Inspection on 23/05/08 for Trianon Nursing Home

This inspection was carried out on 23rd May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Trianon Nursing Home 39-41 St John`s Road Exmouth Devon EX8 4DD Lead Inspector Ms Rachel Fleet Unannounced Inspection 23rd May 2008 9.15 Trianon Nursing Home DS0000071096.V364888.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 Trianon Nursing Home DS0000071096.V364888.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. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trianon Nursing Home Address 39-41 St John`s Road Exmouth Devon EX8 4DD 01395 269637/8 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) Trianon@Guinness.org.uk Guinness Care and Support Ltd Mrs Stephanie Dawn Clift Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Trianon Nursing Home DS0000071096.V364888.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 with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection NA Brief Description of the Service: Trianon provides accommodation, nursing and personal care for up to six people – adults below 65 years of age - with complex physical and learning disabilities. The home is a bungalow within the town, at a distance from the centre of Exmouth but having some local shops. It has level access via two front doors, with parking available at the front of the bungalow. The home no longer has its own transport. The six single bedrooms have handbasins, with two bathrooms available that have adapted bathing facilities and toilets. There are two other toilets, two lounge/dining rooms with television and radio, a sensory room used for relaxation, a kitchen and a laundry room. Staff have access to a sluice room facility. Trianon has existed for several years under different ownership. Guinness Care and Support Ltd. now owns the home and employs most of the staff. A very small number of staff are still employees of the Devon NHS Partnership Trust. Fees are £1150 per week for each service user. Additional charges are made for transport, holidays, some activities and any personal items, including continence pads in some instances. The Commission for Social Care Inspection (CSCI) reports are available on request from the home. Trianon Nursing Home DS0000071096.V364888.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 3 star. This means the people who use this service experience excellent quality outcomes. This inspection took place as part of our usual inspection programme. There were five people living at the home on the day of our unannounced visit to the home, which took place over a period of 9 hours on a weekday. The home’s manager had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’), which included an assessment of what they do well and their plans for improvement as well as information about the people living at the home, staffing, policies in place, and maintenance/servicing of facilities. The manager provided excellent detail of how the home considers all aspects of care. It highlighted minor shortfalls and indicated how they intended to improve. Part of the inspection confirmed the work the home said they were doing was happening. We sent surveys to the home for them to give to each person living at the home, their relatives / supporters, and staff. Completed surveys were returned from everyone living at the home (completed by staff on their behalf), from three relatives, and all seven staff. The people living at Trianon have extremely limited verbal communication skills. They were therefore unable to give us their views in detail verbally. We found out what it was like for people living in the home through observations, talking with staff, and looking around the home. We looked in more depth at the care of three people living at the home, by reading their care records and related information (personal monies records, etc.), and checking how their medication was managed. We met with them, spoke to staff about them, and looked at the accommodation in relation to their needs. Staff recruitment and training files, quality assurance information and records relating to health and safety – such as accident and maintenance records were seen. We ended the visit by discussing our findings with the manager. Information gained from these sources and from communication with or about the service since it was re-registered is included in this report. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: One relative suggested an improvement would be ‘more staff’. Another indicated transport would be an improvement - something the home had until recently. Staff suggestions included better staffing in relation to providing opportunities for activities. One, however, answered this question with, “We try to find new ways to make life more interesting for the service users.” Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 7 Improvements in aspects of medication management and safeguarding measures would promote peoples’ health and welfare more robustly. They would be further assured of good support day and night if more care staff had a recognised care qualification, especially since there is no nurse at the home overnight. Refurbishment of certain areas would make it more homely for the people living at the home, whilst one There are various systems in place that ensure peoples’ health and safety are promoted, but one matter should be addressed to further protect everyone from risk of harm. Reviewing one laundry practice would reduce a risk of cross-infection to staff. 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. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 8 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 Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 9 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. Thorough pre-admission processes ensure that peoples’ needs and wishes are assessed very well, so they can know how those needs will be met if they go to live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people we met had been living in the home for many years, and there have been no recent admissions. The AQAA information evidenced a very comprehensive pre-admission assessment process and introduction to the home. These included that the manager would explain why the home couldn’t meet any needs, if relevant, and look into external ways of meeting them. The needs and views of people already living at the home would be considered before offering accommodation to the prospective resident. We saw the comprehensive template that would be used to collect information about the individual’s needs. Trianon Nursing Home DS0000071096.V364888.