Care Home: Trembaths

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What the care home does well The residents we spoke with praised the staff at the home and said they are all caring and support people as they prefer. A comment from a returned survey said staff pay "attention to detail" and another said they "provide good care in a warm and loving way." Activity and food provision was also praised in the surveys and we saw evidence of excellent meal variety and preparation. An extensive range of activities is offered so that all residents can spend their days in interesting ways or as they choose. The management is good and the returned AQAA was comprehensive and gave great detail about how the home is run and the plans to provide even more services for residents in the future. What has improved since the last inspection? Care planning has been streamlined and we found great detail in the plans we checked enabling all staff to be clear about the individual needs and choices of the residents concerned. There is a sound system for administering medication in the home which helps to ensure that residents` good health is promoted. What the care home could do better: No requirements have been made as a result of this inspection. Key inspection report Care homes for older people Name: Address: Trembaths Talbot Way Letchworth Hertfordshire SG6 1UA     The quality rating for this care home is:   three star excellent 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: Patricia House     Date: 0 1 0 7 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 24 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 24 Information about the care home Name of care home: Address: Trembaths Talbot Way Letchworth Hertfordshire SG6 1UA 01462481694 01462485606 home.let@mha.org.uk www.mha.org.uk Methodist Homes for the Aged care home 41 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: This home may accommodate 15 older people who require personal care. This home may accommodate 15 older people with dementia who require personal care. This home may accommodate 31 older people who require nursing care. Date of last inspection Brief description of the care home Trembaths is a two-storey, purpose-built care home providing nursing, personal care and accommodation for 41 persons over 65 yrs of age. It is owned by Methodist Homes and is situated in a quiet residential area of Letchworth within easy reach of the town and shopping facilities. All bedrooms are single with en suite wash hand basin and toilet. The ground floor comprises a self-contained unit for 15 persons with dementia. The ground floor has its own lounge, dining room, kitchenette, 4 assisted bathrooms and three separate assisted toilets. Also on the ground floor are a main lounge, a hairdressing salon, an administration office, a smaller office, the main Care Homes for Older People Page 4 of 24 Over 65 15 41 0 0 Brief description of the care home kitchen, the laundry room and a staff dining and changing room. The second floor is divided into 2 units for a total of 26 persons requiring nursing care. Each unit has its own lounge, dining room and kitchenette and shares 5 assisted bathrooms and 4 assisted toilets. The managers office is located on the first floor. To the front, the home affords ample parking spaces. It has a very pleasant rear garden, which is securely enclosed, with a patio, a circular concrete path, a summerhouse and raised beds. Information about the home, the last CQC Inspection Report, the homes Statement of Purpose and Complaints Procedure are all available in the entrance foyer along with facilities for seeking the views and comments of visitors and friends. The fees which are determined according to the level of care needs range from £655 to £814 per week. Additional charges are made for newspapers toiletries chiropody and hairdressing. Care Homes for Older People Page 5 of 24 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: three star excellent 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 last key inspection of this service was completed on 16th July 2007. The information in this report is based on an unannounced inspection of the home, which took place over one day with one regulation inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The manager was on duty throughout the day and we spoke with staff, residents and visitors. We visited all parts of the home and checked a variety of records. Before the inspection the manager had completed and returned to the Commission an annual self-assessment quality review, the Annual Quality Assurance Assessment, (the AQAA). This document included statistical information about the home and confirmation of policy reviews and equipment checks. Completed quality surveys have Care Homes for Older People Page 6 of 24 also been returned to the Commission from seven residents and two of the staff from the home. Comments from these surveys have been used in this report. We have also reviewed any other information we have received about this service since the last inspection. A ten bedded extention is currently being built at the home and there are plans for this new area to be used by people who have a dementia. Care Homes for Older People Page 7 of 24 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 8 of 24 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 24 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. Standards 3 and 4. People who use the service have their individual and specialist needs fully assessed before they enter the home so that all parties can be sure the home can meet these needs and the home is the right place for them. Evidence: During the inspection we checked a selection of residents care plans and all contained detailed assessments of need, which had been completed by senior staff at the home. We also saw copies of written care summaries sent by referring agencies. From this information, initial written care plans had been completed so that care staff could be aware of individual needs and clear about how to meet these needs. The home has a specialist unit for people with a dementia and we spent some time talking with and observing residents and staff in this area. The care workers we asked Care Homes for Older People Page 10 of 24 Evidence: confirmed that all staff at the home complete dementia care training and the manager told us that some of the staff have completed a more specialist dementia course. The manager also said that further training and planning is underway for the specialist area of dementia care so that current guidelines and ideas can be implemented in the home for the benefit of the more confused residents. During the visit we saw a variety of activities going on and three residents were watching a film which they were clearly interested in and enjoying. Residents also benefit from the use of local specialist transport , which enables trips out to be safely made. Care Homes for Older People Page 11 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9, 10 and 11. People who use the service can be sure that their individual health needs will be met and their general health promoted by procedures followed in the home. The system followed for administering medication also helps to protect residents from