Inspection on 28/10/08 for Trezela

This inspection was carried out on 28th October 2008.

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

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 21/11/06

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Trezela 23 Egloshayle Road Wadebridge Cornwall PL27 6AD     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: Helen Tworkowski     Date: 2 8 1 0 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 Adults (18-65 years) 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 Adults (18-65 years) 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 © (2009) 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 Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Trezela 23 Egloshayle Road Wadebridge Cornwall PL27 6AD 01208813756 Telephone number: Fax number: Email address: Provider web address: janet.trezela@tesco.net Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Lang Type of registration: Number of places registered: Mrs Janet Brewer care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Service users to include up to 8 adults with a learning disability (LD) up to the age of 65 years on admission. Service users to include up to 8 adults with a mental illness (MD) up to the age 65 years on admission. Total number of service users not to exceed 8 Date of last inspection Brief description of the care home Trezela House provides care for up to eight people with mental health needs or a learning disability. 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 toilets and a staff room/sleeping in room with an adjacent toilet. On the first floor there are five single Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 0 8 8 Brief description of the care home bedrooms, one shared bedroom, a bathroom and a shower room. There is no lift or stair lift. The home is not suitable for anyone with significant mobility issues. with a physical disability.The home is accessed from the road by a number of steep steps. There is a very small garden/patio area at the front of the house. The fees for the service, at the time of this report, are from pounds 550. This does not include toiletries, clothing, transport or other personal items. Care Homes for Adults (18-65 years) 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection undertaken by one inspector. The inspection started at 8.00 a.m. and was finished at 2.30 p.m. The report refers to we throughout, this reflects that the report was undertaken on behalf of the Commission. The Registered Manager was present throughout the visit. We spoke briefly with all of the people living at the home who were present during the day, in addition we spoke with two people of the people in private. We looked at the care records of two people who live at Trezela, and talked with the staff and manager about the care provided. We were shown around the home and had lunch in the dining room. We looked at medication system, how staff are recruited and trained, and we also looked at safety and the general management of the home. Care Homes for Adults (18-65 years) Page 6 of 27 As part of this visit we also spoke with one of the relatives of someone at Trezela, a Social Worker, and received information from the Registered Manager in the form of a completed questionnaire. 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 Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People who are thinking about moving to Trezela can be confident that their needs will be known, before they move. Evidence: We looked at information about the person who had most recently moved to Trezela. We found that although the person had moved in an emergency the manager knew about their needs before they moved. The Social Worker had provided this information. The Manager told us in the Annual Quality Assurance Assessment that people are only admitted after a full assessment, and then there is a trial period to ensure their suitability and compatibility with the other people who live at Trezela. We looked to see if there were contracts for people, so that they knew what service they were buying or was being bought on their behalf. We found that there were clear contracts, however it was not entirely clear the amount that was due to be paid, who was paying it and how it was to be paid. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 Trezela are well supported so that they are able to make choices about their lives. Evidence: We talked with people at Trezela about the support and help they received. People told us they were happy. We looked at the documents that described the sort of help people needed. We found that there was good information on file about what peoples needs were and how these were to be met. There was also information about the risks people might experience and how these risks or dangers might be reduced and managed. Information about what help people needed had been regularly reviewed, and where people wished, they were involved in these reviews. We discussed with the Manager the way the information was recorded. Much of the information about how needs are to be met is in the Risk Assessments. We would recommend that consideration is given Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: to ensuring that the care plan and risk assessment are more clearly defined. Where information needs to be in both documents, it could be cross referenced. When we looked around the house we found that things that were described in the care plan, were in place. For example a notice board was used to help one person to recollect what they had to do that day.We spoke with a Social Worker about whether staff did what was agreed and she confirmed that this was the case. We looked at agreements that were in place to limit and manage expenditure for one individual and found that appropriate discussions had taken place to ensure that the persons best interest were protected. We discussed this with the Social Worker and were told that staff from the home had worked hard to provide support in this very difficult area. They were quick to identify when things were not going to plan and to involve her at an early stage. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 Trezela are provided with good support, and they are able to take advantage of and benefit from a range of activities in the community. Evidence: Our visit to Trezela coincided with breakfast and lunch. We saw that people were able to make choices about what they ate, and the meals were relaxed and informal. we were told that the people who live at Trezela are able to help plan the menu for the week, a copy of this is kept in the dining room. When we asked people about the meals and they said that they fine. We shown records of meals. We saw that where someone does not like what is on the menu, an alternative was provided. Some of the people who live at Trezela attend Social Services run day centres, other people are involved in a range of different activities. It was impressive to see the effort Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: that had gone into enabling people to follow their interests, and to be part of the wider community. A Social Worker commented that staff had gone to great efforts to find activities and occupation that would be of interest to an individual. We asked people about rules and were told that they could get up and go to bed when they chose. We were also told about how individuals were supported to keep in touch with friends or relatives. We spoke with one relative (who lived abroad) by telephone, whilst we were visiting Trezela, and we were told about how the staff had helped them keep in touch. She felt that they were very kind people, who had shown great consideration for her relative at a recent celebration. All four of the people from Trezela who filled out a survey said that they could do what they wanted during the day, evening and at weekend. Three people said that they sometimes were able to make decisions about what to do each day. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Medication is well managed and the people who live at Trezela are given the support they need to keep well. Evidence: We were shown the system for the management of medication. This was in good order. Information in the AQAA confirmed that all staff who handle medication have received appropriate training. We discussed with the manager an individuals right to choose not to take particular medication. The Manager and staff demonstrated a good understanding of both rights of the individual and the support and guidance they might need in this situation. As has already been noted we were told by a Social Worker that when an individuals well being changed, then they were quick to seek help at an early stage. When we looked at staff training we found that staff were offered and had attended a number of training courses around mental health needs that would provide them with the information and the skills to meet the needs of the people at Trezela. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Two of the four people who completed surveys said that carers always listened and acted on what they said, the other two people said this was sometimes the case.Three of the people said that staff treated them well either always or usually. When we spoke with a relative of a person at Trezela she commented on the kindness of staff, and how she felt her relative was happy at the home. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. 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. There are good systems in place to ensure that the people who live at Trezela are protected from abuse, and able to raise any concerns they might have. Evidence: We were told by the Manager in their Quality Assurance Questionnaire that they had received no complaints in the last 12 months. All four of the people responding to the survey said that knew who to speak to if they were not happy and how to make a complaint.The Manager has informed us that all staff have received training in relation to responding to suspicion or evidence of abuse or neglect, and that further training is planned in relation to the personal safety of staff. Meetings with residents are held on a regular basis and we were told that there are systems in place to respond to comments and suggestions from the people who live at the home. One person had made a suggestion in recent months, and this had been listened to and had been acted on. Care Homes for Adults (18-65 years) Page 18 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Trezela provides a good standard of comfortable accommodation suited to the needs of the people who live there. Evidence: As part of this visit we looked around the house. Some of the people who live at the home showed us their bedrooms. We found that the house was warm, clean and tidy. Individuals had furnished and decorated their rooms in a manner that suited them. The furniture provided was domestic in character and of a good quality. A number of people had kettles in their room so that they could make hot drinks. We discussed with the manager the provision of tables for this purpose. People are not allowed to smoke in the house, though there is a patio area where people do smoke. The four people who completed the survey all said that they thought that the house was fresh and clean. We saw that where people were interested they were encouraged to be involved in domestic tasks. We discussed with the Manager the future use of the double bedroom, which at the time of the inspection was unoccupied. Care Homes for Adults (18-65 years) Page 19 of 27 Care Homes for Adults (18-65 years) Page 20 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 Trezela are well supported by staff who are competent and well trained. Evidence: We looked at the information on a personnel file for a person who had started work in the home since the last inspection. We found that appropriate checks had been made with previous employers and to check if the person had a criminal record which would make them unsuited to work with vulnerable people. We saw that appropriate checks had been made. We also looked at the way new staff were inducted. We were told that staff complete two inductions, one from Skills for Care which is suited to someone starting work in the care sector, the other was an in house induction, specifically relating to Trezela. We spoke with one of the staff on duty and was told that there is a staff meeting every 6 to 8 weeks, and that staff receive regular supervision. We asked about training and was told that staff have the opportunity to do lots of training. We looked at the records on the notice board and this showed the training that had recently been done by staff or was to be attended in the next few months. Training was particularly focused on mental health needs or other needs of the people at Trezela. Such courses included Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Mental health in Older People, anxiety, depression, psychosis, and schizophrenia. The Manager told us in the questionnaire that all of the staff had gained their National Vocational Qualification Level 2, and that three of the staff either had NVQ 3, or were in the process of completing it. We discussed with the Manager the staffing level and was told that there is a member of staff awake on duty between 6.30am and 10.30pm. After 10.30pm there is a member of staff in the house, available in an emergency. In addition the Manager works Monday to Friday. All indications were that this level of staffing is sufficient to meet the needs of the people living at the home. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 service benefits from a competent and well trained Manager. Evidence: The Manager, Patricia Lang, told us in the written information supplied to the Commission that she has obtained the Registered Managers Award amongst other qualifications. We saw evidence that she was updating her training and and in our discussions with Ms Lang we found that she was aware of changes in the care sector and had kept herself up to date of new legislation and developments. We looked at the environmental risk assessments, including the fire risk assessment. We found that regular checks had been made in relation to fire safety. Ms Lang had obtained guidance on updating the fire risk assessment and was in the process of updating this assessment. We looked at the homes Quality Assurance System and found that this had last been completed in December 2007. As part of this inspection we discussed the need to keep Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: and store records. Ms Lang had records dating back many years. The Commission requires that records are kept for at least 3 years from the last date of entry. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 25 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 5 The people who live at Trezela should be provided with clear information about the amounts of money paid for the service and the methods of payment. The risk assessments and care plans should be reviewed so that both sets of documents contain the appropriate information. 2 6 Care Homes for Adults (18-65 years) 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 © (2009) 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. 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