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Inspection on 09/04/09 for Tabley House General Nursing Home

Also see our care home review for Tabley House General Nursing Home for more information

This is the latest available inspection report for this service, carried out on 9th April 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A senior staff member visits people wherever possible to carry out an assessment of their care needs before they move in to the home to ensure that their needs can be met there. Individualised care and attention is provided and there is a welcoming cheerful environment so that people who are cared for feel comfortable and at home. People`s plans of care were well documented and reflected each person`s individual needs. The home has an established team who were keen for standards to be maintained. We found people receive care and support that matches their expectations. Staff are quick to respond to changes in people`s health care needs and have an excellent understanding of the importance of treating people as individuals and promoting their privacy and dignity. Meals were varied and offered choice and variety. The home provides a varied range of activities so that people who live in the home have enough to do. A good standard of hygiene was seen throughout the home and the standard of decor was good. Comments from relatives were " we are looked after as well as my relative" " the staff work as a team and my mother had the best care she could have had in the last weeks of her life" " all the staff are fantastic" " " it is the extra touches that make the difference" " you made my mum feel safe and protected" Staff were seen to treat people they cared for with respect and had an easy friendly manner. Staff were seen to provide support in a sensitive and caring way. We found that the management team are involved in the day to day running of the home and that a number of systems are in place to check that peoples expectations are being met .

What has improved since the last inspection?

The home is at present undergoing a major refurbishment. The areas that have been completed are to a high standard and work is on going on some corridors and areas in the West wing.

What the care home could do better:

