Care Home: Tropicana

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What the care home does well The registered providers and their family have for a number of years provided a stable, comfortable, and homely environment for residents. The people were clearly relaxed, content and able to talk comfortably with the staff and the inspector. The registered providers demonstrated a good understanding of the care needs of the residents, and there is an evident commitment to individualised care provision. There is an established and committed staff team, some of whom have worked at the home for many years. The registered providers are actively involved on a daily basis. Staff were observed to interact with the residents in a professional and caring manner. The staff were also observed to be busy throughout the inspection attending to the needs of the residents. What has improved since the last inspection? The registered providers continue to offer a stable, relaxed and comfortable home for the residents, who, without exception, were praiseworthy of the home, the registered providers and the staff. Staff supervision now takes place regularly. Staff training, quality assurance, and care records have improved since the last inspection. Many areas of the home have been decorated since the last inspection. What the care home could do better: Care plans would benefit from more detail. Alternative formats (e.g. audio-visual) for information would benefit people with sensory deficits. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tropicana Newquay Road St Columb Major Cornwall TR9 6SD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 1 1 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Tropicana Newquay Road St Columb Major Cornwall TR9 6SD 01637880779 01637880779 info@trop.ssnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ernest Westbrook,Mrs Marina Westbrook care home 10 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Tropicana is a large Victorian house with well-kept secluded gardens to the rear of the home and a small car park to the front of the home. It is situated within a short distance of St. Columb Major town centre. The house has been extended to provide a small quiet home for up to ten residents who require personal care and are over the age of sixty-five. This is a family run home, the registered providers with their daughter manage the day to day running of the home and live on site. Accommodation is on two floors. There is no lift or stair lift to the first floor. There is large lounge and a comfortable dining room on the ground floor. Wheelchair access is available to the side Care Homes for Older People Page 4 of 24 Over 65 3 10 0 0 Brief description of the care home of the property. Regular contact with friends and family is encouraged; visitors are welcomed, and the home enjoys good relations with the local community. Fees are in line with the current basic rate of Social Services funding. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place on the 11th August 2009. The inspector met and spoke with four of the seven residents, staff, the registered providers and their daughter. The documentation, policies and procedures, and the environment were inspected. Tropicana is a family-run home, which provides a comfortable and appropriate home for up to 10 residents. On the day of the inspection there were seven residents living at the home. The relaxed family atmosphere, and the evident contentment of the residents impressed the Inspector. The registered providers should their improvements in record keeping. Nothing should detract from how highly the residents speak about their home, the staff, and the care that they receive. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The most recent admission to the home was properly assessed prior to finalising the move. Intermediate care is not offered at Tropicana. The people who are thinking about a move to Tropicana are provided with good information to help inform them about their choice of home, though consideration should be given to alternative formats. Evidence: The registered providers confirmed that copies of the Statement of Purpose and Service User Guide (documents that tell a person about the home) are given to prospective and current residents. This also includes the Complaints Procedure. We discussed the potential benefits of offering information in alternative formats (e.g. audio-visual) for people with sensory deficits. As part of this inspection we looked at the assessments that were carried out prior to a person moving to Pendarves. The care documentation of the person most recently Care Homes for Older People Page 9 of 24 Evidence: admitted to the home showed that a proper pre-admission assessment had take place. Comments received from residents at the time of the inspection, and provided by the quality assurance surveys sent out prior to the inspection were positive, and confirmed that people feel they receive the information they need. One resident confirmed that they visited prior to deciding to move in permanently. Residents are involved in determining their care plans. Intermediate care is not offered at Tropicana. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care. The care documentation shows the involvement of other health care professionals, and residents confirmed that they receive a good standard of care and felt well looked after by staff. Medicines are handled appropriately, and the home has a relevant procedure. The residents could not speak highly enough of the care, attention, and respect shown by the staff at Tropicana. Evidence: Residents care plans and documentation were inspected. Two care plans were inspected, and one showed evidence of resident/family involvement in the development and review of the care. The residents health, spiritual, social and personal care needs are set out in an individual plan of care and these are being reviewed with resident and/or representative involvement, where possible. More detail would be of benefit (e.g. as well as indicating that dentures are worn, how are they cleaned?). The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Daily entries in the care documentation show the involvement of other healthcare Care Homes for Older People Page 11 of 24 Evidence: agencies as appropriate to the needs of the resident. Daily entries made by staff evidence the general health care given. Residents are registered with a GP, and professional advice is sought as needed. The residents confirmed that they have the opportunity for exercise and activity. All the residents have access to support services such as opticians, and a chiropodist visited at the time of the inspection. A medicines cupboard and fridge, in addition to a cupboard for the storage of controlled drugs is provided. A Controlled Drugs register is available, but not in use at the moment. A medicine policy is in operation. Medicine Administration Records were seen to be in order. The supplying pharmacist visits annually. Residents and their representatives or relatives are treated with respect and their right to privacy is upheld. Staff were observed to treat people with respect and dignity at all times throughout the inspection. The residents preferred name is documented as well as peoples likes and dislikes. People spoken with confirmed that they are treated respectfully; their privacy and rights to make decisions are supported, and they spoke very highly of the staff and the autonomy that they are afforded. Residents confirmed that they are able to meet relatives and friends within the communal areas, in the garden, or in their own rooms. Mail is delivered unopened to the relevant person. The size of the home means that it runs as a large extended family, with the established and experienced staff having an in-depth understanding of the residents and their needs. Clients have access to a telephone for private use. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents said that the staff could not do enough for them, and that they were free to see visitors as they wished. They also confirmed that they have enough to do to keep themselves occupied. The residents said that they enjoyed the food that was provided, and confirmed that they were offered a choice. Evidence: The residents informed the inspector that they were able to make choices about how to spend their time, and they felt that their recreational interests were being met on an individual basis. Discussion took place with the registered providers about the use of technology in an attempt to meet the sensory needs of some of the people that live there. Individual interests are recorded at initial assessment. People were observed to be able to choose where to eat e.g. dining room, lounge or in their room. Spiritual and social needs are included in the care plans. There is a broad range of reading matter and a large selection of videos/DVDs available within the home. Residents have a daily paper delivered if desired. Preferred meal, waking up and getting up times are clearly documented and respected. The residents were happy with the flexibility within the home and felt that it met their needs and wishes. The care documentation shows the quality of the residentsday and reflect the individual preferences of that person. Care Homes for Older People Page 13 of 24 Evidence: Residents are able to meet relatives and friends within the communal areas, in the garden or in their own rooms. Visitors are welcomed to the home, depending on the residents wishes, which are respected at all times. Rooms are personalised with plenty of evidence of personal possessions being brought in. Bedrooms are fitted with suitable locks to ensure residents privacy. The likes and dislikes of each resident are noted and an alternative provided if the resident is known not to like something. Residents are advised of the menu planned for the day. The menu card displayed shows the options available to them. Residents were aware what was for lunch that day. Choice is provided at all meals. Food records are kept and special diets are catered for, as required. Fresh fruit and vegetables are readily available. Baking takes place on a regular basis. The residents were complimentary about the food. The dining room provides an attractive, comfortable setting that is laid up for residents who choose to eat there. There is a menu, but this is planned only a few days ahead as the registered providers often decide what to cook the day before. The kitchen was seen to be clean and orderly. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Neither the home nor the Care Quality Commission have received any complaints since the last inspection. The registered providers and staff were seen to interact well with residents, who confirmed that they would feel able to raise any concerns. Residents welfare is protected. Evidence: There is a complaints procedure in operation, and residents confirmed that they would feel able to express any concerns. The complaints procedure includes the current contact details for the relevant Adult Social Care Department or the Care Quality Commission, and is included in the Service User Guide and is also displayed in the entrance hall. The residents said that they knew who to talk to if they had a concern, and would feel able to do so. There is a Protection of Vulnerable Adults policy and a whistle blowing policy. Contact details for adult protection agencies are clearly displayed on the notice board. Residents are additionally safeguarded by the family approach of the home and the small, established staff team. Safeguarding training is provided for all staff, as is regular staff supervision. People are protected by the homes recruitment procedures. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents said that they were comfortable and very happy with their accommodation. Residents rooms were personalised and comfortably furnished. There is no lift or other aid to assist access between floors. The environment is clean, and homely. Evidence: The grounds are accessible and attractive, and new garden furniture has been provided since the last inspection. There is a small extension of five rooms to the rear of the property, all having easy access to the gardens through individual french doors. Four rooms are situated on the second floor. There is no lift. The home meets the needs of the current residents, and offers a homely atmosphere for the people to relax in. The home is decorated with paintings, pictures and fresh flowers. Residents said, without exception, that they found their accommodation very homely, comfortable and it met their needs. New digital televisions (with DVD player) have been provided in each room since the last inspection. Large areas of the home have been redecorated since the last inspection: lounge, dining room, hallway, top floor, upstairs bathroom, and extension hallway. The garage door to the front of the property has been removed and replaced with a window (this is used for storage). There is a dining room and a comfortable lounge. There is an attractive, private garden to the rear of the home and seating to encourage people to go outside and enjoy the grounds, though in practice many prefer to sit out the front where they can say hello to passing locals. One person made particular reference to having enjoyed watching this years village carnival. Care Homes for Older People Page 16 of 24 Evidence: The home is clean, pleasant and free from any odours. Gloves and aprons are available within the home. Hand towels and a soap dispensers are available. The laundry facility is small, but functional. Red sacks are available for fouled linen. The kitchen is domestic in nature, but perfectly adequate for the size of the home. The kitchen was seen to be clean and orderly. Bedrooms are fitted with suitable locks to ensure residents privacy. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training records have improved to better demonstrate that staff are provided with the skills and knowledge to perform their roles, and residents were very complimentary about the care provided. A National Training Organisation compliant induction programme is in use. The home uses a robust employment procedure to protect residents. Evidence: This is a small establishment with a small team of mostly long-serving staff. Staffing levels are recorded in the diary. Staff often share roles within a shift, such as cooking and caring or cleaning and caring. Residents were, without exception, complimentary about the staff and the care they provide, saying nothing is too much trouble. Staffing levels were appropriate to the care needs of the residents at the time of the inspection. Staff were observed to be caring and respectful during their interactions with each other and the residents. There is an evident rapport with residents and a relaxed atmosphere that is the result of attention to individual needs and preferences. Staff training records have improved since the last inspection and now demonstrate a commitment to furthering the staffs skills and knowledge base. Three staff members have achieved the NVQ Level 2 qualification or above. The registered providers daughter said she is currently undertaking NVQ Level 3. The home and residents would benefit from the continued promotion of training relevant to the role staff carry Care Homes for Older People Page 18 of 24 Evidence: out (e.g. 1st Aid). A staff personnel file was inspected and seen to be satisfactory, and showed that the home is running a National Training Organisation compliant induction programme. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The inspector is of the opinion that the registered providers have the residents best interests at heart, and this is supported by the positive comments received from the people that live there. Evidence: The registered providers are in day-to-day control, assisted by their daughter, and have been working within the care profession for over thirty years; running this home since 1984. Their daughter is the senior carer within the home. There are clear lines of accountability within the home. The registered providers have reintroduced a quality assurance system to ascertain the views of others, especially those that use the service. Discussion took place around how best to summarise and publish any feedback and findings from the surveys. The Care Quality Commission has not received any complaints about this service since Care Homes for Older People Page 20 of 24 Evidence: the last inspection. The registered providers keep letters and cards received complimenting them on the care provided. The home enjoys close links with the local community and are able to respond to feedback received. The registered providers do not handle any residents money, and there is a relevant policy in place. If a resident needs to purchase anything and does not have ready access to the amount needed, the home will provide the money or purchase the item and invoice the resident or their representative. Staff supervision is regular and frequent with appropriately detailed records kept. The home is well maintained, clean, and safe for residents, staff, and visitors. There is relevant maintenance and safety work carried out, and the home carries appropriate insurance cover. Residents and staff were complimentary about the home and the people. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 7 The registered providers should consider the benefits of providing information n alternative formats. Care plans would benefit from more detail. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!