Care Home: Trevanion House Holidays Ltd

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What the care home does well Trevanion provides the opportunity for people to have a holiday in a place that offers a hotel style service. The accommodation is clean and comfortable, and of a high standard, thought some of the bedrooms are small. Meals are well cooked and presented, guests are waited on at table and there is a varied weekly menu. Guests clearly enjoyed the food, and many had stayed at Trevanion before. One person responded to the survey they "I thoroughly enjoyed my two weeks holiday at Trevanion House", another person said "I want to go back for two weeks next year". Guests are able to choose the trips they go on, and from a range of activities in the evenings. People are supported to make their own decisions. Guests are given the support they need to write postcards and are given a record of their holiday to share with friends and family on their return. One of the staff completing the survey said "It`s (Trevanion) emphasis is to provide as much support as possible to enhance fun and enjoyment in Cornwall whilst guests are in a strange environment and away from home. There are good levels of staff on duty during the daytime and staff are well motivated, trained and managed. There are very good systems to ensure that information is passed between staff. Trevanion is well managed. The task of managing this service is very complex, and requires more organisation that homes of a similar size. It is to the Manager and staff`s credit that they manage to provide such a high standard of service to guests week after week. What has improved since the last inspection? We found that Trevanion has improved the system for recording the meals that people choose to eat. This is on a computerised system. We were also told that a manager is always on duty on the day people arrive or leave Trevanion. Also that the start finish day has been changed from a Friday to a Thursday, this allows for any issues or concerns to be followed up before the weekend. What the care home could do better: Staff at Trevanion did not always have sufficient information about people`s needs before they arrived to plan their care. Also the Service User Plans or Care Plans were not as comprehensive as they should have been. They did not always specify how staff should meet needs. We discussed with the Manager our concerns that because a different group of people come to stay at Trevanion every week the risk assessments relating to scalding or other harm need to be very robust. We also discussed with the Manager the fact that they need to have risk assessments in place to ensure that people who stay at Trevanion are not placed at risk by other guests. We were concerned that staff are not immediately available throughout the night, and that if help is needed then the guest must be able to use a telephone. CARE HOME ADULTS 18-65 Trevanion House Holidays Ltd Trevanion House Trevanion Road Wadebridge Cornwall PL27 7PA Lead Inspector Helen Tworkowski Unannounced Inspection 4th August 2008 09:0 Trevanion House Holidays Ltd DS0000069183.V366845.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 Trevanion House Holidays Ltd DS0000069183.V366845.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. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trevanion House Holidays Ltd Address Trevanion House Trevanion Road Wadebridge Cornwall PL27 7PA 01208 814903 0870 7059682 enquiries@trevanion.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trevanion House Holidays Ltd Tracey Lee Barrett Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Trevanion House Holidays Ltd DS0000069183.V366845.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 only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 14. 9th August 2006 (under the previous registration) Date of last inspection Brief Description of the Service: Trevanion House is registered to provide accommodation and personal care for fourteen people with a learning disability. Trevanion provides holidays for adults with a learning disability; they may choose to stay for one week or longer. Trevanion can accommodate a further seven guests. These adults do not require personal care/support from Trevanion House, or if they do an accompanying carer may provide it. The guests receiving accommodation or day care only are not registered under the Care Standards Act and therefore were not the focus of this inspection. There is no segregation of rooms or services and the principle guiding the provision of holidays at Trevanion House is to maximise the extent to which the experience is like that of anyone else visiting Cornwall and staying in a small hotel. The fees vary depending on the length of the stay, the time of the year, the needs of the individual and whether a single or a double room is booked. Additional charges are made for items such as laundry and bar drinks. Guests are expected to pay for their own admission to activities and where additional care or support is needed a charge is made. A full list of charges is available from Trevanion House along with information about the home and the services provided. Information about Trevanion is available on their website, but the Service User Guide and Statement of Purpose are available in the home from the office. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out between 8.10am and 4.10pm on 4th August 08, and 2pm and 5pm on 6th August 08. As part of this inspection we sent surveys to people who have recently stayed at Trevanion and to staff. We also received an “Annual Quality Assurance Assessment”, which had been completed by the Manager. This gave us information about how they were organising the home. During our visits to Trevanion we looked around the house, we talked with staff and with some of the people staying that week. We spent time with people whilst they ate breakfast and lunch, and we sat in on a session where trips out were being planned. We also talked with staff about the service they provide. We looked at the records of how care was planned and provided. We also looked at the way medication in the home is managed, at the staff records, including recruitment records and at records relating to health and safety. What the service does well: Trevanion provides the opportunity for people to have a holiday in a place that offers a hotel style service. The accommodation is clean and comfortable, and of a high standard, thought some of the bedrooms are small. Meals