Care Home: Trelawne

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What the care home does well People living at Trelawne speak highly of the staff and of the meals offered. Trelawne continues to provide care of an intuitive nature, supporting people in an environment that is homely and well maintained. All people spoken with were positive about the home and the people living there appeared at ease and were happy to talk to us. Interactions between staff and the people living at Trelawne observed during this inspection were positive. Staff at Trelawne were positive in their approach to their work and worked well together to meet the needs of those living at the home. The staff respected the needs and rights of those living at Trelawne. What has improved since the last inspection? Some improvement has been noted to care plans whereby they have become more person centred and include life maps. It was noted that care records had improved with regard to the frequency of reviews, and individual plans show details of all the assessed needs. Greater attention is being paid to daily recordings and assessment recording. Risk assessments are generally all in place now. It was noted at the home`s last inspection staff records had improved with all required pre-employment checks being conducted and appropriate documentation maintained. Service user records had also improved and showed evidence of regular review. All radiators in communal areas of Trelawne have now been guarded to reduce surface temperatures and therefore minimise the risks to those living at Trelawne. It is however acknowledged that the AQAA submitted for this inspection was more objectively completed with more detail and specific development actions and plans clarified. What the care home could do better: Through assessment and consultation with service users the team at the home must ensure that residents` individual social care needs are met and that their independence and self worth is promoted. Social histories of residents should be completed and consideration should be given to ensuring residents are provided with appropriate activities that meet their interests and wishes. Improvements need to be made in the range of activities available to people living at Trelawne. One radiator which is still not covered, in an area where service users may be at risk i.e. the bedroom should be risk assessed. Trelawne still needs to develop a robust quality assurance process to demonstrate the home is run in the best interests of those living there, as well as a business plan to show the home`s continued financial viability. At the last three inspections, there has been only slow progress in relation to meeting the requirements made. The requirements made at the last inspection have only decreased marginally, two were met, with three being repeated. The manager is aware of the importance of ensuring these be met and had assured us at the last inspection that this will be the case by the next inspection, and that has not happened in totality. Additionally four recommendations were made at this inspection. Key inspection report Care homes for older people Name: Address: Trelawne 31 Lancaster Gardens West Clacton On Sea Essex CO15 6QG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Laker     Date: 1 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Trelawne 31 Lancaster Gardens West Clacton On Sea Essex CO15 6QG 01255220259 NA Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Monica Roberts care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Trelawne Rest Home is situated in an established area of Clacton-on-Sea, known locally as the Gardens, close to the sea front and within easy walking distance of all local amenities. The home is registered for thirteen older people. The registered person is Mrs Monica Roberts who has managed the home for a number of years. The home provides accommodation on two levels. A passenger lift is provided for access to the first floor. A number of communal areas are available. The home has a large garden area to the rear of the property. The fee range for the home ascertained at this inspection was between 390.39 pounds - 420.00 pounds per week, additional charges are made for the following: Hairdressing, Chiropody, and Toiletries. Care Homes for Older People Page 4 of 28 Over 65 13 0 2 0 0 5 2 0 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star This means the people who use this service experience adequate quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The inspection focused on all of the key standards. A tour of the premises was undertaken. Discussions were held with people living at the home and staff on duty, as well as the opportunity to look at most records of how people living at Trelawne were supported and how staff were recruited and trained. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some progress be noted as this contributes to the inspection process Care Homes for Older People Page 5 of 28 and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. The judgements made within this report are based upon evidence found on the inspection visit along with information submitted by the service and feedback from service users, staff and other parties since the previous inspection. The previous inspection report was also reviewed and five surveys were returned by service users, and three by staff to the CQC. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 28 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that their needs will be considered before any agreement to their admission and that they will receive information to enable them to make a positive and informed choice about where they wish to live. Evidence: The home has a published Statement of Purpose and Service User Guide, both of which are made available to existing and prospective residents at Trelawne. Copies of these were seen in residents care plans. The examination of two care records showed that people living in the home had their individual needs assessed and these assessments formed the basis of individual care plans. The AQAA submitted states We have a comprehensive assessment tool to use prior to admitting a service user to the home. The tool ascertains the physical, social and emotional needs of prospective service users. This is used to plan their care in a Care Homes for Older People Page 10 of 28 Evidence: person centred fashion. Two residents spoken with on the day of inspection both confirmed that they did have enough information about the home to enable them to make an informed choice and the most recent resident admitted to the home confirmed that they had been involved with the admission process and relatives visited the home prior to their admission. Discussions with the staff and service users supported the evidence found in care records and indicated that admission assessments gained views and insights from the individual, and their families and professionals were involved in the individuals care. The homes AQAA also identifies that Quite a number of our service users have been admitted to Trelawne via recommendations from people who regularly visit the home for example chiropodists and visiting professionals. Comments from people who recommend us include comments such as we have a very welcoming atmosphere, the staff are friendly and the environment is very clean. The feedback gained from surveys and residents spoken with on the day of inspection show that the information given to them is accurate and gives them informed choice. At the last inspection in May 2009 we were informed that improvements to be made were that pre admission visits to the home with service users and their relatives will be a more inclusive process involving all members of the staff team. Discussions with the staff team and service users, combined with survey feedback confirmed this is now happening and documentation has improved and is now more detailed and informative. Trelawne does not provide intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed in a person centred way that enables staff to have a better understanding of each individual and the care and support that service users need is planned and recorded sufficiently well to guide staff in promoting their well being and safety. Evidence: At the homes last inspection in May 2009 it was noted that there was an existing care planning system in place consisting of an assessment, care plans and risk assessments. Care plans seen at this inspection cover the residents identified needs. They are informative and contain sufficient detail to ensure residents needs can be met. Also at the homes last inspection it was noted that not all paperwork had been sufficiently completed highlighting a support need for staff via training. Clear progress has been made in this area and care plans now include information on personal preferences and use a more person centred approach concentrating on strengths, rather than needs and putting support in place to optimise residents abilities. Life Care Homes for Older People Page 12 of 28 Evidence: maps have been developed which correlate with the residents care plan. The examination of three care records and individual plans of care showed that there had been improvements to the frequency of the reviews of plans. The quality of daily entries in the evaluations were noted to be much more specific and detailed and less repetitive. The homes AQAA acknowledges that We could monitor and evaluate more effectively what care staff document on the care plan as documentation needs to reflect changes in a residents care. A need to further develop skills in documenting care more objectively rather than making vague statements such as slept well, we feel this has improved with training Residents spoken with were positive in their comments relating to staff members understanding of their current needs and staff spoken with showed a good awareness of service users needs. A monthly review system is in place and undertaken by key workers, and this is generally consistent. Those seen completed show a good staff appreciation of residents needs and changes, although attention is still required to include dates, times and signatures on documentation. This was discussed with the staff on duty on the day of inspection. A range of risk assessments are completed that include manual handling, falls, general and environmental and nutrition. Evidence that these are kept under review were on file and in general do contain sufficient detail. Of the care plans reviewed only one person who was prone to falls did not have an assessment in place. A discussion with the staff was held regarding this and short and long-term goals, and staff should ensure that identified risks are reflected in the care plan so that the management of the risk is clear. The AQAA further advises us that over the next twelve months the home plans to Re visit the risk assessments to identify service users changing needs and continue to develop strategies to incorporate the values and beliefs of each person in their care The homes general policies and procedures and practices for the storage, administration and recording of medicines were seen to be appropriate and offered sufficient protection to those living at Trelawne. The proprietor was advised at the last inspection and this one that all transcribed medications should have two signatures and this was noted to still require attention at this inspection. The observation of interactions between staff and people living at the home provided evidence that people were treated with respect and their right to privacy was upheld. Staff were seen to knock on doors before entering private bedrooms and address those living at the home in a respectful and caring manner. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People who use this service could be better supported to have opportunities to be part of the local community and are able to maintain contact with their family and friends following a lifestyle they would choose. Evidence: The examination of social care plans within the home showed there were activities on offer to people living at Trelawne. There was a programme displayed on the wall showing tabletop activities on a daily basis and records were maintained detailing how people had participated and whether they had appeared to enjoy the activity. Staff spoken with stated Activity provision is difficult as sometimes residents prefer not to do anything The homes AQAA identifies under what they could do better, We plan to introduce more social activities depending on individuals choice and to value the views of residents as an integral part of this One service user spoken with stated I can go out but am about the only one who can. the other people need help. On the day of inspection there were no planned activities taking place, music was playing in one lounges, two service users were in their rooms, and one being visited by relatives. Some people living at Trelawne are more independent and were able to independently Care Homes for Older People Page 14 of 28 Evidence: pursue activities outside of the home, others can be supported to go to the shops or to the seafront. The home does not have an activities coordinator and care staff therefore undertake any social activity either on a one to one basis or in groups. However staff agreed on the day of inspection that not many activities take place within the home and this could be improved upon. Discussions with staff and with people living at the home generally indicated that the activities when offered were enjoyed and people generally felt there was something to do. Care records showed that people living at Trelawne were encouraged to make decisions about how they lived and how they spent their time. However there were some time gaps in recording. A discussion with the manager at the homes last two inspections and also with the staff at this one again highlighted the need for consistencey with entries and recording one to one or group activity participation. The homes AQAA identifies the need for the home to research new skills and undertake training to meet all the diverse needs of the service users. It states At present our activity schedule is tailored towards group interaction. We want to develop an approach which meets individual wishes a bit more. We want to promote escorted visits to the town to ensure those residents who wish to be more integrated with the community benefit. We are also hoping to explore ideas of introducing the internet and would like to foster links with external organisations such as Help The Aged The home is open to visitors at any time and people living at Trelawne stated that they had regular contact with relatives and friends. There were some visitors in the home at the time of inspection and all spoke of being made to feel very welcome at Trelawne. People living at the home spoke well of the food offered at Trelawne. Records showed there was a good range of meals provided and snacks and drinks were available throughout the day. The main meal of the day was served at lunchtime. On the day of inspection this consisted of lamb stew, brussel sprouts, potatoes and ice cream. This was seen to be nutritionally balanced and attractively presented. The home generally provides choices on a daily basis and set menus are not in place. The manager/proprietor usually undertakes the cooking duties but on the day of inspection was on holiday so a member of staff took over the task. A discussion was held with staff regarding the appropriateness of them undertaking kitchen duties whilst in a caring role. This is not considered best practice for health and safety cross infection reasons and also because on the day of inspection there were only two members of staff on duty in total for eight residents. Therefore designated kitchen staff should be available at all times with separate staff undertaking a caring role. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can expect that they will be listened to through the homes complaints and safeguarding adults systems. Residents can also be assured that all carers are trained to safeguard their welfare. Evidence: Trelawne has a robust and accessible complaints procedure and appropriate Protection Of Vulnerable Adults protocols that are understood by staff. Service users spoken with felt safe at the home and indicated that they could raise issues of concern with the proprietor/manager and these would be acted upon. Staff spoken with were aware of whistle blowing procedures and had attended POVA training and were aware of the safeguarding procedures. We have not been made aware of any complaints and no safeguarding referrals have been made in the last twelve months. The homes AQAA identifies the need for staff to be vigilant via audit and recording processes. The complaints procedure was noted to require updating with the CQCs new address. Care Homes for Older People Page 16 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The home provides a safe, well-maintained environment that is accessible to the people who live there, homely and meets their individualised needs. Evidence: The home employs a handyman and a domestic who maintain Trelawne to a good standard. All areas are generally well decorated, clean and free from offensive odours. At the last inspection there were radiators in some rooms that had not been covered and, although the proprietor/manager believed these to be safe, there was no evidence of risk assessments being conducted. Risk assessments have now been conducted to assess