Inspection on 20/04/05 for Glen Tanar Rest Home

This inspection was carried out on 20th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Glen Tanar Rest Home 20/08/07

Glen Tanar Rest Home 23/05/06

Glen Tanar Rest Home 22/11/05

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

CARE HOMES FOR OLDER PEOPLE Glen Tanar 65 Cavendish Road Bispham Blackpool FY2 9NJ Lead Inspector Ruth Edgington Announced 20 April 2005 9:30am th 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Glen Tanar Address 65 Cavendish Road Bispham Blackpool FY2 9NJ 01253 352726 01253 354791 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Fylde Care 2004 Ltd Ms Jacqueline Thomas Care Home 21 Category(ies) of OP 21 registration, with number of places Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2) The home is registered for a maximum of 21 service users in the category of Older People (OP) (service users over the age of 65 years) Date of last inspection 18/10/04. Brief Description of the Service: The Glen Tanar is situated in a residential area within easy access of the promenade and busy shopping area of Bispham. The home provides accommodation for a maximum of 21 persons aged 65 years or above. The accommodation comprises of one double bedroom and 19 single bedrooms, only one of which has ensuite facilites. There are adequate bathing and toilet facilities and a large lounge and dining area. A passenger lift enables the residents to have access to the rooms situated on the first floor. Various aids are provided around the home to assist the residents in their daily lifes. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and started at 9.30am, taking over 8 hours. The Inspector spoke to five residents, four members of staff, the registered manager and the registered provider. During the inspection the Inspector looked at a number of records including those of selected residents and staff. The Inspector also toured the home and spent some time observing the daily activities in the home. What the service does well: What has improved since the last inspection? Since the last inspection there has been a change of ownership of the home. In the short period of time that the new management has been in place there have been improvements to the décor, carpets and furnishings in several bedrooms. The overall atmosphere of the home has improved. Residents and staff were much more relaxed and confident in making comments during the inspection. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The admission and assessment procedures were clear to ensure that the care needs of the residents are met. EVIDENCE: The records of three residents were looked at in detail, however only one of these residents had been admitted since the new management took over the home. Examination of the records confirmed that in each case a full assessment had taken place prior to admission to the home, therefore ensuring the home could meet the needs of these people. The staff were able to describe in detail the care needs of the residents and from discussions with the residents the Inspector found that the information recorded on the pre admission assessments was correct. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 9 The absence of important information, including written risk assessments, potentially puts residents at risk and means their needs may not be met. The systems for the administration of medication could potentially place residents at risk. EVIDENCE: Individual care plans are kept for each resident. The Inspector was able to see that the residents had been involved in agreeing the care provided and that reviews had taken place. When looking at the files of three of the residents, the Inspector found that two of these residents go out on their own and the other resident requires assistance with all care needs including getting out of bed and lifting out of a wheelchair. From the record kept of accidents, another resident was seen to fall very regularly. There were no risk assessments for these residents and no preventative measures to ensure their needs are met. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 10 Discussions with staff demonstrated that they were knowledgeable of the individual needs of the residents, however some of the information recorded in the individual care plan was brief, partly through staff not completing the information fully. There was no evidence of any life history about the individual residents that would assist the staff in understanding the resident more. The residents spoken to said that the staff are, ‘ lovely and they look after us well, ‘the manager cannot do enough for us’. The medication procedures were looked at and the Inspector found that one of the residents kept their own medication. The daily record for this resident showed that they had seen their GP two days previously and had been prescribed medication for pain, which they had decided not to take. The Inspector could not find any record of this on the medication records. The manager stated that this had been an oversight. A lockable box had been provided for the resident to keep their tablets in. Through discussions with staff it became clear that that medication procedures in the home were not being followed correctly. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14 and 15 Social activities and meals are well managed to suit both the individual and group. Contact between residents and their families is encouraged to help them maintain relationships. EVIDENCE: The care plans seen showed very clearly that staff encouraged residents to take part in activities in the home and mix with others whilst keeping their independence. Residents spoken to said that they keep in touch with their friends and relatives and visitors were welcome at any time. A number of relatives visited during the inspection and the Inspector was able to see the good relationship between the staff and the relatives. During the inspection a relative telephoned to speak to the manager and the Inspector was also able to witness the assistance given to this relative. One resident attends the church of their choice weekly and also informed the Inspector that they keep in regular telephone contact with a family member who lives in Australia. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 12 Another resident who prefers their own company said that they like to go out for a walk every day, ’sometimes twice a day even if it is raining, which never hurt anyone’. A number of residents spoken to commented that the food was good. The Inspector spoke to the cook and was able to see the record of meals being provided, any individual likes and dislikes and any special diets required. One resident confirmed that due to a medical complaint they often have something different than was on the menu. The staff were very aware of this residents dietary preferences. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected during this visit. EVIDENCE: Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24 and 26 Improvements have been made since the last inspectionand a programme of upgrading and refurbishment is in place to ensure that the residents live in safe,comfortable surroundings. EVIDENCE: Since the new providers have taken over the home, they have started redecorating and replacing furniture, fittings and carpets as part of an agreed programme of upgrading the home. The Inspector toured the home and was able to see the changes. One positive change was that a door had been fitted to the ground floor toilet area to provide greater privacy for the residents. The Inspector spoke to three residents in their own bedrooms. They all were happy with their rooms and said that the furniture provided met their needs. One resident stated that’’ this is the best room in the house, because it is comfortable and I can see everyone passing by and see straight up to the sea front.’’ Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 15 The Inspector found the home to be warm, clean and free from any offensive odours. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29and 30 Shortfall in the recruitment of staff and the number of staff on duty during the evenings potentially leave the residents at risk. EVIDENCE: There has been only one new staff member recruited to work at the home since the last inspection. The information on the staff files was very limited. The provider confirmed that the recruitment procedures were to be looked at and improved. The staff rotas showed that in an evening the staff numbers were not sufficient to meet the needs of the residents in the home. Examination of records indicated that since the last inspection the needs of the residents have changed and an extra member of staff was needed to meet the dependency needs. The provider stated that they had carried on from the rota operated by the previous provider, however by the second day of the inspection a new rota had been produced showing that the additional member of staff had been provided each evening. Records showed that there has been a number of training courses specific to the work by care staff and the manager confirmed that training was seen as a priority. Staff spoken to said that they were given the opportunity to undertake training and records also confirmed that training courses were ongoing. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 17 At the time of the inspection an NVQ Assessor visited one of the care staff who was doing NVQ level 2 training. Observation of care practices also showed that staff cared for residents in a pleasant and dignified way. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,36, and 38 The leadership from the manager is good and promotes a consistency of care. EVIDENCE: Residents and staff spoke well of the manager and the care and support that she gives. The manager has many years experience in caring for the elderly and has a Diploma in Management. At the time of the inspection she was waiting for a date to start her NVQ level 4 training. The manager has achieved a great deal in the short space of time that she has been in the home, however this has included a more ‘hands on ‘ approach, which she is concerned may result in less time available to spend on the maintenance of records and developing the systems that ensure good care practices. The manager confirmed that the supervision of staff has started but at present this does not include the supervision of the senior care staff by the manager. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 19 During the Inspection a resident became concerned that they had not received the correct amount of personal allowance the week before and although records clearly showed that they had, the Inspector advised the manager to review the way that residents receive their personal allowances so that safeguards are in place to protect the resident and staff from any question of the correct amount of money not being given. Information provided in the pre-inspection questionnaire completed by the manager stated that all safety equipment is regularly serviced. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x 2 2 x 2 Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 21 Yes 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 7 Regulation 15(1) Requirement Full and satisfactory information must be provided on the residents plan of care in relation to their health and welfare needs. The registered provider must ensure that unnecessary risks to the health and safety of the residents are identified and so far as possible eliminated. The registered provider must ensure that photographs are attached to the medication administration records to ensure verification of service users.(timescale of 31/12/04 not met) The registered provider must ensure that the staff adhere to the procedures for the administartion and recording of medication. The registered provider must obtain in respect of the employment of staff, all the information specified in Schedule 2.(timescale of 20/10/04 not met) The reistered provider must ensure that at all times suitably qualified, competent and Timescale for action 3rd June 2005 2. 8 13(4) 3rd June 2005 3. 9 13(2) 3rd June 2005 4. 9 13(2) 20th April 2005 5. 29 19 3rd June 2005 6. 30 18(1) 3rd June 2005 Page 22 Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 experienced persons are working in the care home.( timescale of 31/12/04 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 9 28 31 35 36 38 Good Practice Recommendations All staff who adminster medication should training which is accredited. 50 of care staff should NVQ level 2 qualifications The manager should obtain level 4 NVQ in management and care. The registered provider should review the system in operation for the payment of residents personal allowances. Formal supervision for all care staff should be provided at aleast six times per year. The registered provider should make arrangements for the training of all care staff in first aid to ensure that there is a qualified first aider on duty at all times. Glen Tanar F57 F09 S63150 Glen Tanar V232932 180405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 2nd Floor Unit 1, Tustin Court Portway Preston, PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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