are well cooked and presented, guests are waited on at table and there is a varied weekly menu. Guests clearly enjoyed the food, and many had stayed at Trevanion before. One person responded to the survey they “I thoroughly enjoyed my two weeks holiday at Trevanion House”, another person said “I want to go back for two weeks next year”. Guests are able to choose the trips they go on, and from a range of activities in the evenings. People are supported to make their own decisions. Guests are given the support they need to write postcards and are given a record of their holiday to share with friends and family on their return. One of the staff completing the survey said “It’s (Trevanion) emphasis is to provide as much support as possible to enhance fun and enjoyment in Cornwall whilst guests are in a strange environment and away from home. There are good levels of staff on duty during the daytime and staff are well motivated, trained and managed. There are very good systems to ensure that information is passed between staff. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 6 Trevanion is well managed. The task of managing this service is very complex, and requires more organisation that homes of a similar size. It is to the Manager and staff’s credit that they manage to provide such a high standard of service to guests week after week. What has improved since the last inspection? What they could do better: 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. Trevanion House Holidays Ltd DS0000069183.V366845.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 Trevanion House Holidays Ltd DS0000069183.V366845.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): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The guests who stay at Trevanion House are provided with good information about their stay. Staff at Trevanion House do not always know enough about the guests, before they come to stay, to provide proper care during their stay or to keep them safe. EVIDENCE: We looked at the information that guests who want to stay at Trevanion House are given. There are brochures about the holidays and in addition there is a Service Users Guide and Statement of Purpose available in the office. The new Statement of Purpose and Service User Guide were agreed by the Commission earlier this year, when the home was registered to be run by a company. Most people come to stay at Trevanion House for one week for a holiday; assessments are needed for each of these stays in the residential home. We found that there was an assessment system, where the guest or their carer completed a simple form about what their needs are. However, when we looked to see if these had been completed for each person, we found that this was not always the case. In one case we found that the form had not been completed and that information that had been provided from the previous year was being used. The Manager explained that they sometimes had difficulties in getting the forms completed in time. We discussed with the Manager our Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 9 concerns that the information on the form was very general, and would not be sufficient to provide care for anyone who had all but the most simple of care needs. We also discussed with the Manager concerns that the person completing the form might not have the right skills or knowledge. The Manager explained that she was aware of the shortfalls in the document was in the process of reviewing the document, and where there she had concerns about someone’s needs she did phone up and find out more. The Manager also said that she had ensured that either she or another manager was on duty on the day people arrived at Trevanion, so that if there were any issues that were of concern then there was someone to deal with them. We also discussed the issue that some of the people who want to stay at Trevanion House may not have care needs or in some instances may be providing care to the guest they are accompanying. We discussed the risk posed to individual guests by other guests and the need for there to be system to ensure that no one who posed a risk to vulnerable people stays at the Trevanion. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Guests at Trevanion are consulted about what happens during their stay and their views are taken into account. The information that staff need to know about people who stay at Trevanion is not always complete. The risks that people may be exposed to are not always fully taken into account. EVIDENCE: We sent surveys to 12 of the guests who had recently stayed at Trevanion, and received five surveys back. All of the guests felt that staff always treated them well and listened and acted up on what was said. We spoke with three of the guests, and two said that they were happy with the service; the third person did not want to speak. Staff who responded to surveys said that they were always given up to date information about people’s needs, comments included: “Guests/Support Workers do not always send relevant information before their stay”, and “Care Plans are meticulous and all staff are well versed. Occasionally information does not arrive on time or is not sent but is always sought”. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 11 To understand what help and care each person needs we looked at the care plan documents. Trevanion has a computerised system; we saw that each person had a “care précis” which documented how help was to be given. This information is then used to form part of a table for staff on one sheet of A4 paper. This summary sheet gives brief information to each member of staff about the needs of the guests. It is used at twice daily handovers and provides staff with brief summary of each person’s needs. We discussed with the Manager how the care précis did not always fully reflect needs. One example one person had epilepsy, whilst this was noted in the care précis, it did not contain all of the information that was needed to provide care. The individual had arrived with information in a risk assessment, however this information had not been used in planning care, nor did it provide the basis for a risk assessment. The lack of information meant that appropriate preparations had not been made to keep the individual safe. We discussed with the Manager some of the information on the “Care Précis”, the information did not always explain what staff should do, for example one of the précis indicated that an individual had mental health problems, however