the safety of all radiators through Trelawne. All radiators now have covers on except one which is to be risk assessed and a guard provided as the resident wishes to use this radiator to air towels on. A discussion with the maintenance man on the day of inspection was held regarding this and he stated he would convey the issue to the proprietor who would systematically deal with it. The AQAA states The kitchen has now been refurbished and we are to conduct monthly audits of all equipment in the home and report any faults or items which need serviceing Risk assessments must be more stringent and checks on water temperatures must be enforced. The maintenance person spoken to on the day of inspection stated that water temperatures are tested intermittently but agreed there Care Homes for Older People Page 17 of 28 Evidence: was no documentation to evidence this. He agreed to ensure all maintenance tasks are documented to ensure a clear audit trail and also confirmed that the boiler had been serviced and some thermostatic valves had been replaced since the last inspection. The home is furnished in a domestic style and overall meets the needs of people living there in a homely fashion. The home is considered fit for its stated purpose, accessible and safe. There were sufficient bathrooms and WCs and all but two bedrooms had en-suite toilets. Individuals spoken with living at the home expressed satisfaction with their environment and were happy to allow us access to their rooms. Rooms were noted to be personalised to individual taste and looked homely and inviting. Care Homes for Older People Page 18 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can expect to be protected by the recruitment processes of the home which have sufficient safeguards in place to ensure residents are protected. Evidence: Discussions with the manager and the examination of records showed that staff were employed in adequate numbers to meet the needs of those living at the home. At this inspection staff numbers were deemed appropriate for the dependency levels of the current client group. Staff spoken too felt they were able to meet service users needs in full and confirmed that they felt enough staff were employed on each shift. On the day of inspection two staff were on duty for eight residents. The home has not recently recruited any new staff but the manager said they were aware that new staff would be needed when the numbers of residents increased. The six staff files seen were for staff who had worked in the home for a period of time. There was evidence that checks on identity had been carried out as well as a criminal records bureau (CRB) check but two files only had one reference in place. This was raised with the proprietor who is also the manager who said new staff would have references taken up and they were aware of the importance of doing this to protect the residents. Discussions with those living at the home gave evidence that they felt safe at Trelawne and that they felt staff were able to meet their needs. Duty rotas were seen Care Homes for Older People Page 19 of 28 Evidence: and clarified the ratio of staff on duty in relation to the number of current service users and dependency levels. The AQAA submitted states The staff structure does fluctuate at times however the last year has seen a more stable workforce. There are sufficient numbers for us to meet the needs of the residents. Rigorous recruitment procedures are in place. All staff have attended skills for care induction and 95 percent of staff are training to NVQ level 2 or above. Training records showed first aid, care planning, POVA and moving and handling were all areas that had been covered by courses. The AQAA further informs us that over the next twelve months We plan to train all staff in dementia Care Homes for Older People Page 20 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents living at the home can expect to be supported by leadership who have demonstrated their suitability for the role. Service users are generally protected by the home health and safety practices. Evidence: The management of the service is respected by staff and residents and discussions with the inspector all referred to her leadership and the confidence this provided to both staff and residents. The home is managed by the proprietor who has a number of years experience in caring for the client group. She was undertaking her NVQ level 4 in management and attended the training sessions that are available to the staff group. The AQAA submitted for this key inspection included a statement by the manager saying I have a democratic approach to manageing the home. I have a relaxed approach and service users are the priority. I live on the premises and am aware of all Care Homes for Older People Page 21 of 28 Evidence: the activities in the home. I work most days at the home and rely on a small core number of staff to support me. The personal touch is evident and we have a professional relationship with the local GP, Pharmacist and District Nurses. We are also informed in the AQAA that the manager has now completed her learning and management course NVQ level 4. Discussions with staff and people living at the home showed that the general ethos of the home is open and understanding. Residents were happy at the home and with the way in which it was operated, comments such as It is like staying with family and I get everything I need done for me gave an indication of their strength of feeling. There was no evidence to inspect to support staff or resident meetings being held although it was noted at the homes last inspection in May 2009 that there was an intention to recommence these. Staff spoken with stated that although formal meetings were not always held they were open with the manager about issues and she actively dealt with issues and encouraged them to