Care Home: Trelawney House

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What the care home does well The physical environment of the home is pleasant, comfortable and well maintained. People using the service were all complementary about their care, the food, and the staff that support them. Records are maintained to a good standard. We are very pleased with the on going improvement of this service, and the commitment of the registered persons have shown to bring this improvement about since 2007. What has improved since the last inspection? There has been significant improvement to this service since 2007. Since the last inspection care planning and record keeping has improved, there is improvement regarding the storage of medication, there has been improvement regarding recruitment checks on staff and staff training, and there have been improvements to health and safety standards at the home. What the care home could do better: One statutory requirement has been set regarding improving staff reference checks, although this has continued to improve since we last inspected this service. We have given some advice, in the text, to help the registered provider to continue to bring about improvement but this service is now considered to be well managed and have positive outcomes for the people living there. Key inspection report Care homes for older people Name: Address: Trelawney House Polladras Carleen Helston Cornwall TR13 9NT     The quality rating for this care home is:   two star good 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: Ian. Wright     Date: 1 0 1 1 2 0 0 9 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 23 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Trelawney House Polladras Carleen Helston Cornwall TR13 9NT 01736763334 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rigas Gatzianidis,Mrs Christine Anne Gatzianidis care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To include one named service user with dementia which is outside the registered category. Date of last inspection Brief description of the care home Trelawney Care Home is situated in Polladras, approximately five miles from the town of Helston. The registered persons provide residential care for up to eleven elderly people. Day-care is also available for people living in the community. The home is set in spacious grounds in a very pleasant rural setting. There is sufficient car parking available. Accommodation is on two floors; the first floor can be accessed by a passenger lift. There are two lounges. Meals are cooked in a large kitchen and served in the dining room. Trelawney provide a meals on wheels facility to people in the community. The registered providers are actively involved in the day-to-day running of the home. A team of care staff provide personal care and support. There are opportunities for socialising and visitors are encouraged. A copy of the inspection Care Homes for Older People Page 4 of 23 Over 65 11 0 1 8 1 1 2 0 0 8 Brief description of the care home report is available from management or free from CQC via our website or customer services helpline. The range of fees at the time of the inspection is £375-£475 per week. There are additional charges e.g. for hairdressing, chiropody, trips out and newspapers etc. Care Homes for Older People Page 5 of 23 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: two star good 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: One inspector completed this unannounced inspection in one day. The methodology used for this inspection was: *To case track people who use the service. This included, where possible, meeting and discussing with the people concerned their experiences and inspecting their records. *Discussion with other people who use the service and their representatives. *Observing care practices. *Discussing care practices with management. *Inspecting records and the care environment. *Carrying out a confidential postal survey to ascertain the views of people who use the service, staff who work there and professionals who work with the service. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report.) Care Homes for Older People Page 6 of 23 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 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 7 of 23 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 8 of 23 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. Information provided to people who use the service (e.g. regarding services offered) is satisfactory. For example all people who use the service receive a statement of terms and conditions of residency or contract when they move in. This ensures people are aware of their rights and responsibilities. Pre assessment procedures are satisfactory and should help to ensure the registered provider checks they can meet the persons needs before admission is arranged. Evidence: The registered provider has a satisfactory approach regarding pre admission assessment. We inspected pre admission assessments for four people, and records are to a good standard. Some of the people we spoke confirmed they recall being involved in the process. We were able to inspect contracts / statements of terms and conditions of residency for two people using the service, and information was satisfactory. Care Homes for Older People Page 9 of 23 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. Health and personal care needs of people living in the home is satisfactorily promoted and met, which should give people the assurance that they will be well looked after at this home. Evidence: A care plan was contained in the files for the people we case tracked. These contain satisfactory information and there is evidence care plans are reviewed. Care