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 & 9. Quality in this outcome area is excellent. Staff are provided with excellent information to help them to support people and meet their needs safely and consistently. Any decisions made on behalf of people are made in consultation with others and in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had excellent, extremely detailed care plans that gave a very good picture of the person and their support needs, how they communicated, how they asked for specific things, what made the person’s behaviour change, etc. These had been reviewed relatively recently. We saw how useful and accurate these care plans were during our visit. Staff said they use the care plans, and the manger also updated all staff (and not just peoples’ keyworkers) regularly about peoples’ changed needs. They told us they were encouraged to speak up about peoples’ care if they had an idea for improving it or if they thought something was no longer appropriate. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 11 We saw minutes of staff meetings reflecting this, and observed regular one-toone communication during our visit. A relative noted there was excellent communication between staff. We discussed with the manager that occasionally staff had written observations about people in their care records without going on to show what was done or was to be done about the observation. Staff introduced us to people living at the home, explaining we had sent them the survey they completed recently, and checked they were happy for us to speak with them. We heard staff regularly explaining to people what they were going to do next as they assisted them with aspects of care. Staff were unhurried, caring and respectful throughout our visit, obviously watchful but letting more independent people freely do as they preferred – going outside, moving around the home, etc. When discussing how staff enabled people to make decisions despite their communication difficulties, staff told us one person could say clearly if they didn’t want something or didn’t like something. And we saw they interpreted peoples’ non-verbal communication and responses to their questions, checking their understanding with the individual. One person’s care plan included the signs they used to indicate ‘no’ or a refusal. Decisions made on behalf of people were discussed and agreed within the staff team, with relatives, and with advice from other relevant professionals. These decisions were fully recorded in peoples’ care plans or risk assessments, with explanations why other options had been ruled out. There was evidence that decisions were later re-examined, to see if they were still the best option for the person given the passage of time. There was clear and detailed guidance on how to meet individual needs and how to reduce risks. Records generally showed a positive approach, with possibly negative situations treated as a challenge or opportunity for further exploration, rather than letting associated risks or difficulties stop further action. The manager is appointee, with a second signatory, for the current service users in the absence of anyone else to take on this role. She told us if staff wanted to spend large amounts of individuals’ money, written agreement had to first be obtained from the GCS Ltd. head office staff. Two staff signatures were recorded to verify the transactions shown since people were unable to sign for themselves, with receipts available where we checked at random. Trianon Nursing Home DS0000071096.V364888.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 – 17. Quality in this outcome area is good. Respected as individuals, people are supported to have fulfilling lives despite their complex needs, benefiting from familiar or supportive relationships with families, friends and the local community. Meals are provided with individuals’ needs and preferences in mind, making them as enjoyable yet as healthy as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans and individuals’ activity programmes showed the home enabled people to enjoy various activities despite their disabilities or behaviours finding ways to manage risks and respond in ways that kept the activity as a positive experience overall for the individual concerned. The manager had reviewed the activities undertaken by each person over a year – including Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 13 what was successful, enjoyed, which staff were involved, etc. – to inform the person’s new activity programme. There was much detail in someone’s care plan on how to make a trip to buy magazines a successful occasion. Staff discussed that one of the people at the home was beginning to ‘feel their age’ and was not able to be as active as they had been, so they were going to tailor activities the person previously enjoyed to suit their new level of health. We saw staff were planning to take someone swimming, something the person used to do but had given up. One person’s activity programme included tidying their room. They chose to spend time in their room, during our visit, which staff said had happened increasingly since the person’s room was redecorated and refurnished. We saw bedroom and bathroom doors had privacy locks. Staff spoke in very positive terms about the people they cared for and how they could support individuals to develop or lead a more interesting life. They said they had to plan ahead more, regarding outings and activities, now the home had no transport. We saw one person had had three activities recorded for each of the last three weeks, slightly less than in preceding weeks. One staff member said they couldn’t always do activities they would like to because of staff shortages, but we were also told that there are more staff on duty at times to enable activities to take place. There was little structured activity during our visit, but we were told it was a day people usually had physiotherapy (as reflected in care records), which had been cancelled; since people found the physiotherapy tiring, no other activity was planned on that day. Also, it was evident people living at the home had complex needs, and staff told us they took time in the mornings to provide required care to a high standard but at the individual’s pace. This was observed during the inspection, with staff helping individuals get up over the morning, ensuring