The home should continue to maintain the high standard it has achieved.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tabley House General Nursing Home Tabley House General Nursing Home Tabley Knutsford Cheshire WA16 0HB     The quality rating for this care home is:   three star excellent 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: Joan Adam     Date: 0 9 0 4 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: Tabley House General Nursing Home Tabley House General Nursing Home Tabley Knutsford Cheshire WA16 0HB 01565650888 01565653230 karenlynskey@cygnethealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cygnet Healthcare Limited care home 59 Number of places (if applicable): Under 65 Over 65 15 44 0 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 2 One named service user under the age of 65 to be accommodated for eight weeks until 12 November 2006. This home is registered for a maximum of 59 service users to include:- MAIN HOUSE * Up to 44 service users in the category OP (Old age, not falling within any other category) of which :- * Within the 44, up to 2 agreed service users in the category PD (Physical disability aged under 65 years) WEST WING * Up to 15 service users in the category DE(E) (Dementia over 65 years of age) Date of last inspection Brief description of the care home Tabley House is an eighteenth century country house set in acres of parkland in the Cheshire countryside. The accommodation, set on two floors, caters for up to 44 service users in thirty-eight rooms. All rooms have en-suite facilities. The majority of rooms are single, however a small number of shared rooms are available. The home caters for people over the age of sixty five and provides both personal and nursing Care Homes for Older People Page 4 of 24 Brief description of the care home care. The current charges for the home are #850 to #1,300 per week. This information has been provided by the home manager. 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: three star excellent 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 unannounced inspection took place over six hours by two inspectors. This was to assess if peoples needs were met at the home.A tour of the premises took place and included a majority of the bedrooms and the shared areas such as the lounges, dining rooms, bathrooms and toilets. The manager, deputy manager, some staff and people cared for were spoken with and their views contributed to the report. The visit was just one part of the inspection. Before the visit the home was asked to complete an annual quality assurance assessment (AQAA) to provide up to date information about services of the home. Other information since the last key inspection was also reviewed. Feedback was given to the manager and deputy manager at the end of the visit. Care Homes for Older People Page 6 of 24 Care Homes for Older People Page 7 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 8 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information and their needs are fully assessed before they live at Tabley House so they know their needs can be met. Evidence: We looked at the AQAA and this told us that each person and their family is given good information regarding the home before they are admitted. A brochure and the statement of purpose is given to people in the form of a welcome pack which also contains an activities programme , menus, complaints procedure and gives the name of a senior person to contact if they wish to discuss any aspects of the home. People are informed of the homes web site so that they can gain more information regarding the home if they so wish. Advice is also given in regard to advocacy services to help them to understand the finances when living in a care home. When we visited the home we found this to be true. The care plans for two newly admitted people were looked at. These contained detailed pre-admission documents which had been fully Care Homes for Older People Page 10 of 24 Evidence: completed by senior staff before the person had been admitted to the home. Details from the hospital were also present. This information was used to write a plan of care to let staff know what their needs were and how they could meet them. Care Homes for Older People Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Tabley House have their health,personal and social needs met in a dignified way. Evidence: We looked at the AQAA. This showed us that people who live in the home should expect to receive care in a way that they choose. We saw that each person has a plan of care, which gives staff clear instructions on how to provide care in a way which people preferred. These were core care plans which were individually adapted to the individuals needs. All plans of care were reviewed each month so that any changes were up dated and all staff would know what changes if any had been made. A moving and handling assessment had been completed on each resident so that staff would know how to move them safely. A nutritional assessment had been filled in so that staff would know if the residents were at risk of loosing weight. Weights were recorded on a weekly or monthly basis. Care Homes for Older People Page 12 of 24 Evidence: Choices were recorded such as when they liked to get up, where they spent their day and how their spiritual needs were met. Visits from other health care professionals such as G.Ps, nursing home co-ordinators and district nurses were recorded so staff would know when these visits had taken place and why. The daily records were detailed so that all staff would know what had taken place during the shift. Care plans had evidence that the person who lives at the home or their family had been involved in the care plan. The manager or a senior staff member audited the care plans on a monthly basis so that areas of concern could be acted upon. We saw staff that had the skills to care for people properly by providing them with specialised equipment to reduce the risk of their health deteriorating and by consulting with doctors and other health care professionals when their condition deteriorated. The atmosphere in the home was warm and welcoming and all staff were seen to be friendly and appeared to have good relationships with the people in their care. When spoken with staff were aware of peoples needs and their likes and dislikes. Residents spoken with said it is a very nice home the staff are really good very professional staff. everything runs smoothly. The home cares for people who are at the end of their life and are at present working toward a gold standard framework for end of life care. Staff are undertaking training at present regarding this. Medicines are managed well. Policies and procedures are in place for the safe management of medications and staff training has taken place so that staff are aware of their responsibilities regarding the safety of medicines in the home. The home uses a blister pack system for medication so that staff can see which medicines have been given out each day. All medication administration sheets had been completed. Controlled drugs were looked at and the checking of these by staff had been recorded appropriately. Items with a short shelf life in the drug fridge had been dated and signed so that staff would know when these had been opened. The medication management was audited every three months so that any errors were identified and dealt with quickly. Care Homes for Older People Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Tabley House are able to take part in a range of activities and mealtimes were a positive experience. Evidence: We looked at the AQAA which told us that the provision of activities on offer is varied and takes in to account the needs and wishes of the people who live in the home. When we visited we found this to be true. We found a varied activities programme was on offer each day for people to join in if they wish. When we asked people they said could choose to join in or not. Activities on offer ranged from entertainers coming in to the home to days out to local supermarkets or to the coffee shop in the museum which is adajent to the home. Excesises to music, quizes or crafts are some of the things on offer at Tabley House. Choices are recorded in the care plan such as how the people who live in the home like to spend their day. There is a varied menu on offer and peoplewho live at the home have regular meetings with the chef so that they can discuss changes thye may want to make. More basic food are on offer following one meeting with the chef. The dining room has been refurbished to make a pleasant place to dine and there are two sittings for meals so Care Homes for Older People Page 14 of 24 Evidence: that everyone can enjoy a relaxed meal. Staff were seen to assist people in a sensitive way. peopel spoken with said that the food was very good a good variety on offer. Care Homes for Older People Page 15 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. People who live at Tabley House are confident that their complaints are listened to and staff have received training so that they know what to do to protect people. Evidence: We looked at the AQAA which told us that two complaints had been made to the home. It also told us that staff have received training in how to protect people rights and the complaints procedure. People spoken with said that they knew how to make a complaint. I would speak to the manager, but I have no complaints People could be confident that their complaints would be listened to. The home had policies and procedures on the prevention of abuse and whistle blowing. The safeguarding procedure is how the local council and other agencies respond to allegations of abuse against vulnerable people.Staff have received training about safeguarding people from abuse so that they know how to deal with any incident or suspicion of abuse. Care Homes for Older People Page 16 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. People who use live in Tabley House live in a well maintained environment, which is equipped to meet their needs. Evidence: We looked at the AQAA which told us that there is an ongoing programme of maintenance and replacement. Areas that have undergone a major refurbishment are the dining room, the main lounges and corridors. New furnishings, curtains and carpets have been purchased. At present work has commenced on upgrading the the West Wing. The bath on the top floor has been out of service for some time due to a specialist plumber being called to repair the drainage system on the bath as a flood was caused in the museum. There are a parker jakuzzi bath and three shower rooms on the ground floor which can be used by people who need help with bathing. A high number of bedrooms are en suite. The home was cleaned to a high standard and there were no unpleasant odours. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support from skilled staff that they like. Evidence: We looked at the homes AQAA which showed us that a variety of staff are employed to provide care and support to the people who live in the home and that the staff was recruited correctly. We found this to be true. We found that staff are supplied in sufficient numbers to meet peoples needs and people who live in the home said they thought that there was enough staff on duty on each shift. People said that if they needed help this was supplied quickly. All the staff are very helpful The AQAA said that each registered nurse is allocated supernumerary time to complete care plans and formal supervision of staff. We saw that most of the staff working in the home have achieved a national vocational qualification in care. This shows that staff have had formal training to carry out their roles and is above the expectations of the national minimum standards. We saw staff training is on-going and that all staff have received mandatory training in key subjects. This means that staff have been given the skills to promote peoples health and welfare. The home is working toward a gold standard framework for end of life Care Homes for Older People Page 18 of 24 Evidence: care. All staff have received training regarding end of life care so that people who live in the home are looked after by competent staff. The home facilitates student nurses and adaptation students. Tabley is a partner of the Cheshire consortium in the provision of staff training and has close links with the Primary Care Trust nursing home training co-ordinator. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the views of people who live there are obtained. Evidence: The manager of the home is an experienced nurse with relevant management qualifications and has been at the home for some time. She is supported by a deputy manager and trained staff. The AQAA states that the service responds well to service users needs at point of contact, To treat each individual as a unique person and protect their privacy and dignity. To ensure that the transition in to nursing home life is smooth and all anxieties are dealt with immediately by thoroughly assessing needs To acknowledge our weaknesses and create strategies to solve these and to continuously improve and progress. When we visited the home we found that this was true. Staff feel supported by the management of the home and feel that they receive good training. This was told to us on survey forms that had been given out to staff prior to the visit. We viewed records that showed that monthly checks are carried out on all systems in the home which gives support and care.This is Care Homes for Older People Page 20 of 24 Evidence: good practice and shows a commitment from the home to provide a good service.We looked at how the people who live at the home and their relatives are consulted about the service. Regular meetings are held and topics are discussed which affects their day to day lives. Questionnaires are sent out and a report is written and shared with the people who live there. We looked at how the health and safety of the people who live at the home is protected and found that there are regular checks on all equipment. We also saw that necessary checks are carried out to the services of the building. 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 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. 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