plans are accessible to staff. Risk assessments including a moving and handling assessment were also contained on each file. People who use the service, who we spoke to, were positive about the care they received. People who use the service said they were satisfied with the health care support they receive. This includes visits from GPs, district nurses, chiropodists, dentists and opticians. Records regarding these medical interventions are adequate, but they do need to be contained in one place. It should be possible to ascertain when a person using the service saw each type of medical professional at a glance. The registered provider said there is difficulty obtaining domiciliary NHS dental treatment for people. Care Homes for Older People Page 10 of 23 Evidence: It is advisable for the registered provider to write to the NHS Primary Care Trust regarding this matter. The registered provider has a policy regarding medication. We inspected the medication system. Storage of medication was satisfactory. For example there is a controlled drugs cabinet, and other lockable storage for medication. Stock levels of medication are satisfactory. Records kept regarding administration are also satisfactory. Staff records demonstrated staff on duty, on the day of the inspection, had received training regarding the handling and administration of medication. We spoke to several people who use the service who were complimentary about the care they received. People said they felt their privacy and dignity was respected by staff. Postal survey responses from people using the service, staff and external professional were positive about the care and support provided. Care was deemed caring and supportive. Care Homes for Older People Page 11 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines, food and opportunities meet the needs of the people living in the home Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished, and said routines in the home are relaxed. People, who we spoke to, said they could spend their time in their bedroom or in one of the lounges according to their wishes. Some activities are available to people living in the home. For example there are several organised sessions planned over the next month including a tea dance, music for health and a singer. Activity records also show there are bingo sessions and DVD afternoons. The registered provider has tried, and is continuing to try various other activities which people may be interested in. Current planned activities are displayed on a notice board. Some people are happy to organise their own time either reading, watching TV or listening to music. Some people receive regular visitors, and some people go out with relatives. People are positive about the food provided. There is not a choice of main meal but people said they enjoyed the food and it was plentiful. There is a choice of evening Care Homes for Older People Page 12 of 23 Evidence: tea, and people appear to have hot and cold drinks / snacks available to them. Suitable records of food eaten are kept. Care Homes for Older People Page 13 of 23 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. The registered provider has satisfactory complaints and adult safeguarding procedures. These should help ensure any complaints, concerns and allegations are investigated appropriately should they occur. Evidence: A copy of the complaints procedure was inspected and this appeared to be satisfactory. Information regarding this is kept in the hallway of the home.One complaint has been received by the registered provider and appears to have been investigated appropriately. The registered provider has a satisfactory Adult Safeguarding procedure. Most staff have received training regarding adult safeguarding, and other staff will be trained as opportunities become available either internally or from Cornwall Council. Care Homes for Older People Page 14 of 23 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. Trelawney provides a pleasant environment for the people living there. Evidence: The building was inspected. There is suitable shared space, for example, one lounge and a dining room. There is also a sitting area in the area near the dining room. Communal rooms seem pleasant and homely. Toilet and bathroom facilities are suitable in size and facilities provided. Soap and paper towels were available in bathrooms and most of the toilets. These facilities were clean on the day of the inspection. Locks are fitted on toilet and bathroom doors. Bedrooms are decorated and furnished according to individual tastes. People who use the service said they were able to bring their own furnishings and belongings with them when they moved in. Call bells appear to be accessible to people who use the service. The majority of bedrooms do not have a working lock on the door. However, the registered provider has said people are asked if they want a lock on their bedroom door when they move in. It should be the default position of the home that there is a lock on each bedroom door, and people are issued a key if appropriate. Two vacant bedrooms look like they need to be redecorated / refurbished so they are in a lettable condition. The registered provider said this work was planned shortly. The home was clean, warm and light enough on the day of the inspection. The kitchen Care Homes for Older People Page 15 of 23 Evidence: also was clean. Laundry facilities are satisfactory. Gloves and aprons are provided to staff to assist with cleaning and personal care. Alcohol gel is available to staff, visitors and people who use the service. The outside of the building and the gardens are well maintained. Care Homes for Older People Page 16 of 23 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. Staffing