CARE HOMES FOR OLDER PEOPLE
Tabley House General Nursing Home Tabley Knutsford Cheshire WA16 0HB Lead Inspector
Joan Adam Unannounced Inspection 5th January 2006 11:00 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.V273592.R01.S.doc Version 5.0 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.V273592.R01.S.doc Version 5.0 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 0156563230 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.V273592.R01.S.doc Version 5.0 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) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 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 26th July 2005 2. 3. 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 44residents in Main House and fifteen residents in West Wing. 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 General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit of the home took place over six hours and was carried out as part of the yearly inspection process. Care records, fire records, staff personnel and medication records were inspected. The service history of the home and the previous inspection report were read in preparation for the inspection. Eight residents, four visitors and four staff members were spoken with during the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection there have been a number of improvements to the premises, which will benefit the residents. A shower room has been improved to enable easier access and a “ rhapsody arjo “ bath has been installed to improve the bathing facilities for the less abled residents. An extra disabled toilet has also been installed. The hairdressing salon has been relocated and a new office facility has been built for the matron. A computer system has been installed by the Cheshire Care Consortium to enable staff training to be improved.
Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 6 Following major problems with the telephones at the home a new system has been installed. 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. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 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.V273592.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: The key standards were fully assessed and met at the last inspection. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 Care plans looked at did not address the changing care needs of the resident. Medication is administered, recorded, stored and disposed of correctly to maintain the safety of the residents living on West Wing. The clinical room door on Main House must be kept locked to maintain the safety of the residents living at Tabley House. Treatments not prescribed by the resident’s doctor must not be used for the treatment of residents. EVIDENCE: Care plans were looked at for a number of residents on Main House and West Wing. On Main House the care plan for one resident stated that they were assisted to walk using a stick, however, a risk assessment was in place for the use of a Zimmer frame. Another care plan was in place for unsteady gait that stated, “to allow the resident to mobilise independently.” No mention is made of using a walking stick or Zimmer frame. Staff spoken with stated that this resident
Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 10 used a tripod walking aid. These plans of care are conflicting and confusing and do not adequately guide staff as to the up- to -date care of the resident. One resident has a risk assessment in place for the use of bed-rails, however, this has not been signed by the resident or their relative. Some alterations had been made to the risk assessment but these had not been signed or dated by the member of staff making the alteration as NMC guidelines. The care plan stated that the resident has pressure sores on both heels however although one wound had healed the care plan documentation did not reflect this. There was no care plan in place to direct staff as to which dressing to use on the wounds. The evaluation sheet for the resident detailed a number of different treatments used on the wounds. On a tour of the building a folder was found in the clinical room, which had been left unlocked, containing a wound dressing chart and body map, giving the measurement, depth and exudate for this resident’s wound. It is recommended that all care plans and information for individual residents are kept together within the care plan folder to avoid confusion for staff working at the home. There was no evidence as to what and when the GP had prescribed the treatments that had been used for this resident. Reviews and evualtions of the care plans had taken place on a regular basis. On the West Wing care plans for two residents were looked at. A new care plan system has been introduced for this unit called “pool activity level” giving a more person centred approach for the residents living there. These improved plans of care are to guide the staff as to the mental abilities of the residents looking at areas such as how the resident copes with practical tasks like reading the newspaper or the use of everyday objects. Care plans were detailed, however, one resident whose weight was being monitored had their weight recorded in a separate book and not in the care plan detailing nutritional needs. It is recommended that all information for individual residents are kept together within the care plan folder to avoid confusion for staff working at the home. The problems identified regarding continence and a gynaecological problem did not have care plans in place to address these needs. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 11 Some care plans had been evaluated and reviewed monthly, however, some care plans looked at had not been reviewed on a regular basis. One resident’s plan of care stated that they were unable to be weighed and it is suggested that alternative methods of measuring weight loss are used. The home has only one set of scales for both units making it difficult for staff to weigh residents on a regular basis. Medication recording, management and storage were inspected on the West Wing. Medicine Administration Records were examined and found to have been completed correctly. Medicines were stored and disposed of appropriately. The homely remedies policy was last reviewed June 04 and the medication policy was last reviewed in April 02. These policies should be be reviewed on a twelve monthly basis. As previously stated the clinical room on Main house had been left unlocked. The medicine trolley was locked and secured to the wall, however the drug fridge and cupboards were open. These cupboards contained items that could potentially harm residents. Requirements have been made regarding the health and safety issues and some aspects of the care plans. Residents spoken with said, “ staff are really good” “ nothing is too much trouble” “ staff are kind “. They felt that they were well cared for. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 13 Residents have regular contact with the local community. Visitors are made welcome and can visit the home at any time. EVIDENCE: The home has a new mini-bus which is used to take residents to local garden centres and for pub lunches. It was also used to take people out for Christmas shopping trips. Residents spoken with said that they enjoyed the outings and were aware that more had been arranged. One resident was seen to go out to lunch with family members. Another resident had invited two friends to lunch and were chatting in the dining room. Residents said that they went out on a regular basis and that they could receive visitors at any time. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: The key standards were fully assessed and met at the last inspection. The home has had no complaints since the last inspection. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 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 the following standard(s): 19,21 Areas have been improved to enable residents to live in a safe, clean and wellmaintained environment. EVIDENCE: The requirements from the last inspection report regarding the dining room carpets have been met. Since the last inspection a shower cubicle has been taken out and a disabled shower has been installed and a “ rhapsody arjo “bath has been purchased to improve the bathing facilities for the less abled residents. The hairdressing salon has been relocated and the matron has had a new office facility built. An extra disabled toilet has also been installed. A computer system has been installed by the Cheshire Care Consortium to enable staff training to be improved. Following problems with the telephones a new system has been installed.
Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 More thorough information needs to be present within the staff files at the home to ensure residents safety. EVIDENCE: The records of two recently appointed staff contained all appropriate checks prior to employment. However, one staff file did not have any proof of identification, a current photograph or a health declaration record in place for that person. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,38 Clear individual financial records are in place for all residents living at Tabley House. Some aspects of management at the home need to be addressed to enable the safety of residents to be met. EVIDENCE: Clear individual financial records are in place for all residents living at Tabley House. Residents who live at the home said they feel that their opinions are listened to and that they can make choices as to how they spend their time. The fire logbook was looked at, the fire alarms had been checked on a weekly basis and had been recorded in the logbook, however during December 2005 these checks had only been undertaken once. Emergency lighting had been tested appropriately and recorded. Fire training for staff had been recorded,
Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 17 however there were five staff members who had not had fire training since March and September 2004. One resident has a risk assessment in place for the use of bed-rails, but this has not been signed by the resident or their relative. Some alterations had been made to the risk assessment however; these had not been signed or dated by the member of staff making the alteration as NMC guidelines. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 18 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 X X X x 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 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 X 3 X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 2 Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 19 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. 1. Standard OP7 Regulation 15 Requirement Care plans must address all residents changing needs to ensure that the health care needs of residents are met (previous timescale of 31st August 2005 not met) The clinical room door on Main House must be kept locked at all times. Treatments used for residents must be prescribed by a GP. Information as required in schedule 2 of The Care Standards Act 2000 must be present in all staff files. All staff must have up to date fire prevention training. Timescale for action 25/02/06 2 3 4 OP9 OP9 OP29 13 13 9 13/02/06 13/02/06 13/02/06 5 OP38 23 25/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP38 Good Practice Recommendations Fire alarms should tested on a weekly basis.
DS0000018823.V273592.R01.S.doc Version 5.0 Page 20 Tabley House General Nursing Home 2 3 OP23 OP7 A further weighing scale is purchased to enable the home to have one for each unit. It is recommended that all care plans and information for individual residents are kept together within the care plan folder to avoid confusion for staff working at the home. Tabley House General Nursing Home DS0000018823.V273592.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Northwich Local Office 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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