the risk of harm. Evidence: We spoke with and observed some residents and visitors in the home, in communal areas and in individual rooms. We then tracked a selection of the corresponding care plans. All plans were very detailed and reflected the needs of the residents concerned. Each residents record showed the named nurse or key worker who linked with the resident to ensure individual needs were met and we saw details of the specialist equipment in use and its safety assessment. Care plans contained factual information and also showed the choices made by residents together with how staff should be proactive in promoting peoples aims and preferences. The records contained detailed health promotion support plans and all appropriate risk assessments were Care Homes for Older People Page 12 of 24 Evidence: documented with up to date reviews. We saw evidence of how peoples health needs were being met and saw appropriate referrals to and input from other health agencies. We saw completed turning charts in peoples rooms where this input had been recommended in their care plan. Several residents use electrically powered equipment and we saw details of how this would be managed in the event of a power cut to ensure the residents safety. Individual choices with any associated risk assessments were clearly recorded and there was evidence that the people concerned, or their relatives, were involved in the care planning. The care plans we saw were well balanced and provided staff with information about care and nursing needs but also about individual social preferences and choices. The care staff we spoke with demonstrated an understanding of these individual needs and said they were fully aware of individual care plans and their contents. We saw a recently received Department of Health alert about promoting residents hydration displayed on all floors in the home to ensure all staff are kept aware of this need. We saw care staff offering drinks throughout the visit and staff also told us that kitchen staff make lots of jellies and smoothies to promote peoples intake of liquid and that these are very popular with residents. The nurses we spoke with confirmed that individual blood testing equipment is provided for those people who need this monitoring so that good infection control is maintained. We checked the system for the administration of medication on one floor of the home. Only Team Leaders and duty nurses hold the key to the medication store and we found all the storage appropriate. We spot checked some of the medication and amounts and recording all tallied. We saw details of the regular reviews made by G.Ps to ensure that all residents continue to receive the appropriate medication as their health needs change over time. We spoke with residents and some visitors during inspection and everyone confirmed that staff at the home supported residents in a way they preferred and always showed respect and promoted peoples dignity. Residents confirmed that they saw health professionals in private and that staff always knock and wait before entering their bedrooms. We saw evidence on some care plans of the choices people had made about any serious illness they might have and about arrangements for death and dying. On the day of the visit we saw a display tribute to a resident who had recently died. There was a small table containing the residents photograph and flowers and other items so that other residents could pay tribute to this individual and be aware that everyone in the home is seen as an important part of the whole group. Care Homes for Older People Page 13 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. People who use the service are provided with a wide range of activities and stimulation so that they can enjoy their daily lives and have excellent meals provided so that they can maintain good health. Evidence: The homes activities co-ordinator was on holiday at the time of the inspection but we saw evidence of the events provided for residents at the home. The activity plan showed that there are activities provided on every day of the week and there were details on the notice board of a singer and pianist who would be visiting the home the following Sunday. There had been a religious service which residents had attended on the morning of the inspection and we saw photographs displayed of a recent garden party which residents and visitors had taken part in. People told us that a music therapist regularly visits the home and that hymn singing and other musical events take place. The lounge area has a separate widescreen television area and there is also a keyboard for people to use. However, the remainder of the large room can be used by residents who do not wish to watch television or who want to be quiet. Care staff said some of them had recently been on a training course for the Books to Care Homes for Older People Page 14 of 24 Evidence: Share national project. These members of staff are now using the training to promote an interest in books especially with people who have a dementia. One member of staff has completed a course on reflexology and will be employed for seven hours each week in addition to care hours, to provide this service to any resident who is interested. Staff said some evening activities are also being planned for residents to enjoy and that a volunteer visits the home on Thursdays to provided one-to-one conversation with residents. A notice was also displayed showing where in the home residents and visitors can find and use games and books. The visitors we spoke with confirmed they are welcomed in the home at all times and encouraged to take part in the many events in the home. We saw individual choices noted on the care plans we checked and the people we spoke with confirmed that they make their own decisions about their daily lives and are supported in fulfilling these aims by the staff at the home. The mid-day meal was served during the inspection and the food was plentiful and looked attractive and wholesome. Most people told us the food was excellent in the home and the residents on one table in the dining room said they could choose from three meals at each serving. We visited the kitchen and the chef confirmed that residents choose their meal at the table on the day and do not have to choose in advance. Residents can also choose whether to have their main meal at mid-day or in the evening. Residents also said there were loads of choices at breakfast and we saw evidence that a cooked breakfast was offered twice each week and a continental buffet breakfast was served on Wednesdays. Residents we spoke with said they could also have cheese and biscuits in the evening if they wanted. We saw picture menus used to help the more confused residents decide what to eat and saw trays of snacks prepared for people to enjoy between meals. The snacks and fruit prepared for these snacks were all provided in small pieces to encourage people to take the food. When we arrived at the home we saw kitchen staff checking the temperatures and contents of the fridges on each floor of the home to ensure food safety is maintained and all appropriate temperature checks are completed and documented in the main kitchen. We saw that details of the food eaten by individuals in the