Care Home: Treseder House

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What the care home does well Mencap provides pleasant and homely accommodation at Treseder. People who use the service appear to be well supported and cared for. Organisation in the home is to a good standard so people who use the service should receive an efficient service. Staff work in a manner to promote choice and independence of people living in the home, while ensuring basic care needs are met. People living in the home said they were happy living there. Several of the people living in the home have had very nice holidays which they said they have enjoyed. What has improved since the last inspection? The home continues to be well managed, and people who use the service continue to be positive about their experiences living at the home. What the care home could do better: Two statutory requirements has been issued as a consequence of this inspection. The manager must submit an application to be registered with the Commission for Social Care Inspection. The registered provider must also improve some health and safety precautions. The registered provider needs to ensure a satisfactory electrical hardwire certificate is obtained, and there are suitable precautions regarding the prevention of legionella. CARE HOME ADULTS 18-65 Treseder House 111 Moresk Road Truro Cornwall TR1 1BP Lead Inspector Ian Wright Unannounced Inspection 3rd December 2007 14:30 Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Treseder House Address 111 Moresk Road Truro Cornwall TR1 1BP 01872 274172 01872 274172 H5010@mencap.org.uk www.mencap.org.uk Royal Mencap Society Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ****Post Vacant**** Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 8. Date of last inspection 12th January 2007 Brief Description of the Service: Treseder is situated in a pleasant residential area close to the city of Truro. The home provides care and support for 8 adults with learning disabilities. The home is a large detached property. All people who use the service have their own bedrooms. The home has a large lounge / dining room, kitchen, and appropriate bathroom and toilet facilities. The home has spacious grounds, which are well maintained and there is a patio with seating. The present people who use the service can access all parts of the home and garden, however the home would not be suitable for wheelchair users. Car parking space is available at the front of the home. A copy of the inspection report is kept in the lounge. It is suggested a full copy of the report is requested from management or CSCI if required. The range of fees at the time of the inspection is £378 to £629 per week. There are additional charges e.g. for hairdressing, newspapers etc. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place in just less than six hours in one day. All of the key standards were inspected. The methodology used for this inspection was: • To case track two people who use the service. This included, where possible, meeting and discussing with the people who use the service their experiences, and inspecting their records. • Discussing with staff their experiences working in the home. • 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. • Review the CSCI Annual Quality Assurance Assessment (annual quality assurance and data set return), which was recently sent to the commission by the provider. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: Two statutory requirements has been issued as a consequence of this inspection. The manager must submit an application to be registered with the Commission for Social Care Inspection. The registered provider must also improve some health and safety precautions. The registered provider needs to ensure a satisfactory electrical hardwire certificate is obtained, and there are suitable precautions regarding the prevention of legionella. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information received by people living in the home regarding their rights and responsibilities is to a good standard. This ensures people who use the service should have appropriate information to be aware of their rights and responsibilities. Suitable assessment processes are also in place. EVIDENCE: People who use the service receive a tenancy agreement from the housing association which owns the property. People also receive a copy of a social services contract if they are funded via this body. The registered provider has developed a suitable assessment policy and procedure. This includes the opportunity for people being assessed for the service to visit before admission is arranged. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable information is provided to assist staff to provide appropriate support and facilitate choice. This ensures people who use the service receive a good quality service and they are given appropriate support to make choices about their lives. EVIDENCE: There is a copy of a care plan in each person’s file. Staff said care plans were accessible to them. Some people who use the service said they were aware of their care plans and are involved in drawing them up. The care plan format is comprehensive and gives clear guidance to staff regarding people’s needs. Some people have a ‘person centred plan,’ which includes for example photographs of activities they are regularly involved in, people who are important to them, and a list of goals which the person has said they would like to pursue over the forthcoming year. People’s care is clearly reviewed on a monthly basis and the written reviews are very comprehensive. People who use the service and staff, said residents are encouraged to make decisions regarding their lives. Suitable risk assessment processes are in place Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 10 to ensure independence is promoted, and also, where necessary any risks are minimised. Care staff look after the monies of some people who use the service. Cash held on behalf of people who use the service appears to be well looked after and accounted for. Records regarding any bank / building society accounts held on behalf of people are to a good standard. The registered provider has satisfactory policies regarding diversity and equality. There are currently no people who use the service from ethnic minorities, although the registered provider has stated they would be more than happy to accommodate people who use the service from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, and disability seem to be suitably addressed. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have suitable opportunities to participate in the home and the wider community. Food provided is to a good standard. These measures ensure people who use the service can enjoy a varied lifestyle integrated into the wider community. EVIDENCE: People who use the service said they attend a range of day activities including attending day centres, work placements and colleges. Some social trips are organised at the weekend or in the evening. People who use the service can have an annual holiday, which they have to pay for. For example one lady said she had been on a Mediterranean cruise in the last year, and was keen to show her photographs and discuss her experiences with the inspector. Another man had been to Liverpool to see his favourite football team, and said he would be going to Nottingham shortly, on his own, to visit a friend. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 12 People who use the service said they visit friends and relatives regularly, and they are encouraged to maintain contact via the telephone or post. Visiting arrangements are flexible. People who use the service said they could get up and go to bed when they wish. People who use the service said staff work with them in a way, which respects their privacy and dignity. Staff knock on bedroom doors, and mail is not opened without the agreement of people who use the service. Locks are fitted to bedroom doors. People who use the service are encouraged to participate in household tasks and cooking. Interaction between other staff and people who use the service was observed to be positive. There seems a positive culture of facilitating choice and promoting independence, whilst ensuring people are not neglected and are cared for appropriately. People who use the service are able to go out on their own, use public transport or go to the shops without staff support. People who use the service are involved in the preparation of meals, and generally eat together. People living in the home said they enjoyed the food in the home, and there is always enough food available, for example, if they want a snack. Suitable records are maintained regarding food provided. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and health care support is to a good standard. Medication is managed to a good standard. Appropriate support with health and personal care ensures people who use the service are encouraged as much as possible to lead healthy lifestyles. EVIDENCE: People who use the service said they received suitable care and support from staff. Suitable evidence is available regarding health care support. Any medical interventions from external professionals are appropriately recorded. There seems suitable links with GP’s, dental services, chiropodists and other professionals. Medication is stored securely, and dispensed via a ‘monitored dosage system’. Administration records seem to be kept appropriately and the storage of medication is to a good standard. Staff appear to have received appropriate training regarding medication. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. Suitable systems appear to be in place regarding how concerns, complaints and allegations are dealt with. This ensures people who use the service should be able to be assured any concerns they have will be dealt with appropriately. EVIDENCE: The registered provider has developed a complaints procedure. The manager has included a summary of this in the service user guide. The inspector read the organisation’s complaints policy in the ‘Operations Manual.’ This requires updating, for example the organisational policy refers to the National Care Standards Commission, which has now been superseded by the Commission for Social Care Inspection, which will subsequently be superseded by the Care Quality Commission in April 2009. The policy also regards the complainant’s right to contact the commission as the last stage of the procedure, rather than stating complainants can contact the commission at any time as outlined in NMS 22.3. The registered provider has been notified regarding this in several CSCI reports for Mencap care homes in Cornwall and has consistently failed to subsequently change their policy. This is a concern. Management need to address this issue. However, people who use the service said they would have confidence in staff / management if they had a concern or a complaint, and they felt the matter would be dealt with appropriately. Mencap has an appropriate adult protection policy. New staff attend the Mencap training regarding abuse (Protect Me) as part of the organisation’s foundation training, although records regarding this could be more comprehensive to validate this has actually occurred. Most staff have attended external adult protection training e.g. facilitated by the local authority. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 15 All established staff have a Criminal Records Bureau (CRB) check. Staff and people who use the service said they believed there to be no abusive practices in the home, and were aware who they would approach if they were concerned about abuse. The manager said there had been no concerns or complaints raised since the last inspection. There had also been no matters which have had to be referred to the Department of Adult Social Care (social services) to be investigated under their adult protection procedures. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Treseder provides a pleasant, homely and clean environment for people who live there. EVIDENCE: The building was inspected. The home offers a pleasant and homely environment for people who use the service. Bedrooms and communal areas are of suitable size to meet the needs of people who use the service. The home was clean and hygienic on the day of the inspection. Suitable cleaning routines are in place. Bedrooms are pleasantly decorated according to individual tastes. Furnishings in bedrooms are appropriate. Decorations and furnishings in communal areas are generally to a reasonable standard- although some of the hallways, and toilets / bathrooms, look as if they will need to be redecorated in the next couple of years. The carpet in the downstairs hallway also looks like it will either need replacement or steam cleaned in the foreseeable future. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels and recruitment practices are to a good standard. Training is generally to a good standard. However some staff need an update in training required by regulation or to meet the needs of people who live in the home. Good policies and procedures regarding staffing should assure people who use the service that they will receive appropriate support from staff who are suitably recruited, checked and trained. EVIDENCE: Currently there is a minimum of one member of staff on duty. One person ‘sleeps in,’ but is ‘on call’ between 23:00 and 0700. During the week, there is usually an additional member of staff on duty either during the day and/or in the afternoon/ evening. At the weekend there is usually an additional member of staff, to the sleep in person to assist for example with recreational activities. Staffing levels appear to be generally satisfactory at present, but the registered provider needs to monitor these particularly as people’s needs change- for example as people get older. The inspector observed information kept on staff files. Recruitment records are to a good standard and contain all necessary information required by regulation. This includes for example a Criminal Records Bureau check and two Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 18 references. The inspector read a suitable equal opportunities policy regarding staff recruitment and selection. There are generally suitable records of staff training. Staff have generally completed all training required by regulation, and to meet the needs of people who live in the home. There are some minor gaps in the training which should be received, but the registered manager appears to have a satisfactory plan to rectify this. Some training certificates appeared to be absent for a minority of individual staff. The manager said some of these were still to be sent to the staff from the training provider. Mencap has a suitable approach to ensuring staff have the opportunity to obtain a National Vocational Qualification in care. Currently 56 of staff have either a NVQ 2 or 3. A copy of the people’s certificate needs to be placed in some of the files. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. Management arrangements are to a good standard. This ensures people living in the home benefit from a management approach and management systems that promote a good quality service to meet their needs. However the application for the manager to be registered with the commission needs to be forwarded to CSCI. Some improvement is also required to health and safety precautions. EVIDENCE: Ms Lorna Brydon is the manager of the home. Ms Brydon was previously registered with the commission as a manager for another Mencap home which she managed well. Her application to be registered to become the manager for this home is due to be submitted by Mencap shortly. Ms Brydon has obtained a National Vocational Qualification at level 4 in care and management. Staff and people who use the service, who the inspector spoke to, were positive about her management approach. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 20 Mencap has a suitable approach to quality assurance. A survey of the views of people who use the service, staff and their relatives has been completed. The results of this were positive. A representative from the registered provider visits on a monthly basis. The registered provider also completed their own ‘Annual Quality Service Review’ in February 2007 and this was generally positive. The registered provider has a suitable health and safety policy. Most health and safety records are satisfactory. For example there are suitable records of the testing of fire equipment, the central heating system and the portable electrical appliances. An electrical hardwire circuit test was completed in June 2007. The report states the system is ‘unsatisfactory’, and subsequently the registered provider needs to take suitable action to rectify the situation. A copy of a satisfactory test certificate needs to be forwarded to the commission. Accident / incident records are suitably kept, although some incidents should have been reported to the commission. The registered provider is reminded to ensure any events reportable to the commission under the Care Homes Regulations are always notified- for example accident and emergency admissions or medication errors. A full list of notifiable events is include in regulation 37 of the Care Homes Regulations 2001. Staff can always ring up the commission beforehand if they are unsure if something is reportable. Health and safety risk assessments appear satisfactory. However these were produced in 2004 and should be reviewed e.g. at least annually. There is a risk assessment regarding the prevention of legionella. However testing has not been completed regularly recently, and this needs to be reintroduced. Similarly testing that thermostatic valves (to ensure the prevention of scalding by hot water) needs to recommence as this has not occurred recently. There is a suitable fire risk assessment. Suitable insurance cover appears to be in place. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA37 Regulation 9 Requirement Timescale for action 01/02/08 2. YA42 13, 23 The registered provider must submit an application for the manager to be registered with the commission. This will ensure the manager is accountable for the service and deemed fit by the commission to manage the service. 01/03/08 The registered persons must ensure there are satisfactory health and safety precautions are in place. For example satisfactory precautions and records regarding; • The prevention of legionella • Testing of thermostatic valves to prevent scalding. • The electrical hardwire circuit is safe. A copy of the certificate for this must be forwarded to the commission within the timescale. These measures will help ensure people living and working in the home are protected as much as possible from health and safety risks. Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Treseder House DS0000009138.V352193.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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