Care Home: Trewan House

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What the care home does well Staff members provide a high standard of care to the residents that live at Trewan House. Good relationships were seen to exist between residents and staff and all of the residents said that the staff members were good. All of the residents and visitors spoken with made positive comments about the home and the staff members working there, These included; " Fabulous, the manager and staff are excellent", "the more dependent residents are looked after well, staff are very kind". The comment cards received also contained wholly positive comments about the home, these included, "Home from home", "I have always received every care required, excellent", my family and I have no problems regarding my relatives care, or well-being". Residents said that routines within the home were flexible and that this gave them some control over their lives and enabled them to be more independent. One of the residents has recently visited her son in Africa and said that the home`s management team had supported her to do this. Catering within the home appeared to be well managed and all of the residents spoken with said the food was good. The records inspected were being kept to a good standard. What has improved since the last inspection? The building work to create additional bedrooms and to improve some of the current facilities within the home has now started. What the care home could do better: When the proposed building work is complete the facilities within the home will be considerably improved. This will enable the owners to reduce the number of double rooms that currently exist. CARE HOMES FOR OLDER PEOPLE Trewan House 335 Ditchfield Road Widnes Cheshire WA8 8XR Lead Inspector Paul Ramsden Key Unannounced Inspection 16th May 2006 10:00 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 Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 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. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Trewan House Address 335 Ditchfield Road Widnes Cheshire WA8 8XR 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) 0151 423 6795 0151 423 2212 info@trewanhouse.co.uk Mrs Maria Carmela Evans Mrs Imelda Anne Youds Care Home 28 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (27), Old age, not falling within any other of places category (27) Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 28 service users to include:* Up to 27 service users in the category of DE(E) (Dementia over 65 years) * Up to 27 service users in the category of OP (Old age, not falling within any other category) * 1 named service user in the category of DE (Dementia) aged over 63 years The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 6th October 2005 2. Date of last inspection Brief Description of the Service: Trewan House is a two-storey family owned care home for older people standing in its own grounds, access between floors is via a shaft lift or the stairs. The home is located in the Hough Green area of Widnes, close to a church, shops and other community facilities. It is on a bus route and is close to Hough Green railway station. There are adequate car parking facilities available. The residents’ accommodation consists of 10 single and 9 double bedrooms, all of which have en-suite facilities except for 1 double room that has a wash hand basin fitted. A variety of lounge and dining spaces are provided for residents. There are an adequate number of toilets and bathrooms within the home. The current fee range for the home is £299 - £399 per week. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was carried out on 16 May 2006 by Paul Ramsden and lasted six hours and ten minutes. All of the key standards for older people were looked at during the visit. The home manager, administrator and deputy manager were on duty together with the agreed numbers of senior, care and ancillary staff. Twenty people were living in the home at the time of the visit. During the visit six residents, three relatives, the manager, the administrator and three of the staff on duty were spoken with. A range of care, health and home records were examined and a tour of the premises, including all lounges, other shared areas and a number of bedrooms, was undertaken. Comment cards for use by residents and relatives/visitors were given to the manager upon arrival at the home. Ten resident and nine relative/visitor cards have been returned to the CSCI. Prior to the site visit the inspector spent time examining the preinspection documentation provided by the home and the Regulation 37 notifications received during the previous 12 months. Work on the new extension to improve the facilities at Trewan House has recently started. The rear door is currently being used as the main entrance to the home. What the service does well: Staff members provide a high standard of care to the residents that live at Trewan House. Good relationships were seen to exist between residents and staff and all of the residents said that the staff members were good. All of the residents and visitors spoken with made positive comments about the home and the staff members working there, These included; “ Fabulous, the manager and staff are excellent”, “the more dependent residents are looked after well, staff are very kind”. The comment cards received also contained wholly positive comments about the home, these included, “Home from home”, “I have always received every care required, excellent”, my family and I have no problems regarding my relatives care, or well-being”. Residents said that routines within the home were flexible and that this gave them some control over their lives and enabled them to be more independent. One of the residents has recently visited her son in Africa and said that the home’s management team had supported her to do this. Catering within the home appeared to be well managed and all of the residents spoken with said the food was good. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 6 The records inspected were being kept to a good standard. 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. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 7 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 Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The quality rating for this outcome area is good. Residents are assessed prior to admission to ensure that the home will be able to meet their needs. EVIDENCE: As part of the inspection process the care files of three people living at the home were reviewed. Pre-admission assessments that demonstrated that resident’s individual needs were being assessed in an accurate and consistent way had been carried out. Those seen contained enough information for staff to be able to meet individual needs. Residents, relatives and other healthcare professionals are involved with the pre-admission assessment. Various risk assessments were also completed. Intermediate care is not provided at Trewan House. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 The quality rating for this outcome area is good. Residents had a plan of care providing details of their needs. The systems used to identify and meet an individual residents needs are good. The health, social and emotional needs of people living at Trewan House are being identified and met. EVIDENCE: The home or deputy manager is responsible for drawing up a resident’s plan of care. The five care plans seen as part of the case tracking process provided staff members with the necessary information for them to look after a person’s needs. There was written evidence to confirm that care plans were being reviewed and where necessary re-written on a regular basis. The care plans seen contained evidence of consultation with residents or their families/advocates. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 10 The staff members at the care home monitor the service users’ health and emotional needs daily and there was evidence to show that residents were receiving appropriate support from health care professionals. This included GPs, community nurses, optician, dentist and chiropodist. The comment card received from a visiting community nurse indicated that a good quality of care was being provided to her patients. It was seen throughout the visit that residents were being treated with courtesy, respect and good humour by staff. Staff members were seen to be interacting with individuals in an appropriate and respectful manner, knocking on bedroom doors before entering and addressing people appropriately. All personal care is carried out in the privacy of a resident’s bedroom or one of the bathrooms. Residents spoken with confirmed that they had been able to express their opinions and wishes about their daily routines. Policies and procedures in relation to medication are in place. Medicines are administered using a blister pack system provided by a local pharmacist. The arrangements for the administration of medication during the inspection were considered to be satisfactory. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality rating for this outcome area is good. Residents spoken with were positive about the home and the services provided; they are able to maintain contact with their family and friends and make choices regarding their own lives. EVIDENCE: Residents were able to move around freely within the home and a choice of sitting areas was available. Residents confirmed that routines within the home were flexible and that they were able to make choices in many areas of daily living, for example times of rising and retiring and participation in planned activities. Staff members were observed to knock on the door and to await permission before entering a resident’s bedroom. The residents and visitors spoken with made wholly positive comments during the inspection. One of the visiting family members said, “I visit at various times and the staff are very good. The comment cards received also contain wholly positive comments about the home. These include; “I feel very safe and happy”, “all visitors are made welcome and part of the extended family”. The residents made a number of positive comments regarding the care and services provided at Trewan House. Visitors are free to visit the home at any reasonable time and links with the local community are maintained. Mail is given to residents unopened. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 12 Meals can be taken in the dining room or in the privacy of residents’ own rooms. The kitchen area was well managed and organised. There is a menu that has the flexibility to meet individual needs and choices. All of the residents that commented said that the food was good and that choices were available. Special diets are prepared where necessary. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality rating for this outcome area is good. Residents are able to voice their opinions and are confident that appropriate action would be taken to address any problems or complaints. Policies, procedures and staff training are in place to protect residents from abuse. EVIDENCE: There is a written complaints procedure for the home. This is also included in the Statement of Purpose and Service User Guide. Those residents and family members that commented said that they would inform the home manager or another senior employee of any concerns or complaints. They also said that they felt confident that appropriate action would be taken. One of the relative comment cards received stated that they had made a minor complaint that was addressed immediately. The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance “No Secrets”. The manager, deputy and the majority of staff have received training in this area. Both staff members and the home’s training records confirmed this. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, and 26 The quality rating for this outcome area is good. The environment within the home is good, providing residents with a pleasant place to stay; this will be improved further when all of the refurbishment work is completed. A good laundry service is provided. EVIDENCE: A tour of the premises was undertaken; this included communal areas and a number of bedrooms. The home is maintained both externally and internally to a good standard. Bedrooms seen during the inspection were personalised, comfortable, well-furnished and contained items of furniture belonging to residents’. When the proposed building work is completed the facilities within the home will be considerably improved. This will enable the owners to reduce the number of double rooms that currently exist. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 15 The home was found to be clean and tidy on the day of inspection. The laundry is appropriately equipped and good systems are in place for the care of peoples’ clothes. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality rating for this outcome area is good. Staff morale is high, resulting in an enthusiastic workforce that works positively with residents, families and visiting professionals to improve the quality of life of people living in the home. A robust recruitment process is in place. EVIDENCE: Staff on duty and rotas seen demonstrated that staffing levels and the skill mix of staff is adequate to meet the needs of the residents within the home. Staff members were cheerful and friendly and residents were complimentary about staff attitude and competence. There is in excess of 50 of staff members qualified to NVQ level 2 in care, a recognised qualification for staff involved in delivering care. The staff files seen contained all of the required information and a robust recruitment procedure was in place for the protection of residents. The home’s administrator confirmed that he was aware that all new staff must be checked against the POVA list and that a satisfactory CRB disclosure must be obtained before employment commences. New staff members undertake an induction-training programme. Copies of induction records were seen on the day of the visit. Staff members also confirmed that this had happened and that they had worked as a Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 17 supernumerary staff member when they had commenced employment. All staff members have a training record; those seen demonstrated that the home provides a good range of training opportunities. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 The quality rating for this outcome area is good. The home is being well run and managed on a day-to-day basis. The records inspected were being kept to a good standard. EVIDENCE: The home has an experienced and competent manager who is registered with the Commission for Social Care Inspection. Both she and the deputy manager have completed the registered managers award. An administrator, who is a relative of the owner, supports them. The residents and family members that commented said that the home’s management team were approachable and supportive. A quality assurance survey to ascertain whether residents and families are happy with the standards of care being provided has been undertaken. Copies Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 19 of the results are available. This is an on-going process and a new survey is to be undertaken in the near future. Residents’ personal monies and valuables are not kept by the home. These are the responsibility of the individual resident or their family/representative. The pre-inspection questionnaire shows that two of the residents currently manage their own financial affairs. One of the residents spoken with during the inspection visit confirmed that she was managing her own finances. All staff members are supervised on a continuous basis; in addition they all receive formal supervision six times a year. There was evidence that staff were receiving training in areas such as dementia, moving and handling, first aid and fire safety. The home manager maintains a training record for all staff members employed at the home. The fire precautions record book was up to date and demonstrated that checks of the alarm system, emergency lighting, fire drills and staff training were taking place at the recommended intervals. Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 20 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 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 21 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. Standard Regulation Requirement Timescale for action 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 Trewan House DS0000005200.V289661.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 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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