Inspection on 12/06/06 for Trinity Court Nursing Home

This inspection was carried out on 12th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 13/02/06

Trinity Court Nursing Home 11/05/05

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 Inspection 12th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 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 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) 020 8767 8767 02086823280 Newslease Limited Care Home 49 Category(ies) of Dementia - over 65 years of age (16), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (49) Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Home can admit one named service user under the age of 65 years. The category of MD(E) is for one named service user for the duration of their residence in the home. Date of last inspection 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 who may have dementia. Accommodation 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. Fees range form £520-25 -£660-00 per week. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced inspection. Ten surveys were sent to residents, fifteen surveys to staff and ten surveys to relatives. Only four relatives surveys were received. A site visit was made which lasted a total of five hours. Records relating to staff training and recruitment were examined. A tour of the premises was undertaken. Case tracking was carried out on three residents. Medications were inspected and health and safety within the home. The inspectors spoke with two visitors and two residents, the manager and three members of staff were spoken with. What the service does well: What has improved since the last inspection? What they could do better: Residents must be treated with dignity particularly at meal times. There must be evidence of choice in the menu and where residents wish to eat. Activities provided by the home must reflect resident choice and there must be a variety available, including one to one sessions and outings. Work needs to be done on ascertaining residents’ wishes on end of life care and death, to make sure their dignity is maintained. The home has a clear training programme in place, but staff must make sure that this training is put in to practice, to evidence that residents’ needs are met. In particular this is necessary for needs relating to sexuality and relationships. Staff must demonstrate sensitively toward significant persons in a resident’s life. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The service consults the assessment information to see if they can meet the prospective residents needs. Further assessments must identify all care needs, and in particular social needs and sexuality. EVIDENCE: Residents are assessed prior to and on admission. The home’s assessment takes the form of a long term need assessment and care plan. Residents need to be fully assessed to make sure all needs are identified. Particularly social interests, for example one resident liked reading, but there were no details of the type of books or other reading materials preferred. Examination of assessments showed that carer preference was noted, i.e. male or female. One care plan had good information on communicating with a resident who was deaf. One assessment was noted to be incomplete and needed information on continence, manual handling and skin integrity. Also, care needs had not been identified. This resident had been admitted on 8th June 2006. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 9 Another resident who had been admitted a day later did not have a completed assessment and there were no care plans in place. Staff must make sure that the assessment is completed within forty eight hours and care plans within five days of admission, to make sure that residents are not placed at risk of not having care needs met. It was noted that details on sexuality were scant and concentrated on appearance. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan, but practice of involving residents in the development and review of the plan is variable. The home must make sure that care plans and daily records reflect all care needed and provided, to evidence that residents are appropriately looked after at all stages of their stay in the home. EVIDENCE: As previously stated two of the three care plans examined were incomplete. The third care plan required more input to reflect actual care needs of the resident as identified in the assessment. It was noted that personal hygiene preferences were noted, but this was not documented consistently in the daily records. There was key worker input monthly, which summarised events. Activities residents had undertaken were recorded, but this area needs further development. At the site visit it was noted that activities consisted of physiotherapy input and aromatherapy. (see also under Daily Life and Social Activities). There is evidence that residents are able to access other health professionals, with records of doctors’ and tissue viability nurses visits. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 11 Information on daily routines of residents could be improved by use of the preferred timing that residents wish to do things. Residents can be confident that wound care is appropriate to their needs. There are records in place which detail changes of dressings and the condition of the wound. These were noted to be in line with care plans. Daily records contained scant details of what care had been given, which does not evidence well whether care plans are being followed and whether residents needs are met. The manager is aware of these issues, therefore previous requirements relating to care planning and daily records have been extended to enable her to make sure that the standard is met. Residents’ wishes for end of life care and death need to be documented to make sure that residents are respected and their dignity is maintained. One visitor commented that they thought that a resident was unkempt and poorly cared for. The resident had not been shaved, was wearing dirty clothing and had no socks on. This does not evidence that residents privacy and dignity is maintained. Residents can be confident that medications within the home are handled adequately. The medication policy was noted to be satisfactory. Medication Administration Record (MAR) sheets examined had details of allergies and there were no gaps in administration of medications. A weekly audit is carried out and there were no discrepancies in stock levels. It was noted that the temperature of the room in which medications was stored was above 25°C, which could affect how the medications work. This was rectified at the time of the visit, by use of an extra electric fan and opening the window to provide more ventilation. Medications were noted to be stored in plastic boxes, which could not be secured, as there was insufficient room in the drug trolley. The provider immediately ordered a second drug trolley, which arrived the following day. There was discussion with staff regarding the prescribing of nutritional supplements. It was noted that this had not been carried out for one resident. Staff made sure that this was discussed with the general practitioner and the supplement was prescribed properly. This proactive approach makes sure that residents are protected from harm and medications are stored safely. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in the outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The food in the home is of good quality and well presented. Staff need to be trained to make sure that choice is evident. There needs to be involvement of residents in planning menus. The home tries to be flexible and attempts to provide a service, which is as individual as possible, but further improvement is required to make sure that residents are afforded choice in their daily activities. EVIDENCE: At the site visit it was noted that activities consisted of physiotherapy input and aromatherapy. The home is in the process of restructing the environment, and there is now an air-conditioned room, with a plasma television. It is anticipated that cinema afternoons will be held. The staff need to make sure that the activities programme is developed in line with resident choice, to enable residents to take part in meaningful pursuits. The new manager of the home has introduced residents being taken out for afternoon walks for residents, if they want. The manager said that she hopes to develop activities to include outings to local areas of interest, such as the park, shops and further afield to the coast. Lunch was observed. One survey received from a relative stated that ‘the quality and content of the food needs to be improved and a varied menu introduced.’ There were no specific details of what could be done. The Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 13 manager is introducing a quality audit system, which will cover food choices. The manager must make sure that residents and their representatives are consulted on menu choice. During lunch it was noted that although there were sufficient beverages available, no choice of drink was offered to residents. The food was served hot and the portion sizes were adequately. Staff were aware of special dietary needs and there were adequate numbers of staff to assist residents with eating and drinking. One resident was asked to move from their seat, rather than a table being brought to them. The resident was able to remain where they were only after intervention by an inspector. The home must make sure that residents are able to chose where they wish to take their meals. Choice of meals also needs to be evidenced to make sure that residents receive food and drink that they prefer. It is anticipated that once the new dining room is completed all residents will be able to share a meal together if they chose. Surveys received from relatives indicated that there were no restrictions on visiting, apart from one. CSCI is aware that the home has negotiated visiting arrangements for one resident. Relatives’ surveys indicated that they thought that cultural and ethnic needs of residents are met. One resident had recently been admitted to the home and there was discussion regarding recognising a person who was not a blood relative, as an important and significant person in the resident’s life. The manager stated that she knew this was an area which required improvement and would address it in the training programme. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a very low number of referrals made as a result of lack of incidents, rather than a lack of understanding when incidents should be reported. Residents and their representatives are able to resolve issues at a local level, which maintains effective communication. EVIDENCE: Residents can be sure that staff are aware of Adult Protection (POVA) procedures and complaints handling. There have been no written complaints or POVA investigations since the previous inspection. CSCI has not received any concerns about the service. The complaints policy states clearly the steps that are followed and staff demonstrated an awareness of Protection issues. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a homely environment, there is ongoing maintenance and a refurbishment programme is in place, which will provide the home with a high standard of facilities and decor. EVIDENCE: The environment is in the process of being improved and updated. A tour of the premises was undertaken and the new extension has two walk in showers, profiling beds and sufficient space for care needs to be met. Attention has been paid to use of colour, furniture and soft furnishings to give a homely feel. There is a new call bell system with portable handsets. Residents currently living in the home have been given the choice of moving to these rooms if fees are agreed. The provider is also in the process of upgrading the remainder of the home and this is being managed in a planned way. The environment was clean and tidy on the day of the site visit. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training, and delivers a programme that meets statutory requirements. The home must make sure that specific training such as death and dying is put into practice, to make sure residents’ needs are met. The service has a good recruitment procedure that is good. EVIDENCE: Residents are protected from harm by good recruitment procedures. Staff files examined had a clear process; required checks had been carried out and documented. Staff signed to indicate they have received a job description as required at the previous inspection. The home benefits from a trainer and an induction programme is in place and mandatory training had been carried out. Planned training and awareness sessions include culture, diversity and respect and care of the dying. The home must make sure that this is put into practice. It is recommended that training is given to staff on sexuality and relationships, to enable them to care effectively. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience to manage the home. The manager is resident focused and demonstrates openness and transparency in relation to positive and negative aspects of the service. Residents can be confident that the manager and staff team aim to put the residents interests at the centre of the home’s practices. Care must be taken to make sure that all health and safety issues are addressed, in order to protect residents from harm. EVIDENCE: The manager of Trinity had recently been appointed and at the time of the site visit was undergoing registration with the CSCI. The manager demonstrated awareness of areas for improvement within the home and had already implemented action plans to address these issues. Supervision of staff had not been taking place and evidence of planned Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 18 sessions for the coming year were inspected. Staff meetings had been re-commenced and a relative/resident meeting had been planned for the weekend after the inspection. The manager showed good knowledge of meeting individual needs and making Trinity Court the residents’ home. Residents’ personal allowances are managed by the administrator who maintains accurate records. The only aspect of health and safety, which required attention, was the updating of Control of Substances Hazardous to Health assessments. Records showed there were regular fire alarm tests and fire drills. With the building work in progress, care had been taken to maintain the residents safety at all times. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The registered person must ensure that assessments are completed fully, identifying all needs of residents. The registered person must ensure that assessments are completed within forty-eight hours of admission. The registered person must ensure that care plans are formulated within five days of admission. The registered person must ensure that daily records accurately detail care given. (previous timescale of 30/05/06 not met) The registered person must ensure that residents’ privacy and dignity is maintained at all times, particularly at meals. The registered person must ensure that residents’ wishes with respect to end of life care and death and dying are recorded and acted upon. The registered person must ensure that the activities programme is developed to DS0000019130.V298222.R01.S.doc Timescale for action 30/11/06 2. OP3 14 30/11/06 3. OP7 15 30/11/06 4. OP7 15 30/11/06 5. OP10 12 (4) (a) 30/11/06 6. OP11 12 (3) 30/11/06 7. OP12 & OP14 16 (2) (m) & (n) 30/11/06 Trinity Court Nursing Home Version 5.2 Page 21 8. 9. 10. OP15 OP30 OP38 12 (1) & (2) 12 (1) (a) 13 (2) (c) ensure that residents are able to participate in a variety of activities, which reflect their choice. (previous timescale of 30/06/06 not met.) The registered person must ensure that residents are consulted about menu choices. The registered person must ensure that all training given is put into practice. The registered person must ensure that up to date COSHH assessments are in place. 30/11/06 30/11/06 30/11/06 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 OP30 Good Practice Recommendations It is recommended that specific training is given on sexuality and implemented. Trinity Court Nursing Home DS0000019130.V298222.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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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