the information did not indicate the relevance of this or how the individual was to be supported. Another issue discussed with the Manager was the fact that the information provided to staff on the summary sheet was only a few lines, and important information could be cut off, as it would not fit into the current format. During this inspection we sat in on a session where guests were choosing their activities over the next few days. Guests were given the opportunity to plan what they wanted to do. Information was projected on to a screen so that everyone was able to see what was on offer and who wanted to do what. We asked about risk assessments for various activities, and was told that Trevanion uses the same activities and venues as other people holidaying in Cornwall. A member of staff also goes and carries out a risk assessment prior to the activity being used. The Manager also said that staff also must risk assess situations as they arise, and if for example someone wants to go on a very scary fairground ride they would be encouraged to watch the ride and see what other people think of it, prior to going on it themselves. As this home offers a Hotel style service, guests are not expected to take part in any cooking or cleaning, however there is an area on the first floor where drinks can be made. Trevanion uses a computerised system, and records are kept on the system. Staff were careful to ensure that information was not left lying around. Information was handover between staff in private in the office. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Guests at Trevanion are able to choose the trips or activities they go on whilst on holiday in Cornwall. They are well supported to make choices during their stay. The meals are of a high standard and provided in a pleasant and well furnished dining room. EVIDENCE: The information about Trevanion House that is sent to prospective guests shows that people are given the opportunity to take part in a range of trips out such as visits to the Eden Project and Screech Owl Sanctuary. We found that the Trevanion House did what they said that would do. People were given the opportunity to plan the trips and activities over their holiday. We attended one of these planning sessions and care was taken to help people choose trips that they would enjoy. There are information boards in the hallway so that guests can be reminded of what is on offer and what they have chosen to do. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 13 Guests go out together in groups of usually no more than seven, plus staff. We were told that when people arrive at a destination they often split up into smaller groups. All of the Trevanion guests who responded to the survey said that they could make the decisions about what they did each day and they could do what they wanted through out the day and evening. Guests are able to get up and go to bed when they wish. We saw a communication to staff that reminded them that they were not to routinely wake guests, but if they have not appeared for breakfast then to ensure that they are aware that of the time breakfast ends. This style is appropriate to what Trevanion sets out to achieve as a “Hotel”. We were present when guests had their breakfast and lunch. On the day of the inspection guests were offered scrambled eggs with smoked salmon, a range of cereals, fruit juice and toast. The dining room tables are well laid and food orders are taken by one of the staff. We were told that lunch is usually a lighter meal, and dining is a more formal three-course meal. We were shown a menu for the week which contained a range of meals as you might expect to find in any small hotel in Cornwall. We were told that if people do not like particular food then options are provided, but that guests are encouraged to try food that they may not have eaten before. From what we observed and from the people we spoke with, the meals at Trevanion are thoroughly enjoyed by the guests. We were told that there is a bar and guests are asked to pay a bar deposit at the beginning of their stay, if they manage their own monies, and the bill is settled at the end. We were shown some communication cards that are used by staff so that guests are able to make an informed choice about what they want to drink. These are used at other meals too. At the end of the holiday guests are presented with a record of their holiday which details the activities and trips that they have taken part in and includes photos. This is seen as a way that guests can share their holiday experience with friends and family. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The guests at Trevanion House receive a good standard of care. Medication is safely administered and managed. EVIDENCE: All of the Trevanion Guests who responded to the survey said that staff treated them well, and that staff listened and acted upon what they said. We observed handover between staff and it was clear that there were very good communications systems to try and cope with this very complex service, where there are different group of guests with different needs every week. Not all of the guests who visit Trevanion receive help with their personal care. We were told that if it was found that an individual did need assistance then arrangements would be made for this to be provided. One of the staff responding to a survey said “Occasionally guests needs are greater than care plan depicts. As soon as needs are identified staff cover is increased...”. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 15 As has already been noted we found Trevanion does not always receive all of the information that it should receive prior to someone coming for a visit. We also found that the plans of care were not always as comprehensive as they needed to be. The impact of this is that guests needs could potentially not be met. Trevanion House has set up a system to try and ensure that they receive the correct information about medication via a medication schedule, and the correct medication. The Manager explained that they had changed the start day for holidays to Thursdays, so that if there are any concerns these can be followed up before the weekend. The medication system is well organised and there is a good record of medication administered, as well as an audit of medication received and returned at the end of a visit. The system for managing lunchtime drugs has been amended since the last inspection so that it is a safer system. We discussed with the Manager epilepsy medication that is carried with individuals, that is to be administered if they have a seizure. As this medication cannot be self administered, staff must have guidance on administration. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of people staying at Trevanion are listened to and acted on. Where concerns have been raised regarding an individual’s well being, actions have been taken to ensure that people are kept safe. EVIDENCE: All of the guests who responded to the surveys said that they knew who to speak to if they were not happy, and the majority said that they knew how to make a complaint. Information provided by the Manager to the Commission explains that staff try to deal with issues at the earliest possible opportunity, particularly as guests may only be at Trevanion for one week, so putting things right quickly is important so that the holiday is not spoilt. We looked at the training staff had in relation to protecting people from abuse and was told that all staff had received training in this area, and this was confirmed by records seen during the inspection. All of the staff who responded to the survey said that they knew what to do if a guest had a concern about the home. We looked at Trevanion’s record of complaints, and found that where issues had been raised then these were appropriately dealt with. One issue has been dealt with under the safeguarding process. Some areas were identified where the service at Trevanion could be improved to ensure people are safe, and the Manager said that these have been implemented. These included changing the day of the week the holidays start on and checking out areas of concern in care plans as soon as possible. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 17 We discussed with the Manager the very nature of the service at Trevanion meant that there were higher or more unknown risks than in care homes where all of the people were well known. We discussed the need to ensure that systems are in place to ensure that people staying at the home, who may be more vulnerable because they are in a strange place, are not at risk from other guests to the home. There is no indication that such situations have occurred however it important that such risk are considered and actions taken to minimise them. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 18 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, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Trevanion provides clean and comfortable accommodation, however risk assessments need to be carried out to ensure that only people who are suited to this accommodation stay at the home. EVIDENCE: We looked around the building as part of this inspection. We found that the home was very clean, comfortable and tidy. The communal areas have a range of seating areas so people can sit and watch TV or play computer games, or sit quietly. There was ample comfortable seating and views of the gardens. There is a large dining room that is also equipped with a bar, with a sound system for discos and a projection system so that holiday guests can see what activities are available during their stay. There is a patio and barbecue area just outside the dining room, and this is well used in good weather. The bedrooms we saw were all clean. We noted that some of the rooms have very limited storage space, this is not such an issue as Trevanion is a used by Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 19 people on holiday rather than for long-term accommodation. Some of the bedrooms are small. We noted that when we tested the hot water in showers it was hot and not thermostatically controlled to be less than 45 degrees centigrade. We were told that there no risk assessments in relation to the risk of scalding. When we looked at some feedback sheets from past visitors we noted that one person had said that there was no call bell to call for help if she needed it. We asked the Manager about this and she explained that if people needed assistance that they could use the telephone. It must be clear to people who are thinking of using the service that call bells are not provided, and that this should be taken into account in the assessment of need. We discussed with the Manager that some of the toilet and bathroom doors open inwards. Some of the people who stay at Trevanion have epilepsy and could be stuck behind such a door, if they had a seizure. There are no risk assessments to take account of such a situation. Doors to bedrooms do have keys, and can be locked from the inside. This locking mechanism is complex, and whilst we appreciate that people are told how to use this lock it may be beyond their skills. Given that the other guests are strangers, it is of concern that all guests may not be easily able to lock their doors at night. We were told that no complaints have been received on this matter. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 20 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, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who stay at Trevanion are supported by staff who are well trained and competent, however recruitment procedures are not as thorough as they need to be. Staff are not readily available if needed during the night and first thing in the morning. EVIDENCE: All of the people who returned a survey said that the staff treated them well and that the carers listened and acted upon what they said. We talked to the Manager about the number of staff on duty. We were told that the level of staffing changed depending on the needs of the people staying at Trevanion. We were told that there was one person who slept in an immediately adjacent building overnight. No care staff slept in the actual care home, anyone requiring support in the night would need to telephone for assistance. The staff on duty told us that they start on duty at 7.45am, and that usually a further care staff came on duty at 9am. We were told that there were generally 6 care staff providing support for trips out during the daytime, then after 6pm there are two staff working till 10.30pm. In addition to the care staff there are catering and cleaning staff. The manager explained that Trevanion could also Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 21 provide one to one support for an individual if it was assessed as being needed. We observed that this was level of staffing was appropriate given the level of needs of the people staying at Trevanion. However we were concerned that care staff who were on duty over night