Inspection on 20/06/06 for 1 & 2 Turnbull Place

This inspection was carried out on 20th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

1 & 2 Turnbull Place 10/08/07

1 & 2 Turnbull Place 10/01/06

1 & 2 Turnbull Place 01/10/04

1 & 2 Turnbull Place 23/04/04

1 & 2 Turnbull Place 11/03/03

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE 1 & 2 Turnbull Place Riding Lane Hildenborough Tonbridge Kent TN11 9LN Lead Inspector Lynnette Gajjar Key Unannounced Inspection 20th June 2006 09:30 X10029.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 1 & 2 Turnbull Place DS0000023804.V300347.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 & 2 Turnbull Place Address Riding Lane Hildenborough Tonbridge Kent TN11 9LN 01732 838876 01732 838876 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) The Avenues Trust Limited Mrs Bridie Patricia Kennedy Care Home 5 Category(ies) of Learning disability over 65 years of age (5) registration, with number of places 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users from the minimum age of 60 years may be accepted for the existing category of registration 10th January 2006 Date of last inspection Brief Description of the Service: 1 and 2 Turnbull Place is owned by The Avenues Trust Ltd who have a number of care homes in the south east. 1 and 2 Turnbull Place is a care home providing personal care and accommodation for 5 elderly adults with learning disabilities. Admissions must be over the age of 60 years. The home consists of two bungalows on the same site and the Registered manager is responsible for both units. Private rooms are single; with the use of shared communal lounge/diners, kitchen and bathroom. The home has access to its own vehicle and there is room for several cars to park off road. Staff supports the service users covering a 24-hour roster with sleep-in staff at night in both bungalows. 1 and 2 Turnbull Place is located in a country lane approx 1 mile from the village of Hildenborough where there are shops, a church and bus services to Tonbridge and Sevenoaks towns. The home’s current scale of fees range from £1316.23 to £1316.23 per week 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, the first in the year running from April 1st 2006 to March 31st 2007. The visit on the 20th June 2006 lasted from 09:30 to 15.30pm, with a return visit on 22nd June 2006 9.30am to 11.30am to meet with the manager and assess areas not accessible on 20th June. The home currently has 3 people who live at the home and is running with 2 vacancies. One service user was in hospital for both visits. The visit was spent talking directly with those living at the home, both privately and collectively, with staff, and the registered manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of those living at the home in the report. Some judgements about quality of life and choices were taken from limited conversation with those living at the home, and direct observation followed by discussion with care staff and evidencing records. A tour of the premises was undertaken, with time spent assessing various records and case tracking. Information was also gathered through a pre inspection questionnaire completed by the manager and comment cards returned to the Commission. Documentation was in good order, with monitoring systems in place by the registered manager and staff. A number of CSCI “comment cards” (questionnaires) were sent out to relatives and professionals involved in the home. Only one professional form was returned before the draft report was written but indicated being overall satisfied with the home. Any more received will is held by the Commission to be used for forthcoming inspections. Direct comments from service users included: “ I like it here” “So far it’s a fine place” “We have people cut the grass, they came last Tuesday – Don’t half cost a lot of money”? “She’s nice she is (name of care staff)” What the service does well: 1 & 2 Turnbull Place provides a welcoming, bright, clean and airy home. Service users living here feel well supported and encouraged by staff to be involved in all aspects of their daily lives to the best of their ability. Being encouraged to take part in the local community, follow personal interests through a varied social and leisurely lifestyle at a pace suitable to them. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 6 Service users living here, through the positive interaction with staff and manager, feel genuinely liked and respected. Service users presented as being relaxed and comfortable with staff indicating they feel safe and secure at the home. There are good relationships with other professionals and the G.P to ensure up to date assessments, health care, guidelines and equipment is assessed and made available to promote a safe and supportive lifestyle. The home’s complaints procedures are in a pictorial and audio format making them accessible to service users. Service users benefit from having a very stable, committed and motivated staff team, promoting an open and service user led service. The registered manager offers effective leadership and is motivated to promoting good practice and a personal service to those living at 1 & 2 Turnbull Place. What has improved since the last inspection? What they could do better: Safer access to sections of the garden and pathway to the neighbouring bungalow would be achieved through the re-assessment and advise from an occupational therapist regarding grab railing, steep stepped areas, highlighting edging to steps and patio, levelling of uneven paths and frequent seating, making the garden inaccessible by those who are elderly, frail with limited mobility. Service users would benefit from a full review and assessment by an occupational therapist of their current personal mobility and environmental risk assessments, particularly concentrating on the risk of falls and possible injuries. Service user and staff would feel more secure in the knowledge that alternative filing of accident/ incident records is given serious consideration and stored to ensure compliance with Data Protection and confidentiality. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 7 Service users would benefit from staff receiving formal training in aspects related to elderly care, such as falls management, osteoporosis and other age related health issues, dementia and other cognitive impairments. 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. