CARE HOMES FOR OLDER PEOPLE
Troutstream Hall Chorleywood Road Rickmansworth Hertfordshire WD3 4EX Lead Inspector
Yoke-Lan Jackson Unannounced Inspection 25th January 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 Troutstream Hall DS0000019598.V280580.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. Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Troutstream Hall Address Chorleywood Road Rickmansworth Hertfordshire WD3 4EX 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) 01923 772 703 01923 770 486 Troutstream Hall Trust Ms Karen Steffe Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for 21 people with old age. Date of last inspection 15th July 2005 Brief Description of the Service: Troutstream Hall is a residential home for 21 service users in the Old Age category. It is provided by Troutstream Hall Trust, a Christian Charitable Trust. The building is a large detached house that has been converted into a care home. It is situated in a quiet residential area near to the village of Rickmansworth. The M25 and M1 motorways are a few minutes drive away. There is a driveway with parking spaces to the side. The spacious entrance hall leads to the dining room and kitchen. The staff room and the laundry room are also on the ground floor. The bedrooms, of varying sizes, are on the ground and first floor, which is served by a lift. Each bedroom has a hand basin. The toilet and bathroom facilities are nearby. The communal rooms include two well proportioned lounges. The administrative office and the staff training room are on the top floor. There is a lift to the second floor There is an attractive front and back garden, surrounded by mature trees and bushes. The patio areas have garden furniture and potted plants. All the rooms and gardens are accessible to wheelchairs. Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 25th January 2006. The registered manager and the deputy manager were present. There were 19 service users in the home. Most of the service users were resting in their bedrooms when the inspector arrived. A number of them were interviewed about the service and care provided. They responded with positive comments. All the service users appeared well dressed and well cared for. The care plan files and medication charts were examined. The inspection included a conducted tour of the premises, including the new office and the training room, both situated on the top floor. (Please see below for details of the inspection findings). What the service does well: What has improved since the last inspection?
The standard of service, especially the administration of medication and record keeping is well maintained since the management of services was restructured with the appointment of a new deputy manager to assist. Staff have well defined roles and responsibilities and they are encouraged and supervised to perform those tasks to a high standard. The administrative office has been moved to the top floor. The vacant office is currently being renovated to provide an additional bedroom with en-suite facilities. The training room on the top floor is now in full use, with teaching aids and other equipment in place. Troutstream Hall DS0000019598.V280580.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. Troutstream Hall DS0000019598.V280580.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 Troutstream Hall DS0000019598.V280580.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): 1, 2, 3, 4, 5. A comprehensive assessment is carried out before the prospective service user is admitted into the home. A trial period is arranged before the contract is agreed. EVIDENCE: The Statement of Purpose has been updated. Each service user has a Service User Guide given at the time of admission and it is kept in their bedroom. A service user who was recently admitted confirmed that a full assessment was carried out before she moved into the home. Troutstream Hall DS0000019598.V280580.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. The care planning system ensures that the health and personal care needs of the service users are being met. They are treated with respect and their right to privacy is upheld. The administration of medication is in accordance with legislation. EVIDENCE: The written care plan of each service user has been reviewed and updated since the last inspection. A senior carer has been assigned to check all the care plans to ensure that they are consistently maintained and updated. The administration of medication is well maintained. All records are accurately completed and they are up to date. Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 10 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. The service users are given every opportunity to participate in all aspects of routine living. They are encouraged to maintain links with their family and friends. The meals provided are nutritious and balanced. Choices are given. EVIDENCE: The home has no activity co-ordinator. Staff are involved in the daily activity. One service user interviewed said that she prefers to do her daily walking exercise outside the premises. Her wishes were respected. The service users interviewed are pleased with the meals provided. The menu is reviewed regularly. The preferences of service users are taken into consideration. The service users interviewed confirmed that their family members do visit them. On the day of the inspection there were no visitors in the building. Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 11 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, 17, 18. The home has a robust Complaints’ Policy and Procedure. Complaints are dealt with appropriately. EVIDENCE: All concerns raised are dealt with immediately and appropriately. Staff have training to ensure that the Adult Protection Procedure of the Hertfordshire Social Services is followed correctly if needed. They are aware of the Whistle Blowing policy Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 12 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, 20, 21, 22, 23, 24, 25, 26. Service users live in a clean and homely environment. The facilities provided are adequate and well maintained. The management must ensure the safety of the service users and staff while renovation work is carried out to transform the vacant office into an en-suite bedroom. EVIDENCE: The premises appeared homely and clean. There is an ongoing maintenance programme. The administrative office has been moved to the top floor. The vacant office is currently being renovated to provide an additional bedroom with en-suite facilities. The training room on the top floor is now in full use, with teaching aids and other equipment. The gardens are well maintained. The registered manager has assured the inspector that more evergreen trees will be planted in the coming weeks to make the back garden more attractive and to provide additional fencing to the existing metal fence.
Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 13 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 staffing level is adequate. Staff are trained and supported by management to do their jobs. They have well defined roles and responsibilities. EVIDENCE: Individual staff are supervised and encouraged by the registered manager and the deputy. They are given clearly defined tasks and have the information they need to do those tasks. Staff interact well in performing those tasks and they work as a team. Appropriate training is arranged for staff to ensure that the needs of the service users are met. Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 14 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, 32, 33, 36, 37, 38. The administration and management of the home is well maintained. The home is run in the best interests of the service users. Their health, safety and welfare are promoted and protected. EVIDENCE: The management restructuring has improved the administration and management of the service, which is now well maintained with the assistance of a deputy manager, appointed since the last inspection. Staff are given specific tasks and they are encouraged and supervised to perform those tasks. In particular , the standard of administration of medication and record keeping, including written care plans has improved. Service users interviewed gave positive feedback regarding the care and service provided in the home.
Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 15 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 16 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Troutstream Hall DS0000019598.V280580.R01.S.doc Version 5.1 Page 17 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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