Inspection on 11/04/07 for Tabley House General Nursing Home

This inspection was carried out on 11th April 2007.

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

Tabley House General Nursing Home 12/07/06

Tabley House General Nursing Home 05/01/06

Tabley House General Nursing Home 26/07/05

Tabley House General Nursing Home 03/03/05

Tabley House General Nursing Home 28/10/04

Tabley House General Nursing Home 13/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tabley House General Nursing Home Tabley Knutsford Cheshire WA16 0HB Lead Inspector Joan Adam Unannounced Inspection 11th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tabley House General Nursing Home DS0000018823.V333718.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. 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. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tabley House General Nursing Home Address Tabley Knutsford Cheshire WA16 0HB 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) 01565 650888 01565 653230 karenlynskey@cygnethealth.co.uk Cygnet Healthcare Limited Karen Lynskey Care Home 59 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (44), of places Physical disability (2) Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) One named service user under the age of 65 to be accommodated for eight weeks until 12 November 2006. 12th July 2006 2. Date of last inspection Brief Description of the Service: 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. The current charges for the home are £850 to £1,300 per week. This information has been provided by the home manager. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit took place on 11th April 2007 and took eight hours. It was carried out by an inspector of the Commission. The visit was just one part of the inspection. The home was not informed of the date the visit was to take place, but a few weeks prior to the visit the manager was asked to complete a questionnaire to provide the inspector with some information about the service. The manager was also asked to distribute questionnaires to residents, relatives and health and social care professionals to help the inspector find out what they think of the home. Responses were received from six residents, four relatives one general practitioner and a podiatrist. All were positive about the standard of care in the home. One relative commented that “ the staff are very supportive of relatives as well as caring for mum” one resident said “I am delighted with Tabley House” What the service does well: The questionnaires received and the residents spoken with were all satisfied with the care they received at Tabley House. Comments such as “ the home is the best thing that has happened to my mother” “ I am comfortable living here” The care needs of all residents are assessed to ensure that the home can meet their needs. Care plans are in place so that the staff know how to care for the residents living at Tabley House. Care plans are updated and reviewed on a monthly basis following discussion with residents and relatives. The home is staffed with people who are trained to look after older residents. Social activities are varied and residents can make a choice of how they spend their days. The food is good and wholesome to enable residents to have a balanced diet. Recruitment procedures, staff training and staff supervision ensure that residents are protected from harm. The home is clean and comfortable with a warm and welcoming atmosphere. Residents say that they like living at Tabley House. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are assessed before they move in to the home to ensure that their need can be met. EVIDENCE: There was evidence that residents had been assessed before being admitted to the home to ensure that their needs could be met by the staff. The files of three residents that had recently moved in to the home were looked at and the pre-admission assessments were detailed. These had been completed by the manager. The home is not registered to take residents with intermediate care needs. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good,. This judgement has been made using available evidence including a visit to this service. Residents receive health and personal care based on their individual needs. Residents’ rights to privacy and dignity are respected by staff. EVIDENCE: Individual care plans were in place for all residents. As part of the site visit six residents’ files were reviewed. Assessments for falls, pressure areas, dependency, nutrition, continence and moving and handling had been carried out and were being reviewed on a regular basis. Care plans were found to be detailed and comprehensive, and there was evidence of on-going evaluation and monthly review by staff. Residents and/or their relatives were consulted regarding their care plans, and documentary evidence was available to confirm this fact. Staff spoken with as part of the case tracking exercise were fully aware of residents’ needs. The care plans have been greatly improved since the last site visit took place. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 10 The manager and the trained staff complete audits for all care plans on a monthly basis to ensure that the improvement is sustained. Visits to the home by healthcare professionals such as district nurses, general practitioners and chiropodists were recorded. Residents spoken with said that they felt their healthcare needs were met. They also said that the staff treated them with dignity and maintained their privacy. “ the staff always knock and wait to be invited before they come in to my room” “ the staff are very pleasant “ The arrangements for ordering, storing and disposing of medication were satisfactory. All Medication Administration Sheets were completed correctly. The manager has recently completed a medication audit and this is completed monthly. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,12,14,15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The range of recreational activities provides stimulation and interest for people living in the home. Residents are able to exercise choice and control over what they eat. EVIDENCE: Three activities co-ordinators are employed at Tabley House and the activities on offer are varied. Trips out are arranged to local garden centres, pub lunches and to watch the local amateur operatic society on a regular basis. Bridge, card games, manicures, quizzes, crosswords, crochet and flower arranging also take place regularly and a sherry morning takes place every Thursday. Residents said that they feel “ there is always plenty going on” “ It is nice to be able to go out so often” “ It is nice to choose whether to join in or just sit and read the newspaper” Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 12 The PAT dog service visits the home and relatives are encouraged to bring in pets to visit whenever possible. One resident said ” I have had dogs all my life and it is nice to know I can still see one even as a visitor”. Religious preferences are recorded in the care plan and a monthly Holy Communion takes place for residents who wish to attend. The coffee shop adjacent to the museum was still popular with the residents. Menus are varied and meetings take place on a regular basis between residents and the chef to discuss concerns that they have with regard to the meals at the home. Meals can be taken in the dining room or in the resident’s own room. Residents spoken with said that the meals were “ satisfactory” “ we can discuss any the problems we have at the meetings directly with the chef. “ Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a complaints procedure and are protected from abuse. EVIDENCE: The home had a satisfactory complaints procedure, which was displayed on the main notice board and included in the service user guide. Residents said they would know who to complain to if they had any concerns. Records of complaints were documented. Files contained details of one complaint that had been made since July last year. The complaint had been investigated by the home and action that had been taken was recorded. The home had a satisfactory policy in relation to adult protection. This included definitions of abuse, signs or indicators and reporting procedures. The protection of vulnerable adults was included in the induction training. The staff had attended training in the protection of vulnerable adults. All staff had to supply references and a Criminal Records Bureau disclosure prior to employment. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-maintained, enabling residents to live in a safe and comfortable environment that encourages independence. EVIDENCE: A partial tour of the home was undertaken and the home was furnished to a high standard. The bedrooms are decorated on an on-going basis and residents spoken with said that they are involved in the redecoration of their bedrooms. Since the last site visit has taken place the up-stairs corridor decoration has been completed. The new bath that had been installed was now being used on a regular basis and residents said that this was a positive experience. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 15 The home has received some damage in the January gales and a date to commence this work has been given. A chimney needs to be taken down and rebuilt and a section of the roof in the same area is to be replaced. The leaded windows in the Chapel and tea room have been replaced The home has proposed plans to refurbish Main House lounges and dining rooms in the near future. The home was clean and fresh on the day of the site visit. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is excellent . This judgement has been made using available evidence including a visit to this service. Staff are trained and in sufficient numbers to meet the needs of the residents. EVIDENCE: There are adequate numbers of staff on duty to meet the needs of the residents living there. No agency staff have been used in the home for the last six months. Staff training at the home is on going and copies of courses undertaken were seen on the training matrix. These included moving and handling, fire awareness, first aid, food hygiene, health and safety and protection of vulnerable adults. Trained staff at the home have also undertaken training in medication management, continence/catheter care, dental/oral care, wound care, venepuncture, falls prevention and the use of the syringe driver. A training programme is in place to enable staff to achieve NVQ level two in care. The home has ninety per cent of staff who have achieved the award. Staff records showed that all staff undergo rigorous checks prior to employment to ensure they are suitable for the job. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 17 The residents were generally content and full of praise for the staff. Staff were observed attending to residents’ needs and appeared to do their best to make residents comfortable. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of the service users are protected. The views of service users are obtained to influence the running of the home. EVIDENCE: The home has an experienced and competent manager who is registered with the Commission for Social Care Inspection. She has attended courses/training in order to fulfil her management responsibilities and was able to demonstrate an awareness of the diverse needs of the resident group and how to manage the staff team. She has completed the Regulation in Care Services Award. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 19 The manager carries out staff appraisals on an annual basis and staff are supervised on a day to day basis. A system was in place for formal, documented supervision, and records confirmed that they participated in this every two months. Staff received training in safe working practices on induction and annual updates were provided. There was a computer programme in place to flag up when staff were due for an update. Pre-inspection information submitted to the Commission indicated that all equipment was serviced at the required intervals. No unsafe practices were observed on inspection. The home has a quality monitoring system in place including audits by the manager on a monthly basis of care plans, medication management, accident audit and pressure sore audits. The general manager audits the home on a monthly basis and a regulation twenty six report is completed and a copy sent to CSCI. Resident/relative meetings and staff meetings are held at the home on a regular basis and minutes can be seen by all who attended. Questionnaires are sent out to residents and relatives to gain their views on the service provided by the home. Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tabley House General Nursing Home DS0000018823.V333718.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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