levels appear satisfactory to meet the needs of people currently accommodated at the home. Recruitment checks are generally satisfactory. Training is to a good standard. These measures ensure people using the service are supported by a satisfactory number of staff who are appropriately vetted and trained to meet their needs. Evidence: On the day of the inspection there were two care staff on duty throughout the waking day. There was one member of staff on a waking night duty from 2200-0800. A cleaner is employed. Personnel records were inspected for eight staff (i.e.staff on duty during the 24 hour period on the day of the inspection, plus staff employed since the last inspection). Records kept regarding recruitment checks are generally satisfactory. The majority of staff employed since the last inspection had two references although two people only had one reference on their files. A Protection of Vulnerable Adults First check (POVA First) , a Criminal Records Bureau check (CRB) and a completed application form were available for all staff-although a CRB disclosure was still awaited for two members of staff. The registered provider said these staff were currently being supervised. Information confirming the persons identity (e.g. birth certificate or driving license), and information regarding medical fitness of staff was maintained on individual files. Care Homes for Older People Page 17 of 23 Evidence: In regard to training, the following is required by law: * Regular fire training in accordance with the requirements of the fire authority. * There must always be at least one first aider on duty (at appointed person level). *All staff must have manual handling training and regular updates of this (e.g. annually) * All staff must have basic training in infection control. * Staff who handle food receive food hygiene training. * All staff must have an induction and there needs to be a record of this. Records on individual personnel files are to a good standard. For example induction training records are satisfactory, and staff who have been in post for six months have all the required training. The registered provider said new staff are currently completing their induction training, and will receive other required training in due course. This training needs to be completed within six months of the persons appointment. There appears to be satisfactory access to obtain a National Vocational Qualification in Care and records of NVQ training are kept on individual files. Care Homes for Older People Page 18 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider have suitable skills, knowledge and experience to manage the service. Quality assurance measures are satisfactory. Health and safety standards are satisfactory. These measures all demonstrate that people who use the service can be assured that the home is managed to a good standard. Evidence: The registered providers have owned the home for several years. They appear to have suitable skills, experience and knowledge to manage the home. In our postal survey respondents had a positive view of management and said management did their best to meet the needs of the people living in the home. The registered provider has a quality management policy which is satisfactory. Standards in the home are now good. The registered provider said they are currently in the process of auditing the homes standards against the National Minimum Standards. We note significant improvement in standards for example compared to outcomes in our inspection report in 2007. As part of the quality assurance process it Care Homes for Older People Page 19 of 23 Evidence: may be a useful exercise to carry out a survey of the views of people who use the service, and their representatives. It would also be useful to have an annual development plan for the service. This should outline plans for the year ahead. The registered provider has ensured some resident meetings and staff meetings have occurred. These are good fora for ascertaining peoples views, ensuring people feel supported and involving them in the process of bringing about continuous improvement. The registered providers do not look after monies or valuables on behalf of people who use the service. The registered provider said the home does not act as power of attorney or appointee on behalf of any people accommodated at the home. The registered provider has a health and safety policy. Testing of fire extinguishers, call points, emergency lighting appears is generally satisfactory, although the call points were not tested in the first week of November. However, records show systems were tested at appropriate frequencies previously. There is evidence that staff have received fire prevention awareness training. Health and safety risk assessments are completed. Portable electrical appliances have been tested.The electrical hardwire circuit has been tested and has been deemed as satisfactory. There appears to be a suitable risk assessment and system regarding the prevention of legionella. Manual handling equipment appears to be tested appropriately. The passenger lift has been serviced. Suitable records are maintained regarding the testing of the temperature of bathwater. The heating system has been tested. There is an up to date certificate of insurance which is displayed. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 21 of 23 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 29 19 The registered provider must obtain two written references for all staff employed. This will help to ensure suitable checks take place regarding the suitability of people to work in a care setting. 01/12/2009 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 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!