CARE HOMES FOR OLDER PEOPLE
Tabley House Tabley Knutsford Cheshire WA16 0HB Lead Inspector
Joan Adam Unannounced 26 July 2005 09:00
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. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tabley House General Nursing Home Address Tabley Knutsford Cheshire WA16 0HB 01565 650888 01565 63230 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) Cygnet Healthcare Limited/Mrs Vicky McNally Mrs. Karen Lynskey Care Home 59 Category(ies) of Physical disability - 2 registration, with number Old age, not falling within any other category of places 44 Dementia - over 65 years of age - 15 Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 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 beds no more than 38 service users may be in receipt of nursing care Within the 44 beds no more than 6 service users may be in receipt of personal care only Within the 44 beds, 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) 2. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 3. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection. Date of last inspection 3rd March 2005 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. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit of the home took place by two inspectors over six hours and was carried out as part of the yearly inspection process. A tour of the home was carried out and care records, fire records and staff training files were inspected. The service history of the home and the previous inspection report were read in preparation for the inspection. Five of the staff on duty, seven residents and four relatives were spoken with during the inspection. What the service does well:
Residents’ health needs continue to be met to a good standard, and all of the people spoken with were satisfied with the care that they, or their relatives, were receiving. Visitors are made welcome, and one resident’s relatives said they are kept well informed and are involved in their care. Residents and relatives spoken with felt that the home was managed and run to a satisfactory standard. A good variety of food is provided. The home has a regular group of staff that have worked there for some time and they are aware of the needs of the residents. Staff members are friendly and attentive to the residents. Bedrooms are warm, clean and are well personalised with residents’ own possessions Social activities at the home are varied and the residents spoken to were pleased with the way the home is run and the choices they can make. The matron at the home is experienced and competent. She is the registered manger but uses the title of Matron. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 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.
Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 8 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 Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 9 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) 3,6 Assessment procedures before residents move into the home are thorough and allow family members to be part of the process of assessing needs. The home only admits those people whose needs are in keeping with the skills and knowledge of staff working within the home. EVIDENCE: Care plans of two recently admitted residents contained preadmission assessments. These had been carried out by the manager, matron or senior nursing staff and were also supported by additional assessments carried out by other health or social care workers. For example, where people had been admitted from hospital, staff there had carried out discharge assessments. Copies of these were kept in the residents’ files. The manager and other senior staff confirmed that the identified needs were discussed with family member as part of the admission process. The residents
Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 10 confirmed that the matron or a trained member of staff had visited them prior to their admission to the home Tabley House does not provide intermediate care Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 11 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) 7,8,9,10 Care plans in general at the home are detailed but two plans of care looked at did not address the changing care needs of the residents. Staff members working at the home are aware of the needs of the residents. Residents at the home are treated with dignity and their privacy is respected. The recording of medication on West Wing needs to improve to maintain the safety of the residents. EVIDENCE: Of the care files looked at on Main House and West Wing all had been completed appropriately and there was evidence that the care needs of the residents were being met. During conversation with residents, all those who could express an opinion stated that their needs were met at the home. Individual choices were recorded in the care plans such as what time they got up and went to bed and choices of food. Records showed that residents or their relatives had been involved in the drawing up and changes to the plan of care. Risk assessments were in place for the use of bed rails, risk of falls and smoking. All were up -dated and reviewed on a regular basis. However, one
Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 12 resident on the dementia care unit had a care plan in place to address the risk of falling. Staff had reviewed the care plan in June but an evaluation had not been recorded as to the number of falls the resident had had or whether the residents’ mobility had improved or worsened within this time. One resident on West wing had sustained a recent fall injuring their right hand and knee but no plan of care was in place for this. (See requirement 1). The care plans at the home do not contain any social or life history. (See recommendation 1). Records were made of support from, and visits by, other health professionals such as GP’s, nurse assessors and chiropodists. Residents spoken with stated that they were happy with the care and attention they received at the home and felt that they are treated with dignity and their privacy is respected. Residents said that the staff were lovely and always listened to them. They confirmed that staff are aware of their needs and one resident said the door to her ensuite was specifically altered to meet her individual needs and she was very pleased with the result. A relative said that the staff had excellent relationships with the residents and their relative was seen to receive “ hugs and kisses from the staff”. They felt that the staff were also sensitive to their needs. One resident said that “some of the staff were very young but very nice.” Staff were seen to address the residents in a courteous manner. Staff spoken to were aware of the needs of the residents and of their likes and dislikes. Staff were observed in the routines of providing care and support. This was being done in a very respectful way. Medication recording, management and storage were inspected on Main House and West Wing. Medicine Administration Records were examined and found to have been completed correctly on Main House, however on West Wing there were some unexplained gaps in the recording of medications. (See requirement 2). Medicines were stored and disposed of appropriately on both units. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 13 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) 12,14,15 Residents living at Tabley House are able to make choices regarding daily routines at the home. The residents enjoy a good and varied choice of wholesome and well presented meals. EVIDENCE: Some residents spoken with said that varied social activities take place at the home and they could join in if they wish. A programme of activities was available on the notice board in the entrance hall and a mini-bus is available to take residents to hospital appointments, to local amenities and out shopping. Some residents said that they were bored as they did not wish to join in with activites on offer and “felt that the days were long” Activities that have recently taken place are Barbecues, trips to Dunham Massey and local garden centres, a Chinese takeaway evening and a local pub lunch. The atmosphere throughout the home was warm, friendly and relaxed. Care plans included rising and retiring times and preferences regarding social activities, likes and dislikes regarding foods. Residents said that they can do as they please and can get up and go to bed as they wish. Relatives said that “ they are made welcome at any time.”
Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 14 Bedroom doors at the home can have locks fitted to maintain residents’ privacy if they so wish. Menus at the home offer choice and snack foods are available between meals if requested. Residents said the food was really good. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 15 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) 16,18 Complaints at the home are dealt with in accordance with the company’s complaints policy and residents and relatives know who to raise concerns with. The policies, procedures and management at the home protect the residents from abuse. EVIDENCE: There have been no complaints made to the home or to CSCI since the last inspection. Complaints recorded at the home have been dealt with under the company’s complaint procedure. A copy of the complaints procedure is available in the service users guide. Residents and relatives spoken with said that they had no complaints and that they were aware of who to speak to if they were unhappy about any aspects of the home. A policy on the protection of vulnerable adults is in place . Members of staff spoken with confirmed that they were aware of the policy and the No Secrets guidance issued by the Department of Health. Staff have received training and this was recorded in the staff training files. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 16 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) 19,20,21,24,26 Some areas of the home require attention to ensure that residents live in a safe and well-maintained environment. EVIDENCE: Since the last inspection some redecoration has taken place at the home. The matron has restructured the lounge areas in the Main House to better meet the needs of the residents living at the home. The toilet and bathroom doors on the West wing have new signs to help the residents to identify these areas more clearly. Residents rooms are well personalised with residents’ own furniture, photographs and ornaments. The home was clean and free from unpleasant smells. Residents and relatives spoken with said that the home was always very clean. Residents said that they liked their rooms and the different sitting areas available for use. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 17 However, the carpets in the dining rooms on both Main House and West Wing are stained and will need to be deep-cleaned or replaced. (See requirement 3) The refrigerator in the galley kitchen on West Wing had uncovered and undated food stored, staff could be unaware of how long these food items had been in the fridge. The temperature of this fridge wasn’t being recorded. This was a requirement at the last inspection. (See requirement 4) Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 18 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) 27,30 Residents benefit from a service that provides adequate staffing levels and well informed and knowledgeable staff. EVIDENCE: Induction programmes are in place for all new staff employed at the home. These are completed during the probationary period of employment, which is twelve weeks. Staff at the home receive essential training such as moving and handling, fire training and health and safety. Safe working practice guidance is provided to staff. Staff spoken to were aware of their various roles and responsibilities, understood the policies and procedures that directed their work and had a very good relationship with the residents they cared for. The staffing numbers at the home are adequate to meet the needs of the residents. Trained nurses are on duty twenty fours hours a day supported by care staff. Duty rotas were seen and agreed staffing levels were being maintained. Care staff spoken with had detailed knowledge of the needs and personalities of the residents and spoke about training they had received over the last year. This included Adult Protection, Moving & Handling, fire, first aid, infection control, nutritional screening and NVQ.
Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 19 Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 20 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) 31,33,36,38 The management of the home maintain the safety of the residents living there. EVIDENCE: The matron has recently been registered with the CSCI. She is a qualified nurse with experience of managing care homes. She has obtained RSCA. The general manager has obtained an NVQ 4 in management. The matron has commenced formal supervision sessions for staff since the last inspection and some of the qualified staff have received training to enable them to formally supervise other staff. Residents living at the home said that their opinions are listened to. Residents’ choices are recorded in the individual plans of care. Accidents are recorded appropriately. Safety certificates were in place for items such as hoists and passenger lifts. The fire log was checked and staff training had taken place in fire safety procedures and was recorded.
Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 21 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 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 x x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x 3 x 3 Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 22 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. 2. Standard op7 op9 Regulation 15 13 Requirement Care plans must have detailed evaluations and address all residents needs. All medication administration recording sheets must be signed following the administration of medication. The carpets in the dining rooms on both units must be deep cleaned or replaced. Food stored in the refriderator in the galley kithchen on West Wing must be labelled and covered. Temperatures of this fridge must be recorded. (prevoius timescale of 31/03/05 unmet) Timescale for action 31st August 2005 31st August200 5 7th September 2005 31st August 2005 3. 4. op19 op26 23 13 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. Refer to Standard op7 Good Practice Recommendations Social/life history should be recorded in the care plans. Tabley House F51 F01 S18823 Tabley House V240579 260705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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