home are kept for twelve months for safety and the chef showed us how the thickened drinks some residents needed were made into smoothies and jellies to make them more appetising. We saw jugs of water and glasses in all bedrooms to encourage fluid intake and saw food served and assistance nicely provided for people eating in their rooms. We saw evidence that all the kitchen staff had completed food hygiene training. Care Homes for Older People Page 15 of 24 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. Standards 16 and 18. Procedures followed in the home ensure that people who use the service have their concerns listened to and are protected from the risk of abuse. Evidence: The home has written policies on Making a Complaint, Whistle Blowing and Safeguarding. The staff we asked said they were aware of these policies and showed they were aware of their implications. The residents we asked said they were aware of how to make a complaint and would feel comfortable voicing their concerns if they had any. The manager demonstrated a clear understanding of the Hertfordshire County Council joint agency safeguarding procedures and has made two referrals under these procedures in the past year. The staff we asked said they had received training in adult safeguarding. Care Homes for Older People Page 16 of 24 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. Standards 19 and 26. People who use the service benefit from living in a home which is well maintained and where procedures for infection control help to protect them from the risk of harm. Evidence: We visited all areas of the home and the communal areas and bedrooms were well decorated and comfortably furnished. The home is well maintained and there is a new lounge on the first floor for the use of visitors. There is a notice in this lounge inviting people to help yourself to tea and coffee from the facilities provided. Bedrooms are spacious and have been personalised with all sorts of personal possessions by the residents concerned. Many residents have their own telephones in their rooms. The gardens looked extremely attractive and there is a courtyard garden with a fountain for residents to enjoy. Communal bathrooms and toilets were very clean and all contained liquid soap and paper towels to ensure good infection control is maintained. Care Homes for Older People Page 17 of 24 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. Standards 27, 28, 29 and 30. People who use the service are supported by well trained professional staff and are protected from the risk of abuse by the homes robust recruitment procedures. Evidence: The manager was present during the inspection and we spoke with residents and staff in all areas of the home. Residents confirmed there were usually enough staff on duty to meet all their needs. The staff told us that new working shift patterns had recently been introduced in the home and this meant they felt less tired at the end of their working shifts meaning they provide a better service for residents. We checked some staff records and saw the content of the induction training provided for all new staff. This training is comprehensive and provides staff with all the basic knowledge needed when they first begin to work at the home. Care staff confirmed they are encouraged to undertake NVQ training. We spoke with one of the domestic workers at the home and they confirmed they are included in staff training courses including Moving and Handling and Health and Safety courses. They also said they attend general staff meetings and are provided with relevant information about the home and residents so that they can provide appropriate services to the people concerned. Care Homes for Older People Page 18 of 24 Evidence: We checked a selection of recruitment records and saw evidence that all employment checks were in place before staff started work at the home, so that residents are always supported and protected by appropriate members of staff. Care Homes for Older People Page 19 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. People who use the service benefit from living in a well run home where their views are listened to and acted on and where their well being is promoted by the health and safety practices followed. Evidence: The manager of the home has a diploma in management and has also completed the Registered Managers Award. The residents, visitors and staff we spoke with said the home is well managed and that the manager is accessible and supportive and listens to the views of all interested parties. The home operates a robust quality assurance programme and some of the residents and visitors we asked said they had completed quality surveys for the home. The manager said the returned surveys are monitored by the company head office and outcomes are discussed and changes made where appropriate. We saw the minutes of Care Homes for Older People Page 20 of 24 Evidence: a residents and families meeting which had been held in May, displayed on a notice board and a visitor we spoke with confirmed their attendance at this meeting. The manager said these meetings are held three monthly and that some changes had been made to the residents menus as a result of suggestions made. Also, at the request of residents, the manager is advertising for a Chaplain for the home, who will have a ten hour contract of employment, so that residents spiritual needs can be met and issues connected with end of life care can be pursued. Care staff told us that there are monthly staff meetings as well as unit meetings and nurses meetings. All the staff we asked said that communication was good in the home and during the visit we saw some of the methods successfully used for passing daily information. The manager also produces a newsletter for the home which is sent out at regular intervals to residents, families and friends of the home. This document gives current information about the home and lists the wide variety of activities, events and outings available and includes photographs taken at recent events. We checked the system in operation for dealing with the personal allowances of some of the residents. Families bring amounts of cash in to the home at regular intervals and are provided with receipts. Monies are kept individually for residents and each person has a record book which is signed by two people. We saw evidence of the regular audits completed to ensure all these accounts are accurate. During the visit we observed good practice demonstrated when staff assisted residents to transfer and staff who spoke with us were clear about health and safety issues and said they all receive regular updates of safety training. Qualified nurses in the home all complete First Aid training and the manager said she will be completing a risk assessment for the home to ensure that care staff receive appropriate first aid training. Appropriate records are kept of fire drills, accidents and incidents and any complaints which might be made and the manager completes monthly monitoring work to identify any trends in these areas which might need attention. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 23 of 24 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. 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