Inspection on 11/05/05 for Trinity Court Nursing Home

This inspection was carried out on 11th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Trinity Court Nursing Home 05/07/07

Trinity Court Nursing Home 12/06/06

Trinity Court Nursing Home 13/02/06

Trinity Court Nursing Home 01/11/04

Trinity Court Nursing Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Trinity Court Nursing Home 165-167 Trinity Road Tooting London SW17 Lead Inspector Janet Pitt Unannounced 11 May 2005 10:00 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Trinity Court Nursing Home Address 165-167 Trinity Road Tooting London SW17 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8767 8767 020 8682 3280 Newlease Ltd Care home with nursing (N) 37 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Dementia (DE) Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home can admit one named service user under the age of 65 years of age. Date of last inspection 1st November 2004 Brief Description of the Service: Trinity Court is situated on the main A214 Trinity Road, between Wandsworth and Tooting. Nursing care is provided for thirty-seven residents, ten of whom may have dementia. Accomodation is provided over three floors. There are twenty-nine single rooms and four shared rooms. The home has two passenger lifts and there are plans to extend to home to increase resident numbers to fifty and provide more communal space. The home has a large level garden which can be accessed via a ramp from the lounge area. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place unannounced and started at 10:20 am and lasted until 3:45pm. During the inspection a brief tour of the premises was undertaken, records examined consisted of care documentation, medicine administration records, policies and procedures and records relating to staff employment and training. There were no visitors at the time of inspection and it was decided that the next inspection would take place announced, as the provider indicated that relatives of residents visit at weekends and in the evening and would like to comment on the service provided. Two members of staff were spoken with, one member being the new manager of the home, who was on induction. What the service does well: What has improved since the last inspection? What they could do better: Residents or their representatives could be more involved in planning their care and in the review process. Daily records should be improved to reflect care given and not contain entries such as ‘all care rendered’ or ‘care as planned’. Accurate records of wound progress and dressing changes would evidence that healing is occurring or alternative dressings are needed, or advice should be sought from other health care professionals. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 6 Residents risk assessments of manual handling needs and risk of pressure sores need to be routinely reviewed and undertaken to ensure that residents’ potential care needs are recognised. Interventions by staff when a resident exhibits challenging behaviour or lack of motivation in care needs should be recorded, in order that care given is evidenced thoroughly and accurately. Residents medication should be recorded and there should be a clear auditable trail of medicines within the home to demonstrate that prescribed treatments are being given and no resident is placed at risk of not receiving medication. Staff training needs to be recorded accurately and demonstrate that mandatory training has occurred, which would indicate that staff are trained and competent to undertake their duties. 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. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 4 Residents are provided with details of the service provided and the assessment of the residents on admission identifies care needs that are required to be met. The social needs of residents need to be identified and time given to maintaining their interests and hobbies to achieve a balance. EVIDENCE: There has been no change to the Statement of Purpose which details the service provided. The Statement of Purpose will be amended once the building works have been completed to reflect the service provision. The inspector identified that there are some residents who are out of category, such as those requiring dementia care, in the home, i.e. have mental health issues, however their care was satisfactory and when the application for the new rooms is received the provider will review the categories of care that the service is to provide. Assessments of residents are completed on admission and identify care needs. Details of sensory impairments, personal care, mobility and past medical history recorded give a clear indication of interventions required ensuring that residents care is planned according to their assessment. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 9 There was information on family/friend contacts and information on hobbies and interests, which indicated that the social needs of residents are identified. However staff must ensure that interests are recorded accurately, in order that residents can continue to enjoy their favourite pastimes. One resident had recorded ‘likes to read pocket books’, but there was no indication of the subject of the books. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11 Residents care plans are not consistently completed and risk assessments were not consistently evaluated, which potentially places residents at risk of not having care needs met. Residents are treated with respect and their privacy is respected. EVIDENCE: Residents care plans were noted to be formulated from the assessments, however only one of the four plans examined identified resident/representative involvement in the process. This is necessary to ensure that resident choice and involvement in their care is clearly evidenced. Manual handling and Waterlow Pressure Risk assessments were in place, but not consistently reviewed and evaluated, which does not evidence that care needs are consistently being met. Pressure relieving equipment was in place for one resident, but this had not been recorded in the care documentation, so there was no information on whether the equipment was effective. One resident was documented as neglecting their personal care, but there was no indication that advice had been sought from other health professionals or of any interventions by staff within the home. This potentially could place the resident at risk of harm. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 11 Care plans were evaluated monthly and changes noted. However, staff must ensure that wound-dressing changes are accurately documented and continence promotion is detailed in the daily records. There were some entries, particularly when a resident was ill of detailed and specific information being recorded in the daily records. Doctors’ records are kept within the care documentation, which eases crossreferencing to ensure that appropriate information on a resident’s condition is available. Residents were observed to have their privacy and dignity maintained and staff interacted positively with residents. Resident’s wishes regarding terminal care and death were noted to be recorded. Immediate requirements were served in relation to medications within the home. There was no clear auditable trail of medicines received into the home and a stock balance being maintained. Gaps in recording of medication given were also noted. Medicines that was recorded as being received into the home, was dated as being dispensed after the date of receipt. These issues put residents at risk of not receiving medication as prescribed. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 Residents should be enabled to participate in activities of their choosing and the current programme needs to be developed to ensure this occurs. EVIDENCE: Trinity Court has developed activities since the previous inspection, but these require further input to enable residents to achieve a balance and continue to be active mentally. Attention to religious and cultural needs should be part of the programme. Aromatherapy, physiotherapy and painting all occur once a week. The provider said that staff are encouraged to read newspapers with residents and chat with them. Activities were noted not to be consistently recorded. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Lack of complaints received by the home indicate that residents and their representatives are satisfied with the service provision. EVIDENCE: There have been no complaints since the previous inspection. The provider and new manager are available to speak with anyone who may have concerns. Policies and procedures have not change since they were last inspected and seen to be satisfactory. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21,25 and 26 Residents are accommodated in a safe environment and the registered person has planned to improve the overall environment once building work has been completed. EVIDENCE: Residents have adequate bathing and toilet facilities, which are situated close to their rooms. A heater was removed from a shower room as required at the previous inspection. The home was clean and tidy on the day of inspection providing a safe environment for residents to live in. The provider explained that once the building work was completed, then a full redecoration and refurbishment would be commenced to improve the environment. Some bathrooms were observed to be in need of redecoration. There are plans to install a new call bell system Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff training should be organised and recorded to ensure that staff are trained and competent to undertake their duties. EVIDENCE: Staff training files did not evidence that mandatory training in fire and moving and handling was consistently achieved, which place residents at risk of harm. The latest fire training was undertaken in October 2004 and there was a list of attendees. Fire training should be undertaken twice yearly and moving and handling yearly, to maintain staff competence. NVQ training has progressed well and is accessed via Learn Direct. Continence training has been booked for staff to attend. Attention to detail when recording training attended will assist in evidencing that staff are trained and competent to undertake their jobs. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 37 Residents are care for by staff that are appropriately supervised and supported by the management team. EVIDENCE: Residents can be confident that staff are supported in their work. Supervision of staff is planned to occur six times per year. Supervision sessions are recorded when they occur. Records required for the purposes of inspection were readily available, however care plans and medication records should be accurately maintained. Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x 3 x x x 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x 3 2 x Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 18 yes 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. 1. Standard 3 Regulation 16 (2) (m) Requirement The registered person must ensure that hobbies and interests of residents are documented accurately on admission to the home. The registered person must ensure that interests and hobbies identified on admission and as far as reasonably practicable are provided within the home. The registered person must ensure that residents care plans evidence resident/representative involvement in the process, (the previous timescale of 28/2/05 not met). The registered person must ensure that interventions by other health professionals and members of staff are accurately documented in the care plans. The registered person must ensure that details of actual care given is recorded in the residents care plans(the previous timescale of 28/2/05 not met).. The registered person must ensure that continence promotion is evidence within the care plans and daily records. Timescale for action 30th July 2005 2. 4 16 (2) (m) 30th September 2005 3. 7 15 30th August 2005 4. 7 15 30th July 2005 5. 7 15 30th July 2005 6. 7 15 30th July 2005 Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 19 7. 8 15 & Schedule 3 (k) 8. 8 15 & Schedule 3 (k) & (n) 9. 9 13 (2) 10. 12 16 (2) (m) 11. 30 18 (1) (c) 12. 37 17 The registered person must ensure that risk assessments relating to skin integrity and manual handling are reviewed monthly and changes noted. Use of pressure relieving equipment must be documented within the care plan and detail the effectiveness of the equipment in use. The registered person must ensure that wound dressing changes and the condition of wounds at each dressing change are recorded in the daily records(the previous timescale of 28/2/05 not met).. The registered person must ensure that there is a clear auditable trail of medicines, administered and disposed of within the home. Any gaps in medication administration must be documented with reasons why. (subject of immediate requirements which the providor has written to confirm that the issues have been addressed.). The registered person must ensure that a full range of activities are offered which reflect resident choice(the previous timescale of 28/2/05 not met).. The registered person must ensure that mandatory training is undertaken at appropriate intervals and accurately recorded(the previous timescale of 28/2/05 not met).. All training undertaken by staff must be recorded. The registered person must ensure that all records required for inspection purposes are up to date and accurately maintained. 30th July 2005 30th July 2005 Immediate 30th September 2005 30th December 2005 30th September 2005 Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 20 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 Good Practice Recommendations Trinity Court Nursing Home G54-G04 S19130 Trinity Court V211795 110505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 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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