Care Home: Tregonwell Lodge & Two Wells

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What the care home does well People told us that they were able to choose whether or not they wanted to live in the home. The home assesses people`s needs before they move in so that they know whether or not they can meet their requirements. Care plans are written in a person-centred style and people are encouraged to have ownership of their plan. This is important as it ensures people have some control over the support they receive. The home tries hard to adapt written information into a format that is accessible to people and use photographs to promote understanding. People are given opportunities to make choices and decisions about various aspects of their lives. Their independence is encouraged so that they can lead ordinary lives in their home and community. People we spoke with enjoy the activities that are available to them. The home has done well to tailor activities according to people`s needs and choices, for example, promoting access to work placements where this is possible, supporting people to attend college and offering varied activities as part of the day service. People`s rights are acknowledged and respected and they are encouraged to be part of their local community. People receive support with their personal care to meet their needs in a way that also promotes their independence. Medication is appropriately managed in the home so that people can be confident that they are safe. The home has a complaints procedure which people are aware of. Procedures are also in place with regards to safeguarding adults from abuse and the home has a good track record of responding promptly and effectively to issues that arise. People who live in the home like the environment they live in. The home is undergoing a programme of refurbishment and we saw some evidence of this at the inspection. The Expert by Experience commented positively on the homely atmosphere at Tregonwell Lodge.Recruitment processes within the home are sound and ensure that appropriate checks have been undertaken before people commence work. This is important to ensure that only people who are suitable to work with vulnerable adults are able to do so and that people who use the service are safe. The home has benefited from consistent management over the last four years. The home has its own quality monitoring process which ensures that good standards are maintained. Health and safety checks are in place to ensure that people are safe in the home. People who use the service told us; `I like living here with all my friends. It`s a lovely place`; `I like living here because there`s so much to do!`. The Expert by Experience who was part of the inspection team commented; `Talking to residents, everyone was happy. This was a really nice place to visit and there was a very friendly atmosphere. If I moved into a home I would like it to be the same as Tregonwell`. What has improved since the last inspection? At the last inspection of the home we repeated a requirement for gaps in staff training to be addressed. This has now been done with all staff receiving their mandatory training in the past year. This means that people who use the service can be confident that staff know how to keep them safe and can meet their needs. What the care home could do better: As a result of this inspection we have not made any requirements. We have made three recommendations. These are good practice and should be given serious consideration by the provider. Two of these are in relation to record-keeping which needs some improvement in the specific areas of healthcare appointments and recording individuals` food intake. It is important for these records to be well-organised and sufficiently detailed so that there is a clear audit trail to demonstrate how the home is meeting people`s needs in these areas. We received feedback from care workers telling us that the staffing of the home could be improved. The manager told us that the recruitment and retention of quality staff is an ongoing challenge for the service. This is particularly the case because the home is in a rural village without public transport links and therefore difficult for people to get to. We recommend that the organisation reviews its recruitment and retention strategy for the home to ensure that people who use the service continue to benefit from care workers who know them well and who have the necessary experience to support them. CARE HOME ADULTS 18-65 Tregonwell Lodge & Two Wells Salisbury Street Cranborne Dorset BH21 5PU Lead Inspector Heidi Banks Unannounced Inspection 22nd August 2008 10:50 Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregonwell Lodge & Two Wells Address Salisbury Street Cranborne Dorset BH21 5PU 01725 517458 01725 517918 cranborne@regard.co.uk 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) The Regard Partnership Ltd Mrs Violet Rosetta Alcock Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2007 Brief Description of the Service: Tregonwell Lodge and Two Wells is owned by The Regard Partnership, which is a national organisation running care services around the country. The Regard Partnership took over ownership of the home in April 2003. Tregonwell Lodge and Two Wells provide accommodation for sixteen adults. The home provides care and support to people who have a learning disability. Tregonwell Lodge is a large country property in spacious grounds in the rural village of Cranborne in Dorset. Two Wells is a separate house situated next door to Tregonwell Lodge. People who use the service can easily transfer between the two premises. The home is situated in the middle of the village within walking distance to the local shop, pub, post office and restaurant. The main lodge has ten bedrooms, a communal lounge, kitchen, dining room, shared bathrooms and toilet facilities. In the courtyard there is a further accommodation block providing bedrooms for three people and one shared bathroom. Two Wells is a separate cottage on the same site providing accommodation to three service users including a lounge, dining room, conservatory and kitchen. The grounds of the two houses include a courtyard with seating and workshop areas for computer training and arts and crafts. There is a paddock for a horse and an enclosure for ducks. There is a good-sized area for parking. From information supplied to us in October 2008 by the Registered Manager the current fees for the service range from £667 - £1626 per week. Further information on fees and fair terms of contracts can be obtained from the website of the Office of Fair Trading; www.oft.gov.uk. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection of the service. The inspection took place over approximately twelve hours on two days in August 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the requirement made at the last key inspection in August 2007. At the time of the inspection people living at the home were aged between 19 and 55. For part of the inspection process the inspector was accompanied by an Expert by Experience from Bristol and South Gloucestershire People First. Experts by Experience is a project that involves people who use services in the inspection of those services. Their role as part of the inspection team is help us get a picture of the service from the viewpoint of people who use it. The Expert by Experience, Hayley Hughes, who was accompanied by her supporter, Lesley Doherty, spent time looking around the premises and talking to people who use the service and staff. On the second day of the inspection, the lead inspector was also accompanied by a Pharmacist Inspector, Mary Collier, who specifically looked at arrangements in place to store and administer medication in the home. These findings have been incorporated into this report. During the inspection we were able to meet some of the people who use the service and observe interaction between them and staff. Discussion took place with the Registered Manager, Violet Alcock, and some members of staff in the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were given to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received ten surveys from people who use the service and five surveys from care workers. We received the home’s Annual Quality Assurance Assessment when we requested it which gives us some written information and numerical data about the service. A total of twenty-three standards were assessed at this inspection. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 6 What the service does well: People told us that they were able to choose whether or not they wanted to live in the home. The home assesses people’s needs before they move in so that they know whether or not they can meet their requirements. Care plans are written in a person-centred style and people are encouraged to have ownership of their plan. This is important as it ensures people have some control over the support they receive. The home tries hard to adapt written information into a format that is accessible to people and use photographs to promote understanding. People are given opportunities to make choices and decisions about various aspects of their lives. Their independence is encouraged so that they can lead ordinary lives in their home and community. People we spoke with enjoy the activities that are available to them. The home has done well to tailor activities according to people’s needs and choices, for example, promoting access to work placements where this is possible, supporting people to attend college and offering varied activities as part of the day service. People’s rights are acknowledged and respected and they are encouraged to be part of their local community. People receive support with their personal care to meet their needs in a way that also promotes their independence. Medication is appropriately managed in the home so that people can be confident that they are safe. The home has a complaints procedure which people are aware of. Procedures are also in place with regards to safeguarding adults from abuse and the home has a good track record of responding promptly and effectively to issues that arise. People who live in the home like the environment they live in. The home is undergoing a programme of refurbishment and we saw some evidence of this at the inspection. The Expert by Experience commented positively on the homely atmosphere at Tregonwell Lodge. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 7 Recruitment processes within the home are sound and ensure that appropriate checks have been undertaken before people commence work. This is important to ensure that only people who are suitable to work with vulnerable adults are able to do so and that people who use the service are safe. The home has benefited from consistent management over the last four years. The home has its own quality monitoring process which ensures that good standards are maintained. Health and safety checks are in place to ensure that people are safe in the home. People who use the service told us; ‘I like living here with all my friends. It’s a lovely place’; ‘I like living here because there’s so much to do!’. The Expert by Experience who was part of the inspection team commented; ‘Talking to residents, everyone was happy. This was a really nice place to visit and there was a very friendly atmosphere. If I moved into a home I would like it to be the same as Tregonwell’. What has improved since the last inspection? What they could do better: As a result of this inspection we have not made any requirements. We have made three recommendations. These are good practice and should be given serious consideration by the provider. Two of these are in relation to record-keeping which needs some improvement in the specific areas of healthTregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 8 care appointments and recording individuals’ food intake. It is important for these records to be well-organised and sufficiently detailed so that there is a clear audit trail to demonstrate how the home is meeting people’s needs in these areas. We received feedback from care workers telling us that the staffing of the home could be improved. The manager told us that the recruitment and retention of quality staff is an ongoing challenge for the service. This is particularly the case because the home is in a rural village without public transport links and therefore difficult for people to get to. We recommend that the organisation reviews its recruitment and retention strategy for the home to ensure that people who use the service continue to benefit from care workers who know them well and who have the necessary experience to support them. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they move to the home to ensure that their requirements can be met and to promote a smooth transition. EVIDENCE: We looked at the records for one person who has moved into the home since the last inspection of the service. There was evidence that the home had undertaken an assessment of the individual’s needs which covered their health, medication, personal care requirements, communication, community access, mobility, finances, relationships and work and leisure interests. The person concerned was already known to the home as they had been attending the day service run by the organisation. The person told us that they had been involved in making the choice to come and live at Tregonwell Lodge and had visited the home before moving in. There was some written evidence in the person’s record of these visits taking place including an overnight stay. Nine out of the ten people who responded to the survey told us that they were asked if they wanted to move to the home. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a person-centred approach to care and people are empowered to make choices with due regard for their individual needs. EVIDENCE: We looked at a sample of care plans. The manager told us that every person who lives in the home has an Essential Lifestyle Plan. We were told that they have a copy themselves and a further copy is held in the office of the home. The Expert by Experience talked to two people about their plans – one person knew they had an Essential Lifestyle Plan, the other person was a little unsure about it. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 12 Plans we looked at had been written in a person-centred style and gave information about the person’s needs including things they required help with and things they could do independently. There was also some very good information in the plan about the way the person communicates with people and how staff should respond. Plans detailed people’s likes and dislikes. There was evidence around the home that various notices and information had been translated into a symbols format to promote people’s understanding. We looked at a sample of minutes from residents’ meetings which indicated that people are encouraged to participate in decision-making and express their opinions on different topics. This included discussion around activities, plans for Christmas, household duties, family visits, concerns and complaints and promoting independent living skills. The Expert by Experience noted that people who use the service had been enabled to make choices about where they wanted to go on holiday. This had resulted in three different holidays being planned for small groups of people including a trip to Spain and a canal holiday in the Midlands. The Expert by Experience also noted that photographs are used on people’s timetables so that they know what they are doing each day. Observation of life in the home indicated that people’s independence is promoted. For example, people are encouraged to participate in household chores and meal preparation. Also, where appropriate, individuals are enabled to go into the village independently and use local facilities. Risk assessments were in place for the people whose records we looked at. These showed that consideration had been given to people’s participation in various activities around the home and community. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service enjoy a range of meaningful activities that meet their needs and wishes. They are able to pursue personal interests and fulfil their goals. People’s rights to make choices and be involved in the running of the home are promoted. EVIDENCE: The home operates a day service for people with learning disabilities which is mainly community-based. Inspection of daily records and discussion with residents indicated that activities offered to them include fit club, college, weaving, tai chi, history club, drama, art and craft and swimming, People we spoke with were enthusiastic about the opportunities available to them. People told us that they had been to London to watch one of their peers perform in a Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 14 musical. Another person told us that they were looking forward to visiting a local steam fair. The Expert by Experience noted that one resident who was meant to be visiting their family the following weekend had chosen not to as they did not want to miss a planned trip to Thorpe Park with the other residents. The Expert by Experience also noted that some people who use the service work in the community – one person does work experience with horses which is something they are passionate about, another has a paid job at a coffee shop while another volunteers at a charity shop. The home is located in a rural village where there is no public transport. However, the home appears to successfully overcome this by having a large fleet of vehicles to enable people to attend their various activities and promote community access. All ten people who responded to the survey told us that they could do what they wanted to do during the day, in the evening and at the weekend. The manager told us that people who use the service are well accepted in the village and there is a positive community spirit. People use the local pub and shops, sometimes independently. One person who uses the service told us that they had recently attended a church service in a local village which they had very much enjoyed. They had been supported by staff to do this. This was something they had expressed a desire to do when they were assessed to move to the home. On the first day of the inspection we observed several relatives of service users coming to the home to collect their family member for the Bank Holiday weekend. The manager told us that all the residents have contact with their families and this is something that is recognised as being important to them. The manager has sent out newsletters to families to keep them up-to-date with changes in the home and activities going on to ensure positive links are maintained while respecting people’s right to confidentiality. Discussion with the manager and people who use the service indicated that there is a strong emphasis on people’s rights and responsibilities in the home. People are empowered to take responsibility for aspects of their home, for example, participating in a rota of household chores and through membership of the home’s Health and Safety Committee. The manager is committed to identifying ways in which people who use the service can contribute to the running of the home. Observation showed that people have access to all communal areas of the home and its grounds. People can invite visitors to their rooms. The Expert by Experience observed that during the visit people who use the service were making their own lunch. The Expert by Experience said ‘Staff and residents were chatting in the kitchen and there was lots of happiness, making sandwiches and choosing what they wanted’. Menu records indicated that different options are available to meet people’s preferences. Some entries in menu records were not as detailed as they should be, for example, references to ‘picnic’ and ‘toast and cereal’ were not specific enough to give the reader an Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 15 idea of the nutritional content of the meal or the quantity eaten. It is therefore recommended that the home looks for ways to make recording consistent and sufficiently detailed. People we spoke with told us they enjoyed meals at the home. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people who use the service are met although some aspects of documentation need review to ensure that people’s health issues are clearly recorded. People are protected by the home’s procedures for the safe handling of medicines and are supported to manage their own medicines where possible. EVIDENCE: We looked at a sample of care plans both of which contained information about the individual’s personal care needs, what they need help with and what they can do for themselves. For example, ‘I cannot wash my hair. I do need staff to help me to do this task as I cannot rinse it properly. I like to wash my hair every other day’. Out of five care workers responding to the survey, three indicated that they were always given up-to-date information about the needs of the people they support while two indicated that this was usually the case. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 17 People’s health care needs had also been covered in the care plans including some information about areas in which they need specialist health care support. Discussion with the manager indicated that there was involvement with a range of health care professionals including general medical practitioners, dietitian, chiropodist and psychologist to ensure people’s needs are met. Separate health action plans were also seen to be in place but these were not fully completed. For one person who had recently moved in we were told that the home was awaiting some information from a relative in order to be able to complete the plan. For another person, the checklist had been completed but some other areas had not. We discussed with the manager that there was little use having a health action plan in place if it was not going to be fully completed and used purposefully. We have made a recommendation for the home to review the documentation they have in place to ensure that systems they use work effectively for them and meet the needs of the people they support. We looked at a sample of health appointment records. We noted that information had been recorded in various different places including ‘investigation notes’, the diary and daily records. We recommended that a single system for recording is implemented so that information about individuals’ appointments, and their outcomes, can be found in one place. The manager has drawn up a new recording format in response to this which we suggest that she audits on a regular basis to ensure it is working to good effect. We noted that a system has been developed in the home so that staff accompanying people to appointments have enough information about the purpose of the appointment and to ensure appointments are not missed. People’s care plans specified the help they require around foot and nail care. We noted that most residents are seen by a chiropodist who visits the home every 6-8 weeks. The chiropodist maintains records in the home about each person. The Pharmacist Inspector looked at arrangements for the handling of medicines. Medication is stored securely across the site using separate cupboards for individual residents. This gives people the opportunity to become more independent with their medication if they want to. A controlled drug cupboard is now available in case it is needed. Staff are trained in safe medication handling and two trained staff administer medicines together. Care staff also have extra training for an invasive medicine; the use of which is supported by a clear care plan. Records of all medicines received into the home, sent out with people for visits or returned for disposal are kept and weekly audits take place. Oxygen is stored on site but the warning sign had been removed - this has now been replaced. The medication administration records were not as clear or easy to use as the staff would like but a new pharmacy is taking over their supply and the new forms comply with current good practice guidelines. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 18 Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are protected by systems in place to safeguard their welfare and ensure their rights to complain are upheld. EVIDENCE: The home’s complaints procedure has been converted into symbols format and was seen on display. All the people who use the service who responded to the survey told us that they knew who to speak to if they were not happy and knew how to make a complaint if they needed to. The majority of people told us that their care workers always listened to them and acted on what they said. The manager told us that there had been two complaints made since the last inspection. We looked at the home’s complaints record which showed information and correspondence relating to the complaints raised. We noted that the home had identified through their own quality assurance process that not all relatives of people who use the service were aware of the home’s complaints procedure. There was evidence that the manager had responded to this by sending out a copy of the procedure to all relatives so that they are aware how to raise concerns should they need to. The safeguarding adults procedure for the home was on display in the office. The manager told us that she had drawn this up to incorporate local safeguarding procedures with organisational policy. She told us that this had been distributed to all staff. In the past year the manager has notified us Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 20 promptly of safeguarding issues that have arisen in the home, simultaneously ensuring that the local authority is informed. A care manager we spoke with about one issue told us that the home had communicated with them very well and taken appropriate action to respond to safeguarding issues. Training records that we looked at showed that staff have undertaken training in abuse awareness, this also evidenced by certificates held on their files. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A programme of refurbishment is ongoing to ensure that the home continues to meet the needs of the people who live there and provides a pleasant environment for them. EVIDENCE: The home comprises three separate buildings on the same site. The main lodge which accommodates ten people dates back to the eighteenth century and has three storeys. One bedroom is situated on the ground floor and has an en-suite facility with the remaining bedrooms on the first floor sharing two bathrooms. The stable block accommodates three people with a shared bath and shower. ‘Two Wells’ is a separate cottage in the grounds of the main lodge and accommodates three people. At the time of the inspection there was building work going on at ‘Two Wells’ where a bedroom and en-suite Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 22 facility is being constructed on the ground floor to meet the needs of a person who requires this. A tour of the premises indicated that the main lodge has been redecorated. We saw evidence of new carpets, curtains and some new furnishings in communal areas which have made the environment smarter and more homely. We were told by the manager that ‘Two Wells’ will be redecorated once the building work is complete. The home is set in spacious grounds. There is a paddock for a horse and also an enclosure for ducks. People who use the service are free to walk in the grounds. There is a courtyard area outside the lodge with wooden tables and chairs where people can sit. There is a utility area adjoining the stable block where people can do their laundry. People we spoke with during the inspection told us they liked the home. The Expert by Experience told us ‘The house is lovely’ and commented on the homely atmosphere. She noted that vacuum cleaners and other items were stored in the area where the payphone is situated. It is suggested that this area is kept clear so that people can easily gain access to the telephone when they need to and have privacy when making a call. The home presented as clean at the time of the inspection. Nine out of ten people who use the service who responded to the survey told us that the home was always clean and fresh, one person indicating that this was usually the case. The manager told us that the home employs a part-time cleaner for sixteen hours each week. Their responsibilities are reported to include keeping communal areas clean and tidy but also to clean people’s bedrooms every two weeks. Paperwork we looked at indicated that key workers are also responsible for supporting people to clean and tidy their bedrooms on a regular basis. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are sound processes in place for the recruitment and training of care workers to ensure they are safe to work with vulnerable people and are able to meet people’s needs. Review of recruitment and retention strategies is recommended, however, to ensure that people who use the service continue to benefit from a consistent and experienced staff team. EVIDENCE: The Regard Partnership have an agreement with the Commission for staff recruitment records to be held centrally at their Head Office. A sample of these are audited on behalf of the Commission by a Provider Relationship Manager, the most recent audit taking place in September 2008. The Provider Relationship Manager has told us that policies and procedures in relation to staff recruitment were comprehensive and well-written. The records they audited showed evidence of good recruitment practice with a written record of the interview being in place and evidence of appropriate checks being undertaken before employment started. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 24 We received feedback from five care workers employed to work in the home about staffing levels. Two people told us that there were usually enough staff to meet the individual needs of all the people who use the service. Two people indicated that there were only sometimes enough staff on duty and one person said that this was rarely the case. Comments received were as follows; ‘We suffer from chronic short-staffedness. We appear unable to keep the majority of new recruits and rely heavily on agency cover’; ‘Experienced staff are overworked, underpaid and…rather unappreciated’; ‘Always short-staffed’. In the section of the survey titled ‘What could the service do better’ we received comments including ‘Pay-scales’; ‘Treating experienced long-serving staff well so that they don’t leave’; ‘Support the staff’. The manager told us in the home’s Annual Quality Assurance Assessment that staff recruitment and retention had been a barrier to their improvement in the last twelve months; ‘We have lost staff due to other services offering more money and with no transport links we are finding it difficult to recruit staff.’ This has the potential to affect the consistency and continuity of care provided to people who use the service. The manager told us that they have tried to reduce the impact of these barriers by actively recruiting, getting existing staff to do overtime and by use of agency staff. We looked at records to see how many agency staff were being used at the home. These showed that since 1st July twenty shifts had included the use of one agency worker. We asked to see information about the agency workers that had worked at the home. The manager was able to produce information for some workers immediately but was not able to locate all the information on the first day of the inspection. By the second day the manager was able to show us the information received about all agency workers, reporting that the information had been stored in a different place in the office. We suggest that the manager ensures that information is stored in one secure place so that it is easily accessible. The manager told us that three new staff had recently been appointed who were due to commence on 1st September. She told us that this would mean that the home would be fully-staffed and thus it is expected that the use of agency workers will be reduced. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 25 At the last inspection we repeated a requirement regarding staff training as training records we looked at showed a number of gaps where people had not received all the training they needed. Care workers told us in surveys at this inspection that they were being given training that is relevant to their role, helps them understand and meet the individual needs of people who use the service and keeps them up-to-date. One person told us ‘Mandatory training is done when needed…all staff are up-to-date and re-do the training when needed’. The manager gave us a written record of training that had taken place. She told us that there had been a substantial investment in training since the last inspection to ensure that the requirement we made was fully met. The manager has told us that monthly training audits are taking place to ensure that people are up-to-date with their training. We looked at a sample of certificates on individuals’ files which corresponded with the training record. Of the three files we sampled all staff had undertaken their mandatory training. All had also undertaken training in epilepsy as there are some people who use the service with this condition. Two of the three people had also undertaken training in person-centred planning. The manager has told us in the home’s Annual Quality Assurance Assessment that in the last twelve months they have completed personal development plans with staff which highlight additional specialist training that is needed and they aim to action this in the next year as far as the home’s budget will allow. The manager has told us in the home’s Annual Quality Assurance Assessment in that more than 50 of staff working at the home hold a National Vocational Qualification at Level 2 or above. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well-run and has appropriate procedures in place to ensure that people who use the service are safe. EVIDENCE: The Registered Manager of the home, Mrs Violet Alcock, has been managing Tregonwell Lodge for the past four years. She has appropriate qualifications to equip her for her role including the Registered Manager’s Award. The home has a deputy manager who has a National Vocational Qualification at Level 3. The manager has told us in the home’s Annual Quality Assurance Assessment that the deputy is currently undertaking the Registered Manager’s Award. Care workers spoken with at the inspection spoke highly of the manager and Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 27 her enthusiasm for the home and commitment towards people who use the service. We looked at the various ways the home obtains feedback from people who use the service. We noted that there are regular meetings for people who use the service held in the home. We also saw in individual records that a system is in place whereby people who use the service are supported to complete quality questionnaires on a monthly basis which looks at areas such as their satisfaction with the home, their bedroom, staff, choice of activities and the support they receive. We were told that key workers support individuals with completing these questionnaires. The sample of questionnaires we looked at were not always dated and it is suggested that this is done so that there is a clear record of issues arising. We would also suggest that the home looks at ways in which people can be supported to express their views independently of the staff who support them, for example, by using a person who is not connected with the service. The manager told us that questionnaires had been distributed earlier this year to relatives of people who use the service and care professionals who have contact with the home. These looked at issues around privacy, people’s needs, rights and choices and people’s awareness of the home’s complaints procedure. Comments received by the home through this process included ‘The staff are very friendly and accommodating’; ‘Very responsive staff’; ‘Very person-centred’. We noted that where some people had indicated that they were not aware of the home’s complaints procedure the manager had enclosed a copy of the procedure with her response to the survey to all relatives. On the first day of the inspection a manager from another service run by the organisation was visiting the home to undertake a visit under Regulation 26. The manager told us the The Regard Partnership used to employ a Quality Team who would undertake these visits but now this responsibility had been allocated to managers of services. The manager told us that a fire risk assessment for the service had been completed in November 2007. A system for auditing accidents is also in place, records being returned to Head Office on a monthly basis. The manager expressed concerns that the steps leading to the back door of the lodge were posing a fall risk to people who use the service. She reported that a risk assessment is being completed and they are looking at ways to reduce the risk including coating the steps in rough concrete. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 28 We looked at a sample of temperatures for the home’s refrigerator and freezer facilities. These records were seen to be up-to-date. We have been advised by the manager that testing of portable electrical appliances is also done annually, organised by Head Office, to ensure that appliances are safe to use. As indicated in the section on ‘Staffing’ the home has now responded to the outstanding requirement on staff training. The records we looked at showed that staff have now undertaken training in First Aid, Moving and Handling, Health and Safety and Fire Safety. Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 30 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. 1. Refer to Standard YA17 Good Practice Recommendations The home should review recording of individuals’ food intake to ensure records are sufficiently detailed so that the reader is able to determine whether their nutritional intake is sufficient and meets their needs. The home should review the way in which people’s health care appointments are recorded to ensure there is consistency in the documentation used and records are clear. The home should review their recruitment and retention strategies to ensure that people who use the service benefit from consistency and continuity of care from experienced staff. 2. YA19 3. YA33 Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tregonwell Lodge & Two Wells DS0000034481.V367085.R01.S.doc Version 5.2 Page 32 - 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. 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