Inspection on 15/05/06 for Tropicana

This inspection was carried out on 15th May 2006.

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

Tropicana 11/09/07

Tropicana 10/11/05

Tropicana 14/06/05

Tropicana 10/02/05

Tropicana 05/08/04

Tropicana 22/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Tropicana Newquay Road St Columb Major Cornwall TR9 6SD Lead Inspector Alan Pitts Key unannounced Inspection 15th May 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 Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tropicana Address Newquay Road St Columb Major Cornwall TR9 6SD 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) 01637 880779 01637 880779 Mrs Marina Westbrook Mr Ernest Westbrook Care Home 10 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (10) Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: Tropicana is a large Victorian house with well-kept secluded gardens to the rear of the home and a small car park to the front of the home. It is situated within a short distance of St. Columb Major town centre. The house has been extended to provide a small quiet home for up to ten Service Users who require personal care and are over the age of sixty-five. This is a family run home, the Registered Providers with their daughter manage the day to day running of the home and live on site. Seven service users are currently in residence. Accommodation is on two floors. There is no lift or stair lift to the first floor. There is large lounge and a comfortable dining room on the ground floor. Wheelchair access is available to the side of the property. Regular contact with friends and family is encouraged; visitors are welcomed. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over two days. The inspector met and spoke with five of the seven service users, the staff, the registered providers and their daughter. The documentation, policies and procedures, and the environment were inspected. Tropicana is a ‘family-run’ home, which provides a comfortable and appropriate home for up to 10 service users. On the day of the inspection there were six permanent service users and one respite service user. The relaxed family atmosphere, and the evident contentment of the service users impressed the Inspector. The registered providers must give priority to the requirements and recommendations identified in this report, which are of a managerial nature. The home’s managerial shortcomings should not detract from how highly the service users speak about their home, the staff, and the care that they receive. What the service does well: What has improved since the last inspection? The Registered Providers continue to offer a stable, relaxed and comfortable home for the service users. Service users, without exception, were praiseworthy of the home, the registered providers and the staff. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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 Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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, 6 The most recent admission to the home was properly assessed prior to finalising the move. Intermediate care is not offered at Tropicana. EVIDENCE: The registered providers have produced a Statement of Purpose and Service User Guide, last reviewed in October 2005, which is provided to every service user or their representative. The care documentation shows that the most recent admission to the home was properly assessed prior to admission, and a plan of care was in operation. Service users confirmed that they feel informed and included in the daily running of the home. Intermediate care is not offered at Tropicana. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 9 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 Each service user has a plan of care. The care documentation shows the involvement of other health care professionals, and Service users confirmed that they receive a good standard of care and felt well looked after by staff. Medicines are handled appropriately, and the home has a relevant procedure. Service users could not speak highly enough of the care, attention, and respect shown by the staff at Tropicana. EVIDENCE: Four sample service user care plans and documentation were inspected. Service users health, spiritual, social and personal care needs are set out in an individual Plan of Care and these are being reviewed at least monthly and with service user and/or representative involvement. Daily entries in the care documentation show the involvement of other healthcare agencies as appropriate to the needs of the service user. One service user confirmed the expected arrival of a nurse later that day. A medicines cupboard and fridge, in addition to a cupboard for the storage of controlled drugs is provided. A Controlled Drugs register is now in use. The Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 10 registered providers record medicines such as Temazepam in this register and obtain two signatures and record the number of tablets stored. A medicine policy is in operation. Medicine Administration Records were seen to be in order. Service users and their representatives or relatives are treated with respect and their right to privacy is upheld. Staff were observed to treat service users with respect and dignity at all times throughout the inspection. The service user’s preferred name is documented. Service users confirmed that they are treated respectfully; their privacy and rights to make decisions are supported. Service users spoke very highly of the staff and the autonomy that they are afforded. Service users confirmed that they are able to meet relatives and friends within the communal areas, in the garden or in their own rooms. Two service users have their own telephones, whilst the remainder have access to the home’s phone. Mail is delivered unopened to the relevant service user. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 11 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, 15 Service users said that the staff could not do enough for them, and that they were free to see visitors as they wished. They also confirmed that they have enough to do to keep themselves occupied, and that they are free to receive visitors as they wish. Service Users stated that they enjoyed the food that was provided. EVIDENCE: The Service Users informed the inspector that they were able to make choices about how to spend their time, and they felt that their recreational interests were being met on an individual basis. Individual interests are recorded at initial assessment. Service users were observed to be able to choose where to eat e.g. dining room, lounge or in their room. Spiritual and social needs are included in the Service users plan. There is a broad range of reading matter and a large selection of videos available within the home. Service users have a daily paper delivered if desired. Preferred meal, waking up and getting up times are clearly documented and respected. The Service users were happy with the flexibility within the home and felt that it met their needs and wishes. There are few regular, organised activities and those that do occur tend to be ad hoc. The care documentation does not sufficiently demonstrate the quality of the service user’s day. The registered provider should ensure more Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 12 informative entries in the care documentation about service user’s socialisation/recreation/choices. Service users are able to meet relatives and friends within the communal areas, in the garden or in their own rooms. Visitors are welcomed to the home, depending on the Service user’s wishes, which are respected at all times. The likes and dislikes of each Service user are noted and an alternative provided if the Service user is known not to like something. Service Users are offered a set menu at lunchtime. Those spoken with said that they usually liked what was offered, but were less sure about whether they would feel able to ask for an alternative. The registered provider should take the responsibility of asking for an alternative from the service user, and ensure that an alternative is offered. Choice is provided at teatime. Service users commented that they could anything at all that they fancied. Food records are kept and special diets are catered for, as required. Fresh fruit and vegetables are readily available. Baking takes place on a regular basis. Service users reported liking the food. The dining room provides an attractive, comfortable setting this is laid up for service users who choose to eat there. There is no menu, the registered providers deciding what to cook the day before. The registered providers should ensure that there is a weekly or two weekly menu, which demonstrates the choices available to service users. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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 the following standard(s): 16, 18 Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. The registered providers and staff were seen to interact well with service users, who confirmed that they would feel able to raise any concerns. EVIDENCE: There is a complaints procedure in operation, and service users confirmed that they would feel able to express any concerns. The registered provider should review and amend the complaints procedure to ensure that it includes the contact details for the relevant Adult Social Care Department. The service users confirmed that they knew who to talk to if they had a concern, and would feel able to do so. There is a Protection of Vulnerable Adults policy and a whistle blowing policy. The protection of vulnerable adults and related policies should be reviewed to ensure that staff members know how and to whom concerns may be brought, along with the relevant contact details, and to ensure that any allegation of abuse follows the locally adopted Protection Of Vulnerable Adults procedure. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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 the following standard(s): 19, 25, 26 Service users said that they were comfortable and very happy with their accommodation. Service user rooms were personalised and comfortably furnished. There is no lift or other aid to assist access between floors. The environment is clean, and homely, though the laundry could be improved. The registered providers have not recorded risk-assessments in relation to hot water provision. EVIDENCE: The grounds are accessible and attractive. There is a small extension of five rooms to the rear of the property, all having easy access to the gardens through individual French doors. Four rooms are situated on the second floor. There is no lift. The home meets the needs of the current service users. The home is decorated with paintings, pictures and fresh flowers. Service Users informed the inspector, without exception that they found their accommodation very homely, comfortable and it met their needs. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 15 There is a designated dining room and a large lounge. There is an attractive, private garden to the rear of the home and seating to encourage people to go outside and enjoy the grounds. The Registered Provider must implement risk-assessments in relation to the risk of scalding from hot water outlets. The registered providers said that the bathing facilities are fitted with thermostatic valves. The registered providers daughter identified the hand basin in the downstairs lavatory as needing thermostatic control. The home is clean, pleasant and free from any odours. Gloves and aprons are available within the home. Hand towels and a soap dispenser are available. The laundry facility is small, but functional. However, clean washing was seen to be in a basket underneath a basket of dirty washing, which was then subsequently moved on top of the porcelain sluice. The registered providers should improve the storage space available in the laundry room to ensure the separation of dirty and clean washing. The registered providers should consider the replacement of the existing washing machine with an industrial-type machine with a sluice facility to be better able to cope with soiled linen and enhance infection control within the home. At this time the Registered Provider should then introduce the use of dissolving sacks for the handling of soiled linen. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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, 30 The current induction and training records do not demonstrate that staff are provided with the skills and knowledge to perform their roles, though service users were very complimentary about the care provided. There has not been any new staff employed since the last inspection, though the home are fully aware of the need for a robust employment procedure. EVIDENCE: Staffing levels are recorded in the diary. Staff often share roles within a shift, such as cooking and caring or cleaning and caring. Service users were, without exception, complimentary about the staff and the care they provide, saying “nothing is too much trouble”. Staffing levels were appropriate to the care needs of the service users at the time of the inspection. Staff were observed to be caring and respectful of service users during their interactions. Staff training records offer insufficient information and do not demonstrate a commitment by the registered providers to furthering their staff’s skills and knowledge base. Only one staff member has achieved the NVQ Level 2 qualification. The registered providers must arrange for, and record (with evidence such as certificates), staff training relevant to the jobs carried out (e.g. infection control, manual handling, Protection Of Vulnerable Adults) to ensure compliance with regulation 18. The Registered Provider must ensure that induction training for new staff complies with the National Training Organisation (Skills for Care). Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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, 38 The inspector is of the opinion that the registered providers have the service user’s best interests at heart, and this is supported by the positive comments received from service users. There must be adequate administration and management time to ensure this is reflected in the home’s policies and procedures, staff training and staff supervision records. EVIDENCE: The registered providers are in day-to-day control, assisted by their daughter. The registered providers have been working within the care profession for over thirty years; running this home since 1984. Their daughter is the senior carer within the home. There are clear lines of accountability within the home. The registered providers are aware of the need to have a National Vocational qualification at level 4 in management and care. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 18 The registered providers must establish and maintain a system for reviewing and improving the quality of care. The report must be provided to all Service Users, their representatives and the Commission for Social Care Inspection. The registered providers do not handle any service user money, and there is a relevant policy in place. If a service user needs to purchase anything and does not have ready access to the amount needed, the home will provide the money or purchase the item and invoice the service user or their representative. There are no supervision records, though the registered provider’s daughter has carried out two staff appraisals. The Registered Provider must arrange for the regular and recorded supervision of staff to occur at least six times a year. Recording and storage of documents, such as maintenance and safety invoices, is generally disorganised. Requests for documents during the inspection often lead to a ‘search’ being carried out. The Oxford hoist is overdue a maintenance. The registered provider’s daughter agreed to ensure that she would have at least one day per week for managerial tasks. The registered providers must provide for administrative/managerial time, and provide the required records (staff training, maintenance) to ensure compliance with regulations 10, 12, and 13. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 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 OP25 Regulation 13 Requirement The Registered Provider must implement risk-assessments in relation to the risk of scalding from hot water outlets. Timescale for action 01/09/06 2. OP30 17, 18, 19 The registered providers must arrange for, and record (with evidence such as certificates), staff training relevant to the jobs carried out (e.g. infection control, manual handling, Protection Of Vulnerable Adults) to ensure compliance with regulation 18. 17, 18, 19 The Registered Provider must ensure that induction training for new staff complies with the National Training Organisation (Skills for Care). 18 The Registered Provider must arrange for the regular and recorded supervision of staff to occur at least six times a year. Previous timescales not met 01/09/04 01/09/06 3 OP27 01/09/06 4. OP36 01/09/06 Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 21 5. OP33 24 The registered providers must establish and maintain a system for reviewing and improving the quality of care. The report must be provided to all Service Users, their representatives and the Commission for Social Care Inspection. 01/09/06 6. OP38 10, 12, 13 The registered providers must provide for administrative/managerial time, and provide the required records (staff training, maintenance) to ensure compliance with regulations 10, 12, and 13. 01/09/06 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. 2. Refer to Standard OP12 OP15 Good Practice Recommendations The registered provider should ensure more informative entries in the care documentation about service users’ socialisation/recreation/choices. The registered provider should take the responsibility of asking for an alternative from the service user, and ensure that an alternative is offered. The registered providers should ensure that there is a weekly or two weekly menu, which demonstrates the choices available to service users. The registered provider should review and amend the complaints procedure to ensure that it includes the contact details for the relevant Adult Social Care Department. The protection of vulnerable adults and related policies should be reviewed to ensure that staff members know how and to whom concerns may be brought, along with the relevant contact details, and to ensure that any allegation of abuse follows the locally adopted Protection Of Vulnerable Adults procedure. 3. 4. OP16 OP18 Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 22 5. OP26 The registered providers should improve the storage space available in the laundry room to ensure the separation of dirty and clean washing. The Registered Provider should consider the replacement of the existing washing machine with an industrial-type machine with a sluice facility to be better able to cope with soiled linen and enhance infection control within the home. At this time the Registered Provider should then introduce the use of dissolving sacks for the handling of soiled linen. Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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. Extracts may not be used or reproduced without the express permission of CSCI Tropicana DS0000009243.V293180.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!