Inspection on 21/11/06 for Trezela

This inspection was carried out on 21st November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Trezela 28/10/08

Trezela 07/02/06

Trezela 06/10/05

Trezela 01/03/05

Trezela 23/11/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 Trezela 23 Egloshayle Road Wadebridge Cornwall PL27 6AD Lead Inspector Elaine Bruce Key Unannounced Inspection 21st November 2006 09:10 Trezela DS0000009241.V313471.R01.S.doc Version 5.2 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 Trezela DS0000009241.V313471.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 Adults 18-65. 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. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trezela Address 23 Egloshayle Road Wadebridge Cornwall PL27 6AD 01208 813756 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) Mrs Janet Brewer Mrs Patricia Lang Care Home 8 Category(ies) of Learning disability (8), Mental disorder, registration, with number excluding learning disability or dementia (8) of places Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 8 adults with a mental illness (MD) up to the age 65 years on admission. Service users to include up to 8 adults with a learning disability (LD) up to the age of 65 years on admission. Total number of service users not to exceed 8 Date of last inspection 7th February 2006 Brief Description of the Service: Trezela House provides care for up to eight people with mental health needs. Although the certificate of registration indicates that service users with a learning disability can be accommodated this is not the case at this time. The premises are a large, two storey detached house in central Wadebridge overlooking the River Camel and playing fields. On the ground floor there is a dining room, sitting room, conservatory, two separate WC’s and a staff room/sleeping in room with an adjacent WC. On the first floor there are five single bedrooms, one shared bedroom, a bathroom and a shower room. There is no lift or stair lift. The home is not suitable for a service user with a physical disability. Suitably qualified staff provide personal care. Visitors are welcome to the home and are asked to sign in on admission. There is a very small garden/patio area at the front of the house. There is no car park with parking on street. The home is accessed from the road by a number of steep steps. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection at Trezela was a key unannounced inspection on the 21st November 2006. The inspection took place from 09:10 to 15:20. The registered manager and registered provider were both present during the course of the inspection. All the service users at the home during the course of the day were spoken to. They all expressed very positive comments on the standard of care that they are receiving at Trezela. Four of the service users filled in CSCI service user comment cards. Three of the service users indicated their satisfaction with the care at Trezela. Case tracking took place with four service users in regard to documentation held on them at the home. Prior to the inspection the home completed a pre inspection questionnaire. The weekly cost of care is £410 per week. What the service does well: What has improved since the last inspection? Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 6 The good practice recommendations of the inspection report of the 7th February 2006 have been addressed. It is noted that improvements have been made to care planning documentation since the last inspection. All staff have received adult protection training and policies and procedures are good to ensure the protection of the service users at all times. 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. The summary of this inspection report can be made available in other formats on request. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A detailed professional pre admission procedure takes place at Trezela to establish that the home is appropriate for a new service user. EVIDENCE: A pre admission assessment is carried out by the registered provider and the registered manager prior to any admission to the home. It is unusual for there to be a vacancy at the home as generally the service users stay at Trezela for a long time. A recent admission has though just taken place. Prior to the admission the service user visited the home for a short stay and then had a longer week end stay to ensure that the home was right for her. A formal written pre admission assessment then took place. Information is also obtained in writing on the care needs of the service user from the contracting local authority prior to the placement. Good information is included in the service user guide on the admission process. Significant time and effort appears to be spent making admissions to the home personal and well managed. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 9 Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user’s health, personal and social care needs are being met by the staff and multidisciplinary staff as required. EVIDENCE: Each service user has a care plan in place which is reviewed on a regular basis. It is noted that improvements have been made to care planning since the last inspection. They include clear headings and information on risk and control measures and goals. The care plan is agreed and signed by the service user where appropriate. Good risk assessment information is included in care planning. As discussed at the time of the inspection a recommendation is made to ensure that some important risk assessment information is included in one care plan. Each care plan is supported by very detailed daily records. Records are also in place of external professional visits/involvement (for example general Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 11 practitioner, community psychiatric nurses and practice nurses). The service users can access their care plans should they so wish. All records are held confidentially. The home operates a key worker system and the service users are well aware of this and know who their key worker is. Included in the care planning documentation is information on how the service users spend their time at the home. This includes information held in the form of a calendar/diary. The documentation evidences that they are involved in all aspects of life within the home to include cleaning duties and fire drill practices and service user meetings for example. The care plan is used as a working tool and is understood by all staff. Management of risk takes into account the needs of the service user balanced with their aspirations for independence and choice. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Trezela is providing it’s service users with good lifestyle opportunities that include being part of the community, attending appropriate social care activities, having visitors and enjoying being part of a “family group”. All staff have been recently trained in healthy eating and a dietician has been consulted to ensure that the meals at Trezela are nutritious. EVIDENCE: Care plans evidence that the personal development needs of each service user have been given full consideration and the daily records evidence their daily routines. The routines of each service user are very different and client centred to meet individual assessed needs. Most of the service users attend a number of activities in the week for example adult training centres or colleges. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 13 All the service users are very much involved in the community to include regular shopping in Wadebridge, which is a short walk from the home. The service user guide identifies the rights and responsibilities of each service user at Trezela. Reference is made to the diverse needs of the service users in the statement of purpose with a reference to “helping service users to celebrate events, anniversaries and festivals which are important to them”. On the day of the inspection one service user had attended Link into Leaning in the morning, two were going out shopping locally. Where required individual records are in place of all meals provided to the service users. All the staff at the home have responsibility for meal preparation and all staff have recently received training to undertake this task. On the day of the inspection the main meal of the day (which is in the evening) consisted of southern fried chicken, chips and beans. This was to be followed by fruit cocktail or yoghourt. The registered provider has recently commissioned a dietician to review the content and portions of the meals being provided at the home. Where recommendations have been made these have been put in place. An inspection of the kitchen by the District Council Environmental Health Officer on the 13th September 2006 identified no problems. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A key worker system at the home allows the staff and service user to build a good relationship to ensure that all care needs are met in a way that the service user prefers. All staff are trained to administer medication safely at the home. EVIDENCE: Although Trezela is a small home they operate a key worker system which appears to work very well. The manager also has responsibility for particular service users. Care plans clearly identify all information on each service user to include for example their daily bedtime routine which is individual to each person at the home. The staff appear to have good working relationships with health and social care professionals who regularly visit the home. On the day of the inspection a joint review meeting was to take place in regard to one service user. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 15 Medication administration records were found to be completed correctly on the day of the inspection. The manager has responsibility for checking the medication into the home when it arrives from the pharmacy. The registered manager and the registered provider as well as four care staff are presently undertaking detailed medication distance learning training. All staff who have medication administration responsibilities have received training to allow them to undertake this task. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints policy and procedure provided to the service user and or their representative. Adult protection policies and procedures are good and training has been provided to all the staff to ensure they are knowledgeable on protection issues. EVIDENCE: The home has a detailed complaints policy and procedure that includes timescales for response as required by The National Minimum Standards. The policy and procedure is provided to the service users and their representatives. It is also displayed in the home. The home now has a good detailed adult protection policy and procedure in place to guide staff on these important issues. The home also has in place a whistle blowing policy and procedure. All the staff have undertaken adult protection training. The manager has recently also attended the local adult social care department for adult protection training which is to be cascaded to all the staff. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Trezela is well maintained externally and internally and is well placed to access all the facilities that Wadebridge offers. EVIDENCE: The home is accessed by a number of steps to the front entrance and would therefore not be suitable for anyone with limited mobility. The home is within easy walking distance of Wadebridge town centre and it’s associated facilities. There are pleasant outlooks from the sun lounge at the front of the home. Trezela is homely and the environment is comfortable. Furnishings are domestic in nature and of a good quality suited to the needs of the service users. Maintenance of the home is recorded to include all decoration and repairs. Recent improvements have taken place to include new carpets in three bedrooms and the sun lounge and flooring in the upstairs bathroom and Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 18 shower. Two bedrooms have been provided with a patio area. There are plans to replace the windows in the sun lounge. The home provides six single bedrooms and one double bedroom with a screen for privacy. None of the bedrooms are provided with en-suite facilities. Each bedroom has been personalised by the service users. Communal space for the service users includes a pleasant lounge with a television. There is a sun lounge off this main lounge and smoking is allowed in this area. A dining room is situated off the kitchen. There are no environmental adaptations provided in the home as the facilities are not suitable for a service user with a disability. The home was found to be very clean on the day of the inspection. All staff have responsibility for the cleaning at the home and the service users are involved in these duties where appropriate. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is providing a large amount of training to the staff to ensure that the care needs of the service users can be met at all times. Recruitment procedures are satisfactory to ensure a good quality service and the protection of the service users. EVIDENCE: Staff members are encouraged to undertake regular training to ensure that they can meet the care needs of the service users. All the staff members employed except one have obtained their NVQ 2 qualification which is well over the 50 required by The National Minimum Standards. All statutory training is up to date and includes first aid, moving and handling and fire drill training for example. Good practice training is also taking place and has recently included a training day on bipolar affective disorder and anxiety disorders and their management. More training is planned by the manager in the new year. As well as attending training days the staff watch training videos which have Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 20 included information on schizophrenia, anxiety, depression and epilepsy. The volume of training that the staff receive is good. Correct recruitment procedures are being followed by management. The recruitment of good quality carers is seen as integral to the delivery of a good service. It is noted that the staff team is a very stable team and that the staff have a variety of roles and responsibilities at the home to include for example caring, cooking and cleaning. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users at Trezela benefit from the good leadership and management style of the registered manager. EVIDENCE: The registered manger works 25 hours a week at a minimum and generally these hours will be around 30. She is on call every other week-end. It is a credit to her that the standards assessed are all met considering her hours are not full time. The manager has worked at the home since 1997 and has been employed as a manager there since 2000. She and the registered provider have both obtained their registered manager award qualifications. The manager regularly Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 22 undertakes training along with the staff. The registered provider visits Trezela daily and has specific responsibilities for finances. Ultimately the home has plans to employ a deputy manager to support the registered manager in her duties. The manager has recently carried out an audit of the running of the home in the form of questionnaires to professionals, staff and service users. The results of the questionnaires have been analysed. The home is fully compliant with all requirements of health and safety legislation. Policies and procedures are in place to guide staff for example infection control. There are plans for all staff to undertake health and safety training in the New Year. Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 x 3 x x 3 x Trezela DS0000009241.V313471.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations To include additional important risk assessment information in one care plan, as discussed at the time of the inspection. 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