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users and their representatives have access to the information needed in making a decision as to whether the home can best meet their needs. EVIDENCE: The Service user guides and the Statement of Purpose seen today were in both clearly written and pictorial formats. The home uses the organisation template for this. Further personal reference to working with those over 60 years must be included to reflect accurately the elderly care provided by the home. It was acknowledged by the registered manager that minor adjustments to service user details were in hand for both the service user guide and statement of purpose and copies would be forwarded to the Commission on completion. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 10 Two service users living here have done so since it’s opening on 1988, followed by the remaining resident in 1995. The group have lived compatibly between the two bungalows for the past eleven years. No new admissions are currently being explored. The key working and person centre planning process continues to develop, to offer clear promotion and support in identifying personal aspirations and meeting individual care needs at a pace suitable to the elderly service users. The registered manager demonstrated a clear understanding regarding the category and needs of the service users and what the home could best meet. Her knowledge and experience of the home’s capacity to meet individual needs is good. The Avenues Trust have clear procedures to follow if a vacancy was to occur, including formal assessments, trial visits and involvement of those already living here. Care plans seen today contained a written tenancy agreement/contract, which gives the persons’ security and rights of residency to 1 & 2 Turnbull Place but does not give details of the actual private room assessed as best meeting their care needs. This document clearly lays out the tenant’s and landlord’s rights and responsibilities. Service users had signed contacts seen. The home does not provide intermediate care. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Person centred care plans and guidelines continue to develop offering detailed information to ensure consistent support by staff to meet the individual health and social care needs of those living here and to track the care provided. Further development of risk assessments pertaining to falls management would enhance care provided and address environmental hazards for the frail and elderly people living here. EVIDENCE: 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 12 Through discussion with a staff and assessing two current care plans in detail, it is clear that those living here are given full support and encouragement to maintain personal contact with health and social care professionals, to maintain good standards of health and social care. Personal aspiration and interests are understood and supported by staff. Guidelines enable staff to access information that is most important and to maintain individual and collective goals safely. Due to the elderly service users and concerns over personal mobility directly observed during the visit, it is strongly recommended that moving and handling, and mobility risk assessments are re-assessed (with OT/Physiotherapy advice) and reviewed particularly pertaining to risk of falls with in the home but also accessing to pathway and local community. One service user has weekly sessions with a private physiotherapist. Photographic, pictorial and object referencing is used to aid communication and better understanding by the service users living here. Daily write-ups are kept for each person. Staff complete these in detail each day, with topics including the time they get up and go to bed, the activities they have taken part in, what they have eaten, GP and other appointments plus other details of their day. Giving good summary of the active care and support given and reciprocated. In house care reviews take place regularly. Interaction between the service users and staff continues to be good, showing genuine respect, friendship and appropriate familiarity with each other. Staff have a good understanding of negative language used by one service user and meaning behind these and anxiety caused. Records seen were stored securely. To comply with Data Protection Act alternative storage of the yellow accident form was discussed and to be implemented by the manager. Good medication practices were observed with safe storage of medication. Medication is regularly reviewed with the GP. No service users currently self medicate. Appropriate storage and records were observed. A recommendation was made regarding regular use of a household remedy to be reviewed with the GP. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users living here are given encouragement and support to make choices about a range of local social and recreational interests at a pace suitable to them. The menus and food provided offers the quality, nutritional value and healthy fresh products. Affording them the right to exercise choice and control over their diet. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 14 EVIDENCE: Each bungalow has a weekly activity programme where service users’ are offered the opportunity to participate in a range of activities both within the home and the community at a pace suitable to them. Group activities include visits to local public houses, cinema, garden centres, cafes and town shopping. One service user continues to attend Adult Education classes and is involved with church services and groups. Each service user is allocated 2 x ½ days per week on a one to one basis to follow their interests, one-service users was supported by day care staff to go out to a café for the morning. Holidays have been booked for weekend breaks, with particular personal reference to Blackpool as a preferred destination. Social services provides a people to people visit to the home for internal activity. Service users continue to be involved in drawing up shopping lists and food shopping for the home and make choices for meals to the best of their abilities. Menus viewed indicate continued healthy and balanced diet for service users’. Service users have good contact with family and friends through regular telephone calls to each other, letters and planned visits. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems are in place to enable those living and visiting the home to raise concerns or complaints with staff and people they trust. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: The home has a clear complaint procedure both in written and audio formats. Due to the nature of the service and those living here, using this system is limited. Service users can be reliant on a relative/ advocate/staff to identify concerns and support them by raising them on their behalf. The home’s records indicate they have not had any formal complaints. Staff who have been spoken with evidenced a good understanding of how to protect and prevent abuse, including reporting under local procedures. There are no current Adult Protection alerts regarding this home. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality on this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Service users live in a clean, comfortable and homely environment, which would be enhanced greatly through re-assessment of the home/garden/pathway areas to make a safe access and reduce the risk of falls. EVIDENCE: 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 17 Furnishing and fittings in the home are of a satisfactory standard and on the day of the inspection the home was clean and tidy and free of offensive odours. Service users’ bedrooms are decorated to the individual’s wishes and personal possessions seen reflected the person’s interests and lifestyles. Both service users’ continued to be happy with their environment. All rooms are lockable and staff holds an emergency access key, but these are rarely used. Both bungalows bathrooms have standing bath hoists, there is a mobile hoist and a rising cushion to assist service users to maintain their independence. Bathrooms are in need of maintenance to ensure effective infection control can be maintained, through bath seals to walls and floors being completed. A grab rail identified as loose should be repaired as a matter of urgency and safety. Bases to the standing bath hoist are corroding and rusting, which also compromises good infection control and cleaning as well as poses as a tissue tear risk to the service users with frail skin integrity. Each home has a lounge, dining area and kitchen that are accessible to service users. Due to direct observation today of one service user’s very limited and poor mobility it is strongly recommended environmental risk assessments be reviewed in relation to falls management. Particular attention to hazards such as gas piping sticking out of floor by fireplace, sharp edges of furniture, floor surfaces, use of Zimmer frame and wheelchair. The home does not have a separate laundry facility and washing machines are located in the kitchen area. Staff confirmed they continued to use red sacks for soiled linen and the Environmental Health Officer has approved procedures in use. The external patio area between the two bungalows and pathways around the building remains in an unsafe condition for use by service users’ who are frail and have mobility difficulties. This is an outstanding requirement from previous inspection but staff stated contractors are due to start work from 12 June 2006 to address this but have been delayed due to not finishing their previous job. This is due to commence in approximately 3 weeks. Service users cannot safely access the garden as an all-lawned area and uneven to walk on. It is recommended an area is made accessible with a wide pathway, adequate seating at intervals to allow service users to rest and enjoy a small area of the garden. Due to the mature age and interests of service users this is a valuable leisure resource that is unsafe to access and enjoy. Fire escapes to both bungalows are via two steep stairways and require reviewing with current service users limited mobility and safety to use in the event of a fire. The two steep steps from bungalow 1’s patio doors are a serious safety hazard for those who are frail and with limited mobility. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 18 Repairs to the garage doors should continue to be pursued by the manager with the housing dept and damage caused by the tree roots and movement of garage panels. Cracking to the exterior walls of bungalow 2 due to roots of the large oak tree should continue to be closely monitored by the surveyor and appropriate action taken. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service Service users benefit from a stable staff team, in that there is good morale and enthusiasm to improve the service user whole quality of life. The staff team receives good training and on-going support and supervision but service users would benefit from more training pertaining to working with the elderly and frail. EVIDENCE: The home has benefits from a stable staff team the latest appointment being 2001. The remainder of staff have worked at the home from 1995/98. The organisation continues to encourage and support care staff to completed their NVQ 2 and 3 in care, but new staff have to achieve full probation before being put foreword for this. The home currently has two staff holding NVQ 2 in Care and a further two working towards level 3 at present. A further staff 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 20 member has nearly completed level 4. The training matrix evidences all staff undertaking core training within recommended timescales. Further training in areas related to the elderly and frail, particularly falls management would be of benefit to the staff team. Staff feel supported by the manager and senior managers of the organisation. Care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. Service users reacted fondly towards individual staff and their help. With positive conversation and appropriate verbal responses with the inspector and care staff during the visit. Staff were seen to support individuals respectfully but also with respectful familiarity resulting in some fun joking and banter from both parties. Negative communication experienced from a service user is well understood by care staff and clearly identified in the care plan and guidelines. Staffing rosters have reflected changing care needs of individuals. The home has no current staff vacancies. Agency staff have been used to cover staff sickness over the past few weeks. Staff files are held at head office. Typed forms are sent to the home to hold detailing references received, CRB Number and disclosure, personal details etc. All those assessed today showed appropriate checks have been undertaken and are store securely. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality on this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from living in a home that is run by an experience manager and where their rights and best interests are safeguarded by the home’s policies, procedures and competent staff team. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home’s manager has many years of experience with this service user group and has completed the NVQ 4 in Management. Staff continue to express a high regard for their management approach to the home. The ladies and gentlemen through the interaction observed appeared very comfortable and well supported by the manager. Meetings held in the home seek the views of service users, through quality assurance questionnaires, and more frequently. Service users’ monies are management well with safe systems to monitor and check income and expenditure. Balances are checked at each hand over of staff to service user and petty cash held. Observation at handover evidenced these balancing with records and receipts held. Monitoring health and safety in the home is to good standard, equipment serviced as required to maintain a safe home and facilities. Risk assessments are completed for individual’s activities. Full fire protocols and records are maintained satisfactorily. As stated earlier in the report, advice from the fire officer should be sought regarding current inaccessible fire escapes due to the poor mobility of the frail and elderly service users. Full, recorded supervision takes place at least monthly including set action points and goals. Yearly appraisals also take place. The registered manager evidenced a good understanding of accident/incident recording and reporting under regulation 37 to the Commission. The introduction of a monitoring /auditing tool will assist the manager with observing for patterns and triggers at a glance rather than searching though paperwork but also ensure forms are filed away securely. Accident Incidences are monitored from head office with monthly reports and graphs indicating patterns and trends for the manager to address. Filing of the third (yellow) form should be reviewed to ensure compliance with data protection protocols. Staff training records showed ongoing training in health and safety, food hygiene, moving and handling, care of the back, fire awareness, COSHH with some having been completed, others booked with coming months. Head office monitor staff training and is the manager’s responsibility to ensure that training is booked and attended by staff. A full insurance certificate was on display and concurrent. Lines of accountability within the home and with external management are clearly understood. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 23 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 2 3 X 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 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 ENVIRONMENT Standard No Score 19 2 20 1 21 2 22 2 23 3 24 3 25 3 26 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 3 37 X 38 2 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 13(4) Requirement Health and welfare of service users 13(4), a b, c. In that service users risk assessments are reviewed taking into account the limited mobility and increased falls identified during this visit. Taking into account the environment, activities and health care needs to identify the risks and as far as possible be eliminated. This should include advice from OT/Physiotherapists and falls specialist. To be fully completed by timescale date. Records 17 (1) (b) In that accident /incident records are filed to comply with data protection and freedom of information Acts. To be fully completed by timescale date. Timescale for action 31/07/06 2 OP14 17 31/07/06 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 26 3 OP19 OP38 23(4) Fitness of premises 23(4) b In that, the manager in consultation with the fire brigade seeks advice regarding adequate means of escape that is accessible by service users with limited mobility. To be fully completed by timescale date. 31/07/06 4 OP20 OP38 23(2) b,o. Fitness of premises 23(2) b, In those external grounds, which are suitable for, and safe for use by, service users are provided and appropriately maintained. This requirement has been unmet from three previous inspections. At the time of the site visit work was due to commence on 12 June but was postponed for 3 weeks by the contractor. Further contact with the home on 4th August verified the contractor had just started working on this but this was not nearing completion. This requirement therefore cannot be assessed as met at time of publication of this report. 30/08/06 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 Good Practice Recommendations DS0000023804.V300347.R01.S.doc Version 5.2 Page 27 1 & 2 Turnbull Place 1 Standard OP1 2 3 OP5 OP7 4 OP8 5 OP9 6 OP21 7 8 9 OP22 OP22 OP22 10 11 OP26 OP30 It is recommended amendments in hand to the service user guide and statement of purpose are implemented and a copy supplied to the Commission and Service users within 28 days of revision. It is a good practice recommendation that contracts are reviewed to ensure they include the room to be occupied and that this room meets their assessed needs. It is a good practice recommendation that any original and reviewed documents are dated and signed by the author, to ensure that the latest and most up to date version is followed It is recommended that serious consideration be given to an OT assessment and advice sought regarding safe access to the garden for those with limited mobility and wheelchair users. It is strongly recommended that a service user currently using household remedy paracetomol on a regular basis is reviewed with the GP, and if required written up as a permanent PRN with very clearly written guidelines of use. It is recommended close monitoring of current bathing facilities be maintained and under review to meet the needs of service users and alternative walk-in shower/ wet room facilities be explored through OT assessment of need. It is strongly recommended bath room standing hoists are maintained and sealed due to rusting and corroding metal bases (these are a risk to tearing skin) It is strongly recommended that the pull down grab rail in bungalow 2 be repaired. It is strongly recommended that a full reassessment of external and internal environment is undertaken by an OT to ensure appropriate grab rails and aides are installed to meet the current frail and elderly needs of service users. It is strongly recommended bathrooms be maintained to ensure seals to the bath, wall and floors are to a basic standard to ensure effective infection control management. It is strongly recommended that staff receive relevant training for working with the frail and elderly. Particularly pertaining to falls management as a priority. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI. 1 & 2 Turnbull Place DS0000023804.V300347.R01.S.doc Version 5.2 Page 29 - 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!