reviewed Care Homes for Older People Page 12 of 27 Evidence: regularly and involves the resident and where agreed their family. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Daily entries made by staff evidence the general health care given. Supporting documentation showed that clients have access to relevant professional health care agencies as needed. All the people that live at Trewiston Lodge are registered with a GP from either of two local surgeries. All the residents have access to support services, such as opticians. The supplying GP surgeries dispense medications for the people living at Trewiston Lodge. We looked at the records relating to the administration of medicines. These were seen to be in order, though care should be taken to ensure two signatures to indicate the hand written entries had been checked as accurate. Medicines are stored securely. There is a comprehensive and appropriate medicines policy and procedure. Clients preferred names are recorded and used. Clients have access to a telephone for private use. Staff were observed to interact with residents in a relaxed, unhurried manner. Residents were complimentary of the care provided and the staff. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents, but this is not reflected in the records. The home has open visiting arrangements and residents know they can entertain their family and friends in their own room. The food in the home meets the dietary needs of residents, but more can be done to facilitate resident choice. Evidence: The homes daily entries do not demonstrate the lifestyle of the residents, entries being predominantly health care focused and, with the occasional exception, tend to be bland statements such as health needs met. There is an activity coordinator with defined hours for this role. The current record of activities follows the same pattern, with statements such as watched video in lounge followed by a list of the residents taking part, rather than individual entries in the relevant persons notes providing more detail of the activity and an indication of whether the person enjoyed or disliked the event, or even if they chose not to participate. Comments received from residents confirm that some do indeed choose not to participate in activities, but more can be done to demonstrate the efforts made to make social activities available to all. Care Homes for Older People Page 14 of 27 Evidence: Rooms are personalised with plenty of evidence of personal possessions being brought in. The home maintains a personal property record to reflect this (care should be taken to ensure these are dated). The visitors book shows that visitors are encouraged, and this was confirmed by the comments of residents and observation of a number of visitors at the time of the inspection. Comments from residents also confirmed that they are free to determine their own lifestyle, within the parameters of their care needs. The menu is under review following the recent appointment of two new cooks. The inspector was advised that a choice is available, but this is not currently made known to residents as has been the practice in the past. There are forms for asking for peoples choice of meal, but these have fallen out of use. The deputy manager did say that these were planned to be reintroduced. Lunch was observed (by the inspector and the deputy manager) to be served with both the main meal and hot pudding brought out at the same time. This means that by the time people have eaten the main meal, the pudding will no longer be hot. The deputy manager did rectify this immediately sending the meals back to the kitchen. Meals are important to the people that live at Trewiston Lodge, and one resident did comment that meals are often cold, and some of the meals were too dry (e.g. baked fish as opposed to fried). Other comments were generally positive, so this may reflect a need to tweak the system for distributing meals effectively, and the need to review and establish a menu again (with the involvement of the people that live there. The kitchen was seen to be clean and orderly, with a cleaning schedule in place. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Trewiston Lodge are confident that their concerns will be listened to and acted upon. The people that live at Trewiston Lodge are protected from abuse by appropriate procedures, though more can be done in respect of staff training. Evidence: There is a complaints procedure displayed in the entrance to the home. A copy of the complaints procedure is available in the Service User Guide and Statement of Purpose. Neither the Commission nor the home have received any complaints since the last inspection. Two visitors to the home at the time of the inspection said they would feel able to voice any concerns if they had any. One of the responsibilities a care home has is to protect people from abuse, and the Commission expect homes to be proactive in this matter. There is a comprehensive safeguarding procedure, including a flow-chart of the procedure to follow, and a copy of the local multi-agency policy available. Currently only one staff member has received safeguarding training in 2008. This was discussed with the deputy manager who believed the record of staff training may not be completely up to date. The importance of a commitment to this training was emphasised. The home adheres to a robust employement procedure, including Criminal records Bureau checks to safeguard residents. Three staff have received training in the Mental Capacity Act. Care Homes for Older People Page 16 of 27 Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Trewiston Lodge benefit from accommodation that is appropriate to their needs. The home is currently operating at a maximum occupancy of 29. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The accommodation is clean and odour free. Evidence: We looked around the home with the deputy manager, and the rooms seen were all clean and in good order. There were no unpleasant odours. Some of the people had brought items of their own in to decorate their rooms. All of the rooms are of sufficient size. All of the bedrooms have an en-suite toilet and hand basin. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The televisions provided in communal areas use internal arials and the variable picture quality provided was noted. The deputy manager said that this was recognised as an issue and the matter was already in hand to rectify this. There are three lounges, two adjacent to each other and one less used on the opposite side of the building. The deputy manager said that there were tentative plans to provide a first floor lounge. Care Homes for Older People Page 18 of 27 Evidence: There are two communal toilets on the ground floor, though one is currently designated for staff use only. The home has an infection control policy, with gloves, aprons and alcohol solution available thoughout the home. The kitchen and laundry areas are well equipped and were seen to be clean and organised. The latter would benefit from liquid soap and paper towels (the sink was seen to be obstructed at the time of the inspection). The laundry is situated at the rear of the premises and can only be accessed by going outside. The sluice room was seen to be cluttered with equipment on the floor obstructing access, and the shelving used for vases. The home does employ a maintenance person. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff on duty at the time of the inspection were sufficient to meet the health care needs of the residents, though a review of staffing levels would be of benefit. Residents have confidence in the staff that care for them. The recruitment procedures are robust to safeguard residents. Training is facilitated, though there is room for improvement. Evidence: At the time of the inspection there were 26 people living at Trewiston Lodge, with the deputy manager, and five care staff on duty. Staff shifts are generally as follows: (am) 1 nurse 5 care staff; (pm) 1 nurse 3 care staff; (nocte) 1 nurse 2 care staff. These are supported by additional staff such as kitchen staff, and a floating staff member who has general duties such as collecting up after meals, laundry, etc. Comments from the deputy manager, staff, and residents at the time of the inspection support the documentation in the assertion that there are sufficient staff for the care needs of the residents. However, four of eight staff surveys received expressed the view that the home was short staffed, the remaining four making no comment. One resident commented staff could answer the bell quicker. New staff are undertaking the National Training Organisation induction to care. Care Homes for Older People Page 20 of 27 Evidence: Information provided by the Home showed that only four care staff (approximately 25 ) have a National Vocational Qualification Level II or above. The deputy manager was able to produce a print out of training under a variety of subjects, such as manual handling, which identifies where further training is needed. The deputy manager was aware of the need to continue with staff training opportunities in areas relevant to the jobs they do (such as NVQ and safeguarding). Examination of personnel files showed that the home is adhering to a robust employment procedure, including Criminal records Bureau checks, and the taking up of relevant references. When we looked around the home people were up, dressed appropriately, and there was no evidence of a lack of care. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the required qualifications, and experience, and is competent to run the home. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. The home has access to professional business and financial advice and has all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. Residents are provided with facilities to keep their valuables and money safe. Evidence: The registered manager is a nurse and is also working towards the Registered Managers Award. The registered manager was not available at this inspection, though the deputy manager was. The deputy manager and staff commented that the registered manager was approachable and supportive. Quality Assurance forms have been sent out to find out about peoples views about the service, and also to stakeholders, such as doctors. A number have been returned, and Care Homes for Older People Page 22 of 27 Evidence: the registered manager has analysed the feedback and produced a summary of the findings. The summary provides a mathematical breakdown of the responses, but does not indicate the questions asked so it is not possible to put the responses into context, thereby making the report more meaningful. Small amounts of residents money are held securely at the home at the request of the individual, but the home has no involvement in the management of residents finances. Staff files supported the deputy managers statement that staff supervision had commenced since the last inspection, though this is not occuring at the frequency specified in the national minimum standards. Records relating to the safety of the residents, staff, and building were inspected and seen to be in order (e.g. electrical testing, fire system maintenance, gas safety certificate). There is sufficient insurance cover in place. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 36 18(2) The registered provider must 01/05/2008 ensure that all staff receive regular and frequent recorded supervision at least 6-times a year. Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The registered manager should ensure that each residents Statement of Terms and Conditions includes the frequency of review of fees. The registered manager should ensure the care plans specify the intervention required rather than generic phrases such as regularly. The registered manager should encourage daily entries in the care notes that reflect the lifestyle of the people that live there, as well as participation (or not) in any activities arranged. The registered manager should re-establish a menu that includes resident views, and the practice of offering a daily choice. The registered manager should review the system for distribution of meals to ensure they are received at the correct temperature. The registered manager should promote the homes commitment to safeguarding adults by continuing to facilitate staff training in this. The registered manager should ensure that use of the sluice is unhindered, and appropriate storage is provided. The registered manager should risk-assess the access to the laundry by night staff (e.g. lighting). 2 7 3 12 4 15 5 18 6 26 Care Homes for Older People Page 25 of 27 The registered manager should ensure that there are handwashing facilities in the laundry room. 7 8 27 28 The registered manager should review staffing levels in view of the comments received from staff. The registered manager should do more to promote and encourage NVQ training. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!