Inspection on 23/01/08 for Trewiston Lodge

This inspection was carried out on 23rd January 2008.

CSCI found this care home to be providing an Adequate 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 18/11/08

Trewiston Lodge 14/11/06

Trewiston Lodge 31/07/06

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Trewiston Lodge Trewiston Lodge St Minver Wadebridge Cornwall PL27 6PU Lead Inspector Alan Pitts Unannounced Inspection 22nd January 2008 10:00 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 Trewiston Lodge DS0000065637.V345371.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. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trewiston Lodge Address Trewiston Lodge St Minver Wadebridge Cornwall PL27 6PU 01208 863488 01208 862438 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) Blakeshields Limited vacant post Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30) of places Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 OP- maximum 30 places The maximum number of service users who can be accommodated is 30. 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. 14th November 2006 2. 3. Date of last inspection Brief Description of the Service: Trewiston Lodge is a registered care home providing accommodation, personal and nursing care for up to 23 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 large 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 not have a registered manager at the moment. The range of fees charged is £293.25 - £600.00 Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place on Wednesday 23rd January 2008 over a period of approximately 5 hours. Two inspectors carried out the inspection: Mr Alan Pitts and Mr Mike Dennis. Mrs Tracey Broad, who has submitted application to be the registered manager, was available throughout the inspection. The inspectors met and talked with residents and staff, toured the premises, observed staff delivering care, and inspected documentation. Overall, the operation of this home has improved and the inspectors were encouraged by what they found. Attention to the outstanding requirements should see the home rise in quality ratings. What the service does well: What has improved since the last inspection? What they could do better: The registered provider must ensure that the home is able to meet the needs of prospective residents prior to admission. Improvements can be made to the home’s recording systems. The home could do more to ensure the safe administration of medicines. More can be done to ensure staff’s understanding of the adult protection process. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Trewiston Lodge DS0000065637.V345371.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 Trewiston Lodge DS0000065637.V345371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of prospective residents are assessed as to their care needs prior to admission. The home does not provide intermediate care. EVIDENCE: There is a current Statement of Purpose, and each resident has a written contract or Statement of terms and Conditions, though this does not include the frequency of review of fees. The records of four recent admissions to the home were inspected. One residents’ file did contain a pre-admission assessment, though the resident said they had not seen anyone from the home prior to admission. The manager confirmed that the form had been completed on admission to the home. The Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 9 assessments would benefit from more detailed recording of the information obtained. The home does not provide intermediate care. Trewiston Lodge DS0000065637.V345371.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The delivery of care to promote the health and well being of residents is handled well, as demonstrated by the comments of the residents. Residents were unanimous in saying that staff were kind, respectful and attentive. Systems for medication recording are in place, but improvements are possible. EVIDENCE: The care documentation for 4 residents was inspected. All had a care plan in place, which were informative and clear. There was evidence of regular review, but little evidence of the involvement of the resident or their representative in this process and there is room for improvement in recording change when care plans are reviewed. Some forms intended for use are not completed. There is a separate wound care plan where necessary. There are a number of forms in use for recording care: communication book, two files for each resident, loose sheets of paper. Discussion took place regarding how assessments should inform care plans and daily records reflect Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 11 the care delivered as directed in the care plan. The information required is generally available, but thought needs to be given as to the best way to organise this in one easily accessible place. The residents are registered with local medical practitioners. The care documentation shows that residents have access to specialist health care professionals as necessary. One resident confirmed that hospital appointments were arranged as necessary. Medicine Administration Records were seen to be in order with two staff initials indicating the accuracy of the handwritten entries. There is a medicines procedure. Medicines are stored securely. Medicines are not administered properly. The ‘toolbox’ intended for use for upstairs residents is not used as it is too heavy. Staff ‘pot up’, putting the medicines in a plastic container rather than use the ‘toolbox’. There is a large amount of medicines for return in a black plastic bag, as opposed to the proper containers. The manager assured the inspectors that there was a contract in place for the disposal of medicines. The controlled drug book is inaccurate and care needs to be taken. Residents were unanimous in their positive comments about the care provided at Trewiston Lodge. All said that their privacy and rights were respected. Residents were complimentary about the staff, their kindness, and how hard they work. The inspectors did notice information that related to individual residents in public areas, and this was discussed with the manager (elect) with a view to it being removed in order to protect residents’ dignity. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is evidence of frequent and regular visitors for residents, and there is an improvement in the supporting evidence for the lifestyle of residents. The diet is wholesome, and appealing, and residents confirmed that they are able to choose from the menu. EVIDENCE: Whilst residents were complimentary about the home and the lifestyle afforded them, there is still room for improvement in the care documentation for the recording of the lifestyle of the residents and any recreational/social options available to them. Entries in the activity book vary with collective statements such as “one to one time with residents”, rather than briefly describing how the time was spent with the named resident in their individual care record. Entries in the residents individual daily notes can still be improved in this respect, and would better comply with other legislation such as data protection. One carer’s job description includes specified time as an activities coordinator. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 13 The visitor’s book and the care documentation show that there are regular and frequent visitors to the home and its residents. Residents confirmed that relatives and friends can and do visit at will, and that they are free to decide for themselves who they see. Residents’ rooms were seen to contain personal possessions. All the residents manage their own finances, or have representatives do so for them. All but one of the residents were complimentary about the quality of food provided, and all said that they now get a choice at meals. There is a two-week rotating menu. The menu for the day was on display at the home. The cook confirmed that residents are given a choice, and a record of food provided is kept. The kitchen was seen to be clean and well ordered, though there is only a small amount of storage space for foodstuffs. There is now a telephone and an emergency bell in the kitchen. There is a partially covered walkway from the kitchen to the serving area in the main building, though rain can still encroach on one side. There is still a small lip to negotiate and this is substantial enough to have caused damage to one of the wheels on the hot trolley. There is no risk-assessment of the potential risks posed to staff, though this has been identified at the previous inspection as needed. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were confident that they would be able to raise any concerns they may have with the staff. There is a complaints and adult protection policy in place. EVIDENCE: Residents were confident that they would be able to raise any concerns they may have with the staff, and the home’s complaints policy is on display. The complaints policy includes contact details for the local Commission for Social Care Inspection office, but still needs to include the contact details for the local Adult Social Care office. Whilst there is an adult protection policy, the information provided is unclear and does not specify the lead authority being the local Adult Social Care office, and this was reflected in the comments of a staff member asked about the process. The adult protection policy and procedure should provide clear instruction, with relevant contact details. This matter was raised at two previous inspections. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are generally safe, well maintained, clean, and pleasant. EVIDENCE: The accommodation provided was seen to be pleasant, personalised to varying degrees, and comfortable. Residents said that they were pleased with their bedrooms. Communal space was seen to be similarly comfortable and pleasant. Comments have been made earlier in this report in respect of the kitchen facility. The laundry is small, but functional. The floor in the laundry was cluttered with baskets, and bags of laundry. Access to the washing machine was hindered by two baskets on the floor, presenting a potential risk to laundry users. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 16 The home was seen to be generally well maintained, including fire-fighting equipment. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were complimentary about the care received. There is a record of ongoing training and development. Residents are protected by the home’s recruitment practices. EVIDENCE: At the time of the inspection there were 30 residents living at Trewiston Lodge. There was 1 nurse and 6 carers on duty. Staff were observed to be busy attending to the residents throughout the inspection. Residents were complimentary about the care received. Staff shifts are generally: 7am-2pm; 2pm-9pm; nocte. There is a stable staff team and the home has not made use of agency staff in recent months. The duty rota indicates the role of the staff on duty. Certificates were seen in staff training files, and the manager (elect) maintains a training matrix in order to monitor training needs. There are 19 care staff, seven of which have achieved NVQ Level 2 or above. There are a further eight staff undertaking NVQ training. New staff are undertaking an National Training Organisation compliant induction programme, though there is a need to ensure that the individual steps in the process are signed off and dated. The personnel files inspected showed that the home is adhering to a robust employment procedure, which protects the residents. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not yet have a registered manager. A full professional Quality Audit Survey has not yet been completed. Residents financial interests are safeguarded. Some supervision is occurring, but this is not regular and frequent. The health, safety, and welfare of staff and residents could be better protected and promoted. EVIDENCE: The home does not have a registered manager, and has not done so since July of 2006. The manager (elect) said that her application to be the registered manager would be submitted to the Commission for Social Care Inspection within the week. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 19 A quality assurance questionnaire has been distributed to 18 of the 30 residents, and the manager (elect) assured the inspectors that the remainder would receive one too. Responses have started to arrive. A questionnaire has been devised for staff and other professionals, but this is yet to be sent out. Discussion took place regarding analysis of the results and publishing a summary of the findings. The inspectors were advised that the home does not handle any money for residents. There is some documented evidence of staff supervision, though there was some confusion about supervision and training. Supervision is not occurring at least 6-times a year for all staff, and it is not being properly recorded as such. The home’s policies and procedures are in the process of being updated. The following were seen to be in order: • Accident Records • Fire training, drills and equipment checks • Employers’ Liability Insurance • Equipment maintenance (e.g. hoists) The home could not produce a current gas safety certificate at the time of the inspection, the one seen expiring in November 2006. The manager (elect) is requested to forward a copy of a current certificate. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 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 3 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 1 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 2 X 3 X 3 X X X Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8, 9 Requirement Timescale for action 01/04/08 2. OP3 14 3. OP9 13(2) The registered provider must appoint a manager, making application to the Commission for Social Care Inspection for the applicant to be the registered manager. This requirement was identified at the two previous inspections. The registered provider must 01/02/08 ensure that all prospective residents are fully assessed as to their care needs and the home’s ability to meet those needs prior to admission, and that sufficient information is provided. This requirement was identified at the two previous inspections. 01/02/08 The registered provider must ensure that staff adhere to pharmaceutical guidelines and a safe system for medicine administration. 4. OP18 13(6) The registered provider must ensure that staff have the tools necessary in order to adhere to a safe system of medicine administration. The registered provider must 01/03/08 DS0000065637.V345371.R01.S.doc Version 5.2 Page 22 Trewiston Lodge 5. OP36 18(2) ensure there is a clear adult protection procedure and that staff understand the process. The registered provider must ensure that all staff receive regular and frequent recorded supervision at least 6-times a year. 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP2 OP12 OP26 Good Practice Recommendations The registered provider should ensure that each residents’ Statement of terms and Conditions includes the frequency of review of fees. The registered provider should ensure that the quality of life of the resident is recorded as much as the nursing care provided, and the system for recording is reviewed. The registered provider should risk-assess the laundry facility to ensure it is sufficient to cope with the demands on it, provides sufficient storage for dirty and clean laundry, and minimises any risk to staff. Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © 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 Trewiston Lodge DS0000065637.V345371.R01.S.doc Version 5.2 Page 24 - 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. 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