Care Home: Trevone

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What the care home does well Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 6Trevone provides a safely maintained and generally clean environment for the residents to live in. It provides a very welcoming atmosphere for visitors, and ensures that there is a good amount of information about the home, its services and facilities, as well as useful supplementary information, to assist residents and their families. Residents are admitted to the home on the basis of an assessment of their individual needs, and upon admission each has their own personal documented plan of care to address their individual needs. Many residents and their families spoke very positively about the care and attention they received from the staff. Appropriate support equipment was in use on the basis of individual risk assessments, there was evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of residents receiving good care and support. Although there was some room for a slight improvement, the meals seen appeared nutritious and appetising; residents generally were appreciative of the quality and quantity of the food provided for them. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received; confidence in the manager among residents and visitors was high in this regard. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Trevone is well managed by a committed and experienced manager. There are some good quality monitoring approaches adopted here, and people are encouraged to have a say in how their home is run. Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place, and staff receiving regular supervision. The competence and skill of the staff group is developed through a structured induction-training programme, and through ongoing training in topics relevant to the needs of the residents. There is also a good focus on the National Vocation Training programme for care staff, with progress being made in this area. What has improved since the last inspection? A new and revised Statement of Purpose and Service User Guide (known in the home as the Residents` Handbook) has now been fully introduced, and is in line with the regulations. Although this home is part of The Orders of St John Care Trust planned redevelopment programme, there continues to be ongoing attention to the existing building in order that it is maintained and redecorated as appropriate. Some of the beds have been replaced, but there remain some older divan-style beds that have been well used, and in the absence of valance style sheets expose a worn and unsightly base. The standard of care plan documentation has greatly improved, with individual plans laying out the assessed needs and how they are to be met, providing good clear guidance for staff to follow when delivering care. The standard of documentation associated with medication records has also improved, with much more comprehensive and clear records now in existence. A new social activities coordinator has been appointed, and as this person has not been in post very long at the time of this inspection, has some way to go to develop a programme that will meet all needs, although already has some vision and ideas for the future. There has been an improvement in the cohesiveness of the staff team overall, with the appointment of a committed deputy manager, and with greater reliability among the nursing team. A revised approach is being adopted towards fire safety, with updated policies and procedures to incorporate evacuation procedures, and with more in depth staff training to address the issues much more robustly. CARE HOMES FOR OLDER PEOPLE Trevone 22 Denmark Road Gloucester Glos GL1 3HZ Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 08:30 12 & 13th November 2007 th X10015.doc Version 1.40 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 Trevone DS0000064614.V347867.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 Older People. 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. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trevone Address 22 Denmark Road Gloucester Glos GL1 3HZ 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) 01452 529072 01452 380829 manager.trevone@osjctglos.co.uk The Orders of St John Care Trust Mr Richard Bruce Terry Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Trevone is a care home providing nursing care and personal care for fortyseven older people. It is managed by The Orders of St. John Care Trust, and is situated a short distance from the city centre in a residential area of Gloucester. A registered nurse is on duty 24 hours a day. All health care services are accessible from community resources, and residents can register with a General Practitioner of their choice as far as practicable. The accommodation is provided on three floors and was originally purpose built, although the home is now part of a planned redevelopment programme. A staircase and a shaft lift provide access to the first and second floors. Residents private accommodation is provided in single rooms on all three floors. Each room has a wash hand basin. There is a combined lounge and dining room on the ground and first floors, two very small lounges, one of which provides a smoking area, and two even smaller quiet rooms on the first and second floors. There is also another communal room adjacent to the large lounge diner on the ground floor. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Trevone range from £493.00 to £682.00 per week, and the home also can admit residents at the contract rates from the Local Authority. Hairdressing, Chiropody, Newspapers and Toiletries are charged at individual extra costs. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days in November 2007. Care records were inspected, with the care of four residents being closely looked at in particular. The way in which staff addressed and worked with many of the residents was observed. The management of residents’ medications was inspected. A number of residents and visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Trevone. Some of the staff were interviewed. Survey forms were also issued to a large number of residents and visitors to complete and return to CSCI if they wished; a small number of responses were received, and some of their comments feature in this report. Only a very small number of the home’s staff responded to the survey forms that were issued to them. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training, supervision and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 6 Trevone provides a safely maintained and generally clean environment for the residents to live in. It provides a very welcoming atmosphere for visitors, and ensures that there is a good amount of information about the home, its services and facilities, as well as useful supplementary information, to assist residents and their families. Residents are admitted to the home on the basis of an assessment of their individual needs, and upon admission each has their own personal documented plan of care to address their individual needs. Many residents and their families spoke very positively about the care and attention they received from the staff. Appropriate support equipment was in use on the basis of individual risk assessments, there was evidence of appropriate sourcing of medical reviews and healthcare, and there were many examples seen of residents receiving good care and support. Although there was some room for a slight improvement, the meals seen appeared nutritious and appetising; residents generally were appreciative of the quality and quantity of the food provided for them. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received; confidence in the manager among residents and visitors was high in this regard. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Trevone is well managed by a committed and experienced manager. There are some good quality monitoring approaches adopted here, and people are encouraged to have a say in how their home is run. Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place, and staff receiving regular supervision. The competence and skill of the staff group is developed through a structured induction-training programme, and through ongoing training in topics relevant to the needs of the residents. There is also a good focus on the National Vocation Training programme for care staff, with progress being made in this area. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There were occasions when the residents’ call bell was ringing for prolonged periods before it was answered by staff. There were also times, particularly during the afternoon, when residents were left sitting unattended for significant periods in the communal areas. This resulted in some residents, particularly the frailest, having little social contact and having more limited opportunities to make choices. The layout of the main lounge also impacted on this, as the television was turned on in one distant corner of the large room, but not many could see or hear it. It has been recommended that a review of the provision and deployment of staff be undertaken in order to take consideration of these points. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 8 Although in most regards the provision of food is satisfactory, in the light of certain comments and the cold choice on the suppertime menu always being sandwiches, it has been recommended that a review of the suppertime menus be undertaken to ensure that there is sufficient choice for residents at this particular mealtime. Generally it can be reported that there is appropriate and respectful observation of residents’ dignity, however there have been very isolated cases when this has apparently been remiss. However, when this has arisen there is clear intent on the manager’s part to address such a shortfall with due urgency and attention. To date the home is failing to fully comply with the recently implemented Smoking Regulations such as they apply to care homes, and must take the necessary steps to ensure the proper measures are in place for their compliance and the necessary safeguards for the residents. As reported above, the home is generally clean, but a recently depleted cleaning team is currently facing challenges in maintaining this, until suitable replacements can be found to consolidate the team again. 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. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have access to a good amount of information about it, and are assessed fully prior to their admission so that they can be assured that the home will be able to meet their needs. EVIDENCE: The home has recently introduced a new and revised Statement of Purpose and Service User Guide, known as the Residents’ Handbook. The former is readily available in the entrance hall for anyone wanting to read it, and a copy of the latter, which contains all the information that is required, is issued to each prospective resident. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 11 The Statement of Purpose has had a slight amendment made to it, to demonstrate the fact that the home can provide care and accommodation to some residents who are between the ages of 55 to 65 years of age and who have conditions associated with old age, as well as those over 65 years. As well as this required information Trevone offers a lot of useful supplementary information for interested parties, and the manager has produced ‘a simple guide to finding and funding a care home placement’. All information is readily available in the entrance to the home, and the general ambience at this point is a very welcoming one. Care records belonging to a recently admitted resident contained completed assessment forms that identified their health, care and social needs prior to admission to the home. The assessment was recorded in full, with each process evidently carried out thoroughly. The assessment had been carried out at the location convenient to the prospective resident, and was well supported by information provided by other health and social care professionals previously involved in the care of the individual. Trevone does not provide intermediate care. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have their health and care needs met through good care planning and delivery, which in most instances is mindful of their privacy and dignity, and through a well managed system for administering their medications. EVIDENCE: All residents have their own personal plan of care, which is subject to regular review. Four were selected for a case tracking exercise, and were scrutinised in closer detail. Staff have evidently worked very hard with planning residents’ care to meet their particular needs, and the standard of care plan documentation has greatly improved since the last inspection. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 13 Each of the care plans was directly linked to a fully recorded assessment of needs, including a good range of risk assessments, which incorporated all health, personal and social issues, and provided clear guidance to staff when caring for the individual. Only very isolated gaps were identified, and these pertained to the very minimal care planning for a prosthesis in one case, and for the management of potentially challenging behaviour in another. Nutritional risk assessments and falls risk assessments were well documented, with all appropriate actions taken as a consequence of each. The home now has a combined weighing-hoist machine, which means that staff can closely monitor even the frailest resident’s weight where there are concerns. There was very good evidence of multidisciplinary working between the home and other health care services, with residents afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. All necessary support equipment was in use on the basis of assessed needs and risks, with pressure relieving, mobility, and safety equipment in use in many cases. In one particular case the resident had a serious illness, and required a significant level of pain management. This was being carried out and documented very thoroughly, with regular medical and medication reviews. There were many frail and vulnerable residents at Trevone, who required a high level of care and attention, many of whom were unable to express a view about the care they received. However, those who were able, either on survey forms or in person, confirmed they were happy with the care and support they received from the staff. It was noted that the home was very busy, and that on occasions the call bell was ringing for quite long periods before being answered. Five out of thirty visitors to the home responded to survey forms, and a number seen during the inspection were spoken to in person. Comments from them were mixed. The majority were very reassured by the care their relative received, with one saying ‘there are competent and caring staff here’, another saying ‘they are always well looked after’, with another saying that ‘the staff are very caring and meet all my relative’s needs’. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 14 Conversely one relative indicated that they felt the need to keep checking on progress with their relative, whilst another said that they felt that their relative should get more attention; the manager held a meeting with this family during the second day of this inspection to explore, discuss and resolve their concerns. Although not spoken to directly on this occasion, there were reports of another family who had concerns about a certain aspect of their relative’s care, and again the home were endeavouring to support and provide reassurances in this case. One particular relative said that the care her relative had received when poorly had been very good, that he had been ‘kept so safe and comfortable in bed’, and that staff had kept her well informed throughout. Residents are able to manage their own medications if they wish and are able, and this was being done by one particular resident, for whom there was a documented risk assessment and care plan in their records. Storage for medications was secure, clean and well organised. Items requiring cold storage were stored in a designated refrigerator; temperatures were monitored and recorded regularly. Controlled Drug (CD) storage was provided, and a meticulously and tidily recorded bound register was maintained, with regular stock checks also recorded. The supplying pharmacist prints the medication administration charts, which includes highlighting any relevant allergies. The author had signed any hand written entries made in the home, with a second signatory as witness. Staff have maintained the charts well, with a clear record of administration of each item. The home has done well to ensure that there are now clear directions for the use of external preparations such as creams and eye drops on medication charts, and has directly linked such prescriptions to an associated plan of care. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date, and also provided a good means of conducting audits. Random audits were carried out on two specific boxed medications, and an apparent discrepancy was identified in one case. There were a number of dosages in excess of what there should have been at that particular point in time. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 15 Upon investigation, the reason for this was that more than one box was in use, as medications for this person were held in two trolleys, in order to accommodate her medication needs whether she was in her room or in the lounge. Staff must exercise caution under these circumstances, and ensure very strict, prompt and thorough recording. Care was delivered in the privacy of residents’ rooms, and when assisting in communal areas, most staff were observed to be discreet and sensitive in their approaches to residents. One relative commented that she had overheard a member of staff using a sharp tone with some residents; one particular survey form also mentioned something similar. The home’s practice of putting up small reminder notices in a few residents’ bedrooms regarding particular aspects of their care and equipment could be viewed as a compromise to the individual’s privacy and dignity if not used more discreetly; it would be better that, if such notices are helpful and also reassuring for families as was reported, they are not displayed so prominently as to be visible to passing people in the corridor. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people living in this home have opportunities to exercise choice and maintain social contact, however there are certain factors that are having an adverse impact for others in this area. A nutritious diet is available, which in the main offers choice and variety. EVIDENCE: Trevone has an appointed social activities coordinator, although this person has only held the post for a short time at the time of this visit, and is only just starting her development in this area. Each resident’s care plan contains a record of their family history and a record of their personal hobbies and interests; despite this there is currently no-one really pursuing a particular hobby or past interest. The activity coordinator confirmed her intention to include as many residents in social activity as possible, regardless of any level of disability, and provide any support necessary to enable the person to participate. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 17 One visitor commented that her relative chose not to participate socially, and appreciated that the staff respected this. A social activity programme is available for a short time each day, and an example of one such weekly programme contained evidence of musical entertainment, games and a quiz. Religious services are also held, with different denominations catered for. Residents have been given the opportunity to discuss the provision of social activities at organised meetings, and some of their comments have been addressed by the home. However, the manager views this area as one needing further improvement, and would like to increase the level of community contacts and outings. An outing to a local garden centre and an in-house party has been held recently. A number of residents confirmed that they had good social opportunities in the home, with some commenting positively about the home having an activities coordinator. There were periods during the morning where the ground floor communal area was well attended by staff, and there was evidence of some good interaction and quality time spent with residents, with the atmosphere feeling inclusive, homely and friendly. However, during the afternoon there were spells when residents were sitting unattended in the large lounge, with no stimulation or anything going on around them. Staff seemed to accept that this was the case, and that it is an area that required improvement. The television was on in the corner, but due to the layout of the room not many could actually see it or hear it. One relative’s survey commented that the home could do with a much bigger television in the communal lounge. Two visitors mentioned that they had often witnessed periods when residents were not attended or socially stimulated enough. One visitor’s survey form also said that in their view residents ought be ‘better entertained’. The home imposes no restrictions on visitors to the home, and residents are free to receive their visitors in accordance with their choice and wish. Visitors were observed coming and in and out of the home, and each of those spoken to directly said that they felt most welcome here. Each who responded to the survey felt that staff kept them appropriately informed about their relative and events in the home. One visitor said that they would prefer to see the shutters to the reception office left open during all office hours, as sometimes these are shut if the administrator is very busy with certain computer tasks. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 18 Residents were spending their time more or less as they pleased, although some who were frail and vulnerable were much more reliant on the staff to assist them. Given that those sitting in the lounge were left unattended for periods, it is the inspector’s view that their ability to make choices was somewhat compromised when staff were not around. Some visitors commented that staff are respectful of people’s choices, and that residents are indeed able to live the way they prefer. Advocacy information, plus other useful information about advisory and support services was readily available. Personal choice was reflected in most of the residents’ bedrooms, with most introducing their own personal treasures and belongings, despite some of the rooms being small and space limited. Despite some isolated reservations expressed by two visitors regarding the degree of food choices available to residents, menus demonstrate a reasonable level of choice at mealtimes, with only slightly less choice at teatime. There is a selection of hot and cold breakfast foods, at least three choices of main meal and pudding at lunchtime, and a hot and cold choice at teatime, the cold always being sandwiches though; residents have raised concerns about the quality of the sandwiches previously. At their request extra brown bread has been provided. The service of breakfast and lunch was seen, and the meals appeared wholesome and nutritious, with lunch containing good, fresh produce. Residents spoke well of the food, and staff were overheard offering choices and additional portions. Staff were also assisting where necessary, and although one visitor’s survey commented that their relative needed more help from staff to cut their food, there were many examples seen where this kind of assistance had been readily given. One senior carer paid close attention to those residents who needed more help to sit more comfortably and in a more supported position in order to eat and enjoy their meal better. The tables were laid attractively, and the meals were well presented, with only minor exceptions when a staff member placed the meal in front of a resident, making no comment and offering little interaction. Mealtimes for the vast majority of the residents were well spaced out over the day, however for one particularly frail lady requiring total feeding by staff, it was observed that her lunch followed very closely after a late breakfast, with only two hours in between the two meals. Special diets were catered for, and the cook was able to speak knowledgeably about the needs of certain individuals. Good catering records were maintained, and the kitchen was orderly. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are able to express their concerns, and can be reassured by the home’s complaints procedure and the policies regarding protecting their rights and the prevention of abuse. EVIDENCE: A copy of the home’s procedure for addressing complaints and concerns is well displayed in the home; it is also issued within the Residents’ Handbook to each person. A record of any complaints and concerns received is kept. These records show a very robust approach to addressing those that arise. Residents and visitors spoken to directly all felt confident in the manager’s ability and commitment to deal with concerns, and nearly all of those surveyed also indicated the same; one resident said that ‘not all staff are as receptive as others to concerns when they are raised’. The home has documented policies and procedures to address forms of abuse and whistle blowing procedures, which are readily available for staff to read. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 20 Staff have received training in the protection of vulnerable adults, although there are a small number remaining for whom a more structured session is needed; the manager was currently pursuing this with The Orders of St John Care Trust training manager. Staff who responded to surveys each confirmed their knowledge and awareness of protecting the rights of vulnerable adults in their care. An easy-read version of the recently introduced Mental Capacity Act has been made available to staff, and the manager was beginning a programme of specific supervisions for staff in order to promote their knowledge and awareness in this area. There are documented staff disciplinary procedures, and these have been instigated in one case in recent months, further to the successful use by staff of the whistleblowing procedure. The manager adopts a very open and transparent approach in the home, and quite clearly has a zero tolerance to any kind of abusive practice. In response to a concern regarding the attitude of isolated carers when addressing residents he was intent on arranging meetings with identified staff urgently, with a view to disciplinary proceedings if needed. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some very isolated concerns in this area, people living in this home are generally provided with comfortable accommodation, which is suitable and safe to meet their needs. EVIDENCE: This home features as part of the redevelopment programme being carried out by The Orders of St John Care Trust. In the interim all efforts are being made to maintain the premises in a clean and safe condition, with ongoing attention to redecoration and necessary repairs. A number of areas have been redecorated, and various items of equipment and furnishings have been upgraded. The manager has been trying particularly to establish a more homely appearance in some of the communal rooms. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 22 Some of the divan-style beds in some of the bedrooms, although serviceable for the current occupants, have been well used, and in the absence of a valance sheet the exposed worn base does not create a pleasing impression. The home was not fully compliant with the Smoking Regulations, as the door to the designated smoking lounge was left open, and was not a self-closing door as is required, resulting in smoke pervading to the surrounding area. This must be rectified if the home is to be compliant under these regulations. One visitor commented particularly on how highly satisfied they were with the standards of cleanliness and hygiene that are maintained in the home, whilst another commented similarly. A third visitor said on the survey form that their relative’s room was left in an untidy and dirty condition, and that there were often unpleasant odours. During this visit the depleted cleaning team was working hard to manage cleanliness and hygiene issues, but was facing some challenges with this, and would continue to do so until a full compliment of staff could be recruited. Very transient odours were detected periodically, but there was no evidence that these were necessarily pervading throughout the home at the time of this visit. The laundry room was orderly, with items appropriately segregated and washed in accordance with infection control measures. Clinical waste is correctly managed, and sluice rooms were clean and orderly. There were copious supplies of the necessary protective equipment for staff use as part of infection control procedures, and this included liquid soaps and sanitising hand gels, paper towels, gloves and aprons. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a competent and robustly recruited workforce, but despite an improving cohesiveness within the team, the minimum levels at certain times may present some barriers to residents being closely or promptly attended. EVIDENCE: Comments from residents and their families were mostly complimentary about the staff at the home. Some said that staff were ‘competent and caring’, although several mentioned that the home ‘could do with more of them’. At least two residents said that the home was sometimes short of staff, with visitors making the same observation. There have been a lot of staff that have left in recent months, and recruitment of appropriate staff has been a problem that the home has had to face. The manager said that he was now making progress in this area, and that some good replacements were now being found. The rotas demonstrate that there are two qualified nurses on duty on each morning, with at least one on day and night. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 24 There are eight, six and three carers on duty during the morning, afternoon/evening and overnight respectively. As reported above, there were occasions when the call bell was ringing for prolonged spells before staff responded to it, with residents in communal areas in particular being unattended, and following this inspection carer numbers are considered to be at minimum levels for the current resident group and their needs. The nursing team is more cohesive than it once was, and now has the benefit of a committed, hard working and loyal deputy manager. An ancillary team of cleaning, catering, maintenance, administration and laundry staff supports the care and nursing team, and the manager works in a supernumerary capacity. The ancillary team numbers were somewhat depleted, with remaining staff doing their best until more could be recruited. The home is making good progress with the National Vocational Qualification (NVQ) training programme for care staff, and is working towards having at least 50 of care staff qualified to the NVQ standard. There are eleven care staff qualified to at least level 2 at this time, with a further seven already working towards the award, two of whom are doing it at level 3. Personnel files relating to three members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history; where gaps existed interview notes showed that the reasons for them had been explored. In just one case the necessary medical information had to be followed up as the person had failed to return it as was required, and in another case the manager had yet to put photographic evidence of the person in their file; each of these circumstances was addressed before the end of this inspection. Two written references had been provided in each case, including one from the last employer. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. The home has a designated training coordinator, who maintains a record of training planned and undertaken by all members of staff. These records showed that staff had received a range of mandatory and optional training that had been relevant to their particular roles. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 25 Newer staff had undergone a structured induction training period, which comprised one day theoretical knowledge outside the home, an in-house induction programme whilst working under supervision with a mentor, and a comprehensive electronic induction learning package, which includes training in each of the Common Induction Standards for care workers. Some staff said that they had received a good level of support during their induction period, and had good opportunities to ongoing training. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from open and respectful management, in which a qualified and competent manager strives to monitor quality and standards. EVIDENCE: The manager of Trevone is a registered nurse, who has good experience of managing a care home. He is registered with CSCI for his role, and he has achieved the Registered Manager’s Award. He adopts a reassuring and high profile in the home, and has a very open and transparent style of management. He ensures that he remains accessible to all, and appeared very approachable at all times during this inspection. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 27 The manager of Trevone and other personnel from The Orders of St John Care Trust carry out regular monitoring checks and quality audits at the home. The home has been accredited for the ISO Quality Award. The home’s business plan is shared with residents and their families. Residents themselves are strongly encouraged to have a say in how their home is run, and are invited to complete an annual quality assurance survey, in which they can express their views and opinions about the standards in the home and their experiences of life here. They are also able to attend meetings, as are their families, friends and representatives. Recorded minutes of such meetings also demonstrate that they are strongly encouraged to discuss and air their views; family members have generally not attended these meetings in significant numbers. The manager and staff have endeavoured to make the necessary introductions, improvements where necessary, and changes on the basis of resident comments. A large number of residents have opted to keep personal money in the home’s main safe. There are well-kept and transparent records for each individual, which clearly demonstrate any receipts, expenditure and running balances. In cases where residents are unable to sign their own records, two staff have signed to witness any entries. Receipts are kept of transactions, and there is generally a clear audit trail of events. Although individual receipts were not held for chiropody, it was possible to audit individual payments, although the date on the chiropodist’s list and on the residents’ financial record did not exactly correspond, which could be slightly confusing. The manager has been carrying out structured individual supervision sessions with all staff, and maintains a supervision matrix to demonstrate this. Care staff have received an annual appraisal as part of the programme, but not all will receive the recommended six supervision sessions in this current twelve month period; some will receive more. The manager has endeavoured to introduce relevant topics into staff supervision in order to increase their awareness in certain areas pertinent to their roles and responsibilities. Some staff commented that they felt very well supported and had regular supervision here. The home has written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training is provided for staff. Records showed that regular safety checks and planned maintenance visits are carried out on the fire safety systems, and the policy regarding fire safety training and evacuation procedures is currently under complete review. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 28 It is planned that an external training provider will provide Fire Marshall training for the manager, which will include evacuation and necessary safety procedures, and a number of other key staff who will undergo Assistant Fire Marshall training in order that there is one such person on each shift. All other staff will undergo an annual training session with the training provider, and receive six monthly refresher training from the home’s designated Fire Marshall. There is first aid equipment in the home, and basic first aid training has been provided to eight of the care staff and three of the qualified nurses; one carer has undergone the more rigorous four-day first aid training course. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply have also been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment are undertaken in a timely fashion, and the associated records are kept in these areas. The building was secure, with coded door entries in a number of locations. Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23(5) Requirement Through consultation with the authority for environmental health the registered manager must ensure that the home is fully compliant in relation to the Smoking Regulations in Care Homes. Timescale for action 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 OP14 OP15 OP27 Good Practice Recommendations There should be a review of staff deployment in relation to maintaining a presence with residents in the communal areas, in order that they have the flexibility to remain as socially active and exercise choices as they might wish. There should be a review of the suppertime menus to ensure there is sufficient choice available for residents. There should be a review of care staff numbers to ensure that there are sufficient numbers to meet the needs of the residents at all times. 2 3 Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor 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. Extracts may not be used or reproduced without the express permission of CSCI Trevone DS0000064614.V347867.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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