do further training. We are further informed that views of those living at the home are sought through questionnaires although there was no evidence of a formal quality assurance process being undertaken. A requirement made at the last three inspections was that of a business plan being in place for the home to demonstrate its continued financial viability. This could not be verified at this inspection. A quality assurance system should be in operation in the home with questionnaires provided to residents, relatives, and health and social care professionals and staff. The results should then be audited and used to produce a business plan for the coming year, a copy of which is then provided to the CQC. The AQAA does however acknowledge that the manager recognises that she should prioritise her time better and include an even balance of required managerial administrative tasks, rather than devoting all her time to care tasks. She agrees that she is quite laid back with her attention to documentation and that this must improve. The AQAA submitted for this inspection was noted to have improved and include a lot more detail than the last submission. The AQAA also states that the manager has devoted more time to ensuring training and informal supervisions for staff have been addressed. Staff files contained some copies of line management supervision and individual development plans. The supervision records although infrequent demonstrated that staff do receive some feedback on their performance as well as an opportunity to add to their personal development by identifying training to support them. Staff spoken with maintained that supervision does take place and overall felt the sessions were beneficial to their practice and development. The AQAA also identifies that the service aims to ensure staff receive more consistent formal supervision. There were appropriate policies and procedures in place regarding the health, welfare Care Homes for Older People Page 22 of 28 Evidence: and safety of those living in Trelawne, staff and visitors which included electrical and gas safety checks which had been conducted at appropriate intervals and the home displayed relevant insurance and registration Certificates. Records relating to the maintenance of equipment and health and safety requirements were considered at this inspection. These included documentation such as certificates for gas, electric, fire records, hoist and lift maintenance. These documents were present and in date for their annual checks. Fire procedures were displayed in prominent positions and regular checks of fire alarms and safety equipment had been undertaken. This was confirmed in discussions with the maintenance man. Evidence of fire drills being undertaken was available but must be maintained regularly with drills documenting all names of staff attending. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 Through assessment and 31/08/2009 consultation, the team at the home must ensure that residents individual social care needs are met and that their independence and self worth is promoted. Social histories of residents should be completed with staff being aware of the content. Consideration should be given to the appointment of an activities officer To ensure that residents individual and group social needs are met. 2 33 24 The registered person shall 31/08/2009 develop a formal process for assessing the quality of the service provided at Trelawne to ensure the home continues to operate in the best interests of the people living there. To ensure service users health safety and welfare is promoted 3 34 25 The registered person shall 31/08/2009 develop a business plan for Trelawne to demonstrate the continued financial viability of the home. To ensure service users Care Homes for Older People Page 24 of 28 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action health safety and welfare is promoted Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Through assessment and 30/06/2010 consultation, the team at the home must ensure that residents individual social care needs are met and that their independence and self worth is promoted. Social histories of residents should be completed with staff being aware of the content. Consideration should be given to the appointment of an activities officer To ensure that residents individual and group social needs are met. 2 33 24 The registered person shall 30/06/2010 develop a formal process for assessing the quality of the service provided at Trelawne to ensure the home continues to operate in the best interests of the people living there. Care Homes for Older People Page 26 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure service users health safety and welfare is promoted 3 34 25 The registered person shall 30/06/2010 develop a business plan for Trelawne to demonstrate the continued financial viability of the home. To ensure service users health safety and welfare is promoted Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 All transcribed medications should have two signatures to ensure mistakes in administration are avoided and that residents are protected Sufficient kitchen and care staff should be on duty in such ratios to undertake seperate roles and duties so that all residents needs can be met The registered person shall make sure there are risk assessments conducted to assess the safety of all radiators through Trelawne and take appropriate actions to minimise the risks these present. This will safeguard residents from harm. Staff must have regular supervision and the staff supervision system needs to be developed further to ensure staff are competent to meet service users needs. This will ensure service users health safety and welfare is promoted 2 15 3 25 4 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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