they had enough to eat and drink, etc. Recreational activities, therefore, were usually planned for the second half of the day When a relative rang to enquire about someone at the home, staff updated them then asked if they wanted to speak to the person as well, enabling this to happen. Care records included peoples’ visitors, and showed some had lunch at the home on occasions. Surveys from relatives were positive about the home. One person was with staff in the kitchen while they were cooking the evening meal - intended to be a sensory experience, but also a social occasion, which the person appeared to be enjoying. They responded positively when we asked them if they liked the food they were given. A staff member went grocery shopping during our visit. Staff told us there was enough food available and provided for the people living at the home. Menus Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 14 we saw were varied, but it was not clear how often vegetables and fruit were offered. The manager said any stews shown would be made with fresh vegetable included, roast lunches included fresh vegetables, and that fruit salads were made. We saw a variety of meals were served for lunch, depending on the individual’s likes/dislikes and their physical health problems or needs. One person had spaghetti bolognaise, tinned apricots and cake, with a drink, for example. They needed all assistance with eating, and received this help at an appropriate pace. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 15 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 – 20. Quality in this outcome area is good. Peoples’ dignity and wishes are respected, and they benefit from their health needs being closely monitored and met through good multidisciplinary working. Improvements in aspects of medication management would promote peoples’ health and welfare more robustly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had their life story detailed in their care records, with information about their disabilities or conditions, helping staff to know and understand them as an individual. Staff felt the current facilities, equipment, etc. were sufficient for them to meet the care needs of the people living at the home. Care plans detailed how people liked to receive their personal care, and what support they needed. Staff described individuals’ preferences, likes and dislikes as we had seen recorded in care records. We saw staff giving care and support in a respectful and very caring manner. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 16 They showed a flexible approach, two staff explaining that certain people had a range of possible evening activities, and how they would try to help them if they then had difficulty settling for the night. They told us the possible triggers they would consider for one person if they did not behave as usual, which were reflected in the person’s care plan. Care plans included decisions about care – what had been tried, why some things weren’t pursued, etc. So it was clear why someone was being fed at lunchtime, rather than staff encouraging their independence, for example. We saw care issues were discussed at staff meetings, to ensure individuals with changed needs received the care they needed – such as enough to drink despite having to rest on their bed. Staff also said the manager gave them training and guidance in their daily work as well as at supervision meetings. Some of the people living at the home were very physically frail. Where people couldn’t be weighed, staff had recorded other body measurements to monitor for changes in their size. Staff said they got snacks between meals, and that some people could say if they were hungry or ask for something to eat. A Speech therapist had seen one person about their eating difficulties and given staff relevant training, which staff told us was very useful. We discussed whether using the Malnutrition Universal Screening Tool’ (‘MUST’) tool might be helpful to inform care planning. The manager has since researched this further and concluded that little would be gained by using it, given the guidance available about the tool and the home’s current monitoring practices. Records for those we case-tracked showed none had pressure sores, as stated in the AQAA - a great credit to the staff given some peoples’ frailty. Care records showed people had regular health checks – dental, foot care, women’s health checks, etc. - with staff working with other community-based professionals to ensure potential, new or changed needs were monitored or met as necessary. We checked medications for three people. They were on relatively little medication. All had had an annual medication review. Records were kept of medications received into the home, administered or disposed of. There was no medication requiring cold storage, but the manager described appropriate arrangements for ad hoc items, as later seen in the medication policy. Handwritten entries on administration sheets had not always been signed and dated to verify the appropriateness of the entry. One person’s care plan lacked clear guidance on how, when and why two ‘as required’ medicines were to be given. Guidance is particularly important if someone lacks capacity and the home has to make a best interests decision on whether to administer or not. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 17 The manager agreed to clarify in individuals’ care plans how ‘as required’ medicines were to be used, and how staff were to make the decision to use them. A ‘potting up’ system was used at night, when a nurse is not on duty, with support workers currently giving out one medication. However, there was no proper policy for this, no verification of who put medication in the pot initially, etc. ‘Potting up’ is not considered safe, as it is a secondary dispensing system. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 18 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 & 23. Quality in this outcome area is good. Relatives and people living in the home are listened to, with concerns or complaints used to improve the service they receive. Improvements to certain safeguarding measures would ensure people are better protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives’ surveys said they knew how to make a complaint. Their responses included the service usually or always responded appropriately if they raised concerns, one adding they were very happy with the care. There was a clear complaints procedure on display, with up-to-date required information. We have not received any complaints about the home, and the AQAA said the home had not received any either. Staff said if anyone approached them wanting to complain, they would give them written information about how they could make a formal complaint, directing them to the manager or us. A new staff member had had safeguarding training within a month of starting their employment. They were clear about agencies that could be contacted if necessary to report concerns to. There were ‘Never walk past bad practice’ forms available in the office, for staff to use to report poor practice to the manager or more senior managers if they had observed anything untoward. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 19 Staff gave clear examples of various types of abusive practice, and explained what signs they might look for if people couldn’t express concerns verbally. However, they did not recognise the term ‘safeguarding’, using ‘POVA’ instead. Some staff had not had a safeguarding update for a year; they said they would report any concerns to senior staff, but were less certain about outside agencies that had a role in safeguarding. The safeguarding policy we were shown did not give staff guidance in line with the local authority’s Social Services protocol. A new, up-to-date policy was going to be issued by the new registered provider, although the date of this was not known. The manager told us people’s personal money records were audited by staff from the head office, as well as on unannounced inspections by the provider’s representative and by external auditors appointed by GCS Ltd. We checked personal monies records for three people, finding these were well kept and tallied with cash balances held. See also the section on ‘Individual needs & choices’ regarding how peoples’ finances are safeguarded. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 20 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): 24 & 30. Quality in this outcome area is adequate. People benefit from surroundings that are generally clean and safe, adapted to meet their needs, although refurbishment of certain areas would make it more homely for the people living at the home, and one laundry practice creates some risk of cross-infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home looked clean and bright, including the kitchen and other shared facilities, apart from where carpets were stained or ‘tired’. Both lounge/diners had particularly stained carpets, one being worse than the other; this room smelt musty initially, the door having been closed overnight, but there were no other malodours at the home. Bedrooms were colourful, and had been very personalised by staff to reflect the interests and personalities of the individual. There were two bathrooms with specialist bathing facilities. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 21 The garden at the front of the property had a summerhouse, tables and chairs; two people went out to the area regularly during our visit, with one person particularly enjoying the summerhouse. There are new kitchen fittings, with specific handwash facilities. During our visit, staff wore particular disposable aprons when helping people with their meals. We saw staff taking washing to the laundry room – which was away from food preparation areas - in peoples’ individual laundry baskets. The washing machine had required programmes for proper cleaning of laundry. Staff said they hand-rinsed items if soiled. This creates a possible cross-infection risk to staff. There were no special bags for transporting such items, as can be used, but staff said there was relatively few of such items. We saw disposable gloves and aprons, as well as handwash facilities and infection control information, in the sluice room. Staff confirmed there were always sufficient stocks of disposable protective clothing for them to use when needed. Staff were expected by GCS Ltd. to attend three-yearly infection control updates. Those we spoke with confirmed they had had recent updates. They knew, for example, that hand-washing was still necessary when disinfecting hand gels were provided. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 22 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 & 35. Quality in this outcome area is good. People are supported by caring, experienced and appropriately recruited staff, meaning peoples’ current and changing needs are met. They would be further assured of good support day and night if more care staff had a recognised care qualification, confirming the staff team are able to care for people safely at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived there was one nurse and two support workers on duty, looking after five people. Staff confirmed this was the usual level of staffing. These staff were also responsible for cooking, cleaning and the laundry. At night there is an awake carer and a sleep-in carer, with a nurse not on the premises but on call. Of 10 staff, three were nurses. No care assistants had an accredited care qualification, but four were undertaking one (National Vocational Qualifications in care, or ‘NVQs’), with another staff member expecting to start it very soon. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 23 The manager told us staff do not undertake a nationally-recognised foundation qualification for care work with people with learning disabilities (‘Learning Disability Qualification’ or ‘LDQ’), but have learning disabilities-related modules in the courses they are undertaking. The AQAA said there has been no use of agency staff for the last three months. Staff said they tried to avoid use of agency staff in the day, when people living at the home would benefit from carers who knew them, especially for outings. Staff surveys said there was good teamwork, enabling two current staff vacancies to be covered by existing staff. One person responded positively when we asked them if the staff were nice and kind. We were shown evidence that nurses’ registration status was checked, to ensure they were still registered to practice as nurses. We looked at recruitment information for the two recently employed staff. There was required information - such as an initial police check, full disclosure and references - obtained before they began working at the home. Three references had been obtained to ensure peoples’ suitability. We noted the application form asked for years of employment only, so any gaps in employment of less than a