did not enter the home until 7.45 am. We discussed this with the Manager, and whilst we noted that people were on holiday and therefore might prefer to lie in, other people might be used to getting up early or might not sleep well in a strange place and therefore be up and about before 7.45 am. We asked how a guest would call for assistance during the night. We were told that they would need to use the telephone and they were shown how to do this at the start of their stay. We asked about where the night staff were based and was told that they slept in a room in an adjacent building. The only way to contact this person is by telephone. We therefore require that the home ensure that a risk assessment is completed to ensure that the people who stay at Tremanse are suited to this level of service at night. We observed the way staff worked together and communicated. There were daily handovers and staff were well organised, so that the people at Trevanion got out on trips. We looked at the way staff are recruited and found that there were systems in place to check references and to see if people had criminal records. We found that two references were not always received before someone started work. Also, that a check of a list of people who are not suitable to work with vulnerable people (POVA First) were not received prior to employment. We discussed with the manager the importance of this check and that once this POVA check has been received that the individual may work, but only in a supervised capacity. We looked at the induction and training staff received to do their work, we found that staff received a range of training is received and that staff have a full induction. All of the staff responding to the survey said that they had received and induction and were trained in their work. There were records of staff supervisions on file and one of the staff responding to the survey said “Supervisions and appraisals are always conducted in a relaxed two way manner actions have always been addressed or chased up when necessary”. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who stay at Trevanion benefit from a well managed home, where the views of people who have visited are taken into account to improve the service. Further risk assessments need to complete to ensure that all of the guests who stay are kept safe throughout their stay. EVIDENCE: The manager, Tracey Barrett, is in day-to-day charge of the home, and is supported by other managers who have responsibilities for different areas of the service. It was clear from discussions with Ms Barratt that she was aware of what was happening at Trevanion and had made changes to systems when she thought that this would improve the service. There were records of visits by a representative of the company, (Reg 26 visits), and reports of these visits were posted for staff to read. These visit Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 23 were thorough and identified and dealt with issues- such as staff falling into the practice of waking guests as a routine. We looked at the quality assurance system and found that everyone who stayed at the home was sent a survey. These surveys are collated and the results are posted on the website. Actions are taken to deal with issues raised to ensure that any concerns do not reoccur. We looked at the way health and safety is managed in the home. A number of issues have already been raised in other parts of this report. The hot water in baths and showers is not thermostatically controlled to temperatures below 45 degrees centigrade, (to avoid scalding) and there are no risk assessments. Some of the doors in bathrooms and toilets open inwards and there is a risk of people getting trapped behind them. Radiators are not covered, and there are no risk assessments in relation to these. We discussed with the Manager that the nature of this service means that each week groups of people who have different needs and who present different risks stay. Risk Assessments need to be in place to ensure that all guests at Trevanion are safe, and that where risks exist that they are managed. We discussed the risk posed by fire to the service and was told that a fire risk assessment had been completed on 18/11/07 and that staff received fire training every 6 months, or 3 months if they sleep in. We were told that if the fire alarm does go off in the night, then the “on call” person is available to come and assist. Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 24 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 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 2 X Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 25 Yes 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 YA2 Regulation 14 (1) Requirement A comprehensive pre-admission assessment must be obtained before it agreed that an individual is able to stay at Trevanion. Plans of how care is to be provided should be comprehensive and provide details of the actions staff are to take. Risks to individual guests must be assessed and managed, this includes risks posed to individuals because of particular needs- such as epilepsy and risks that they might be posed because of vulnerability: staying with in a group of people they do not know. The facilities and services at Trevanion must be suited to the people who stay, and able to meet their needs. This must include the system of locking bedroom doors, and system for guests to call for assistance particularly during the night. The staffing levels and availability during the night and first thing in the morning must DS0000069183.V366845.R01.S.doc Timescale for action 01/11/08 2. YA6 15 01/11/08 3. YA9 13 (4) 01/11/08 4. YA29 23 (2) m 01/11/08 5 YA33 18 (1) a 01/11/08 Trevanion House Holidays Ltd Version 5.2 Page 26 6 YA34 19 7 YA42 13 (4) be reviewed, to ensure that no one is at risk because of the current staffing arrangements. Two written references and Protection of Vulnerable Adults must be received prior to employment to ensure that an informed decision can be made as to the suitability of any individual to be employed. Risk assessments must be completed in relation to all aspects of safety in the buildingincluding risks such as injuries caused by hot radiators, from being stuck behind doors, and from scalds from hot water. 01/11/08 01/11/08 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 Trevanion House Holidays Ltd DS0000069183.V366845.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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