year might not be identified, but the manager was mindful of this. A new staff member said the manager had obtained written references but also spoke to the referees. She said her employment history had been discussed at interview. She had an ‘informal interview’, when she looked around and met the people living at the home before being invited for a formal interview. We saw the induction for new staff included professional boundaries, legislation, and the home’s written policies. We saw from staff files that a new staff member had had training on risk assessment and the keyworker role (which included advocacy), and a nurse had completed an in-house medication competency questionnaire in the last six months. We asked staff if they had had any training related to the needs of people at the home. One said they had been taught ‘stretches’ for one person who had contracted limbs, they had been moved using the hoist so they knew what it might feel like for the people they cared for, and matters relating to death or dying had been explored. We saw that staff were being offered learning opportunities relating to dementia and disability discrimination amongst other things. Staff surveys included that that they had had mandatory (health and safety) training and had regular meetings to discuss care issues, besides regular support and input from the manager. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 24 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 & 42. Quality in this outcome area is excellent. People live in a safe home that is run in their best interests, promoting their health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a nurse qualified in Learning Disabilities care, with many years of experience in care settings. She has achieved the Registered Manager’s Award, and attended a hospice course recently, hoping to develop staff skills in end of life care. She said her knowledge of continence management is constantly updated through working with the communitybased continence assessors. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 25 Staff told us she was ‘always supportive’, and she kept them up to date about peoples’ current care needs. Her qualities were said to include professionalism, enthusiasm, and training. Staff felt free to question, and that they would get an answer. One person said, ‘despite great pressure (she) has always held clients’ interests as the main concern’. We saw the Statement of Purpose included the home’s latest action plan based on the results of surveys - for improving the service. Surveys were due to be sent out again in July 2008, the manager told us. The completed AQAA had been made available to staff. Staff confirmed equipment was regularly serviced, there were rarely any breakdowns, and anything needing repair was dealt with quickly. When asked about new equipment, staff said motors had been fitted to wheelchairs (since the home did not have its own transport anymore). A new staff member said the manager had gone around local roads with her and a wheelchair, for training purposes. Staff said they were always given training about any new equipment. We were told all staff had first aid training, and that staff always took a mobile phone with them on outings in case of emergency. We found that professional advice had been sought following an incident that put someone’s health at risk, to prevent it recurring. The home was using the most recent food safety guidance (‘Safer food, better business’) to record daily menus, etc. Legionella-related checks were last carried out 2/5/08, with records of bath water temperatures also seen. Electrical wiring circuits were last checked in 2001. Current guidance from the Health & Safety Executive (‘Health & Safety in Care Homes’) advises fiveyearly checks by a suitably qualified person, for care homes. The fire risk assessment had been reviewed in November 2007, and included assessments of what help each individual living at the home needed in the event of a fire, etc. Staff told us the same information, and said fire safety was discussed at supervision sessions with the manager. The AQAA said fire safety checks were last carried out in February 2007, but more recent servicing certificates (dated 30/4/08) were provided when we queried this. Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 26 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 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 4 4 2 X 4 X 4 X X 2 X Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 YA20 Regulation 13(2) Requirement You must make arrangements for the safekeeping and safe administration of medicines in the home, including: Arrangements must be made to ensure that there are clear directions available to staff on how and when medicines prescribed to be used “when required” are to be used. Arrangements must be made to review current written policies and practices, seeking advice from a pharmacist regarding the practice of ‘potting up’ of medicines. A system for verifying the appropriateness and correctness of any handwritten directions or instructions on medication administration sheets. You must ensure that people living at the home are safeguarded from abuse or harm – Including: 1) That written safeguarding Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 28 Timescale for action 31/08/08 2 YA23 13(6) 31/08/08 policies are robust, up to date and in line with the local authority’s agreed safeguarding protocols; 2) Through staff training or updating on local agencies with a safeguarding role, etc. You must ensure that people at the home are not exposed to avoidable and unnecessary risks – Including evidence of the safety of electrical hard wiring / wiring circuits at the home, in line with current guidance (‘Health & Safety in Care Homes’ Ref. HSG220, published by the Health & Safety Executive). 3 YA42 13(4) 31/08/08 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 Refer to Standard YA24 YA30 Good Practice Recommendations It is recommended that stained and tired carpets in the lounges, etc. should be made good so that people have a pleasant environment. It is recommended that you seek advice about the practice of hand-sluicing soiled laundry, from the Health Protection Agency, with regard to reducing the possible risk of crossinfection. It is recommended that 50 of care staff achieve a care NVQ 2. 3 YA32 Trianon Nursing Home DS0000071096.V364888.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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