Inspection on 03/05/05 for Talbot House Nursing Home

This inspection was carried out on 3rd May 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Talbot House Nursing Home 10/03/09

Talbot House Nursing Home 01/02/07

Talbot House Nursing Home 05/10/05

Talbot House Nursing Home 15/10/04

Talbot House Nursing Home 17/05/04

Talbot House Nursing Home 26/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Talbot House Nursing Home 28-30 Talbot Street Rugeley Staffordshire WS15 2EG Lead Inspector Joanna Wooller Unannounced 3 May 2005 09:50 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. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Talbot House Nursing Home Address 28-30 Talbot Street Rugeley Staffordshire WS15 2EG 01889 570527 01889 586099 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) Prov Ltd Mrs Margaret Rose Ford Care Home 25 Category(ies) of OP 25 registration, with number of places Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Minimum age 60 years on admission Date of last inspection 15 October 2004 Brief Description of the Service: Situated close to Rugeley town, Talbot House is a 25 bedded Care Home with Nursing care. It comprises of one building, built in 1880. The current Proprietor Mr Gupta has run the home for 12 months. Mrs Margaret Ford is the registered manager with the Commission for Social Care Inspection. The home comprises of 19 single bedrooms and three double bedrooms. Some rooms have en-suite facilities. There are three pleasant lounges and one dining room. Other facilities/services include a hairdressing salon and activities/craft room. All areas of the home have service users access via ramps, stairs or a passenger lift. The home is very homely and comfortable. The Philosophy of Care offers the acceptance that a service user who stays in the home involves a special relationship of intimate care from the staff and management. The holistic approach involves both service users and their families with assurances that staff will work to the best of their abilities in a homely and friendly environment for everyone involved. A social diary is maintained. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to Talbot House on 3 May 2005 commenced at 09.50hrs. The National Minimum Standards for Older People was used as guidance to assess the standards within the home. The total amount of time spent on this inspection was 5.5 hours, which included pre –inspection and fieldwork prior to the visit. The deputy Care Manager was in charge of the morning shift and four carers assisted her. Ancillary staff in the home included the Cook who had a kitchen assistant with her, a laundress worked in the laundry, there was one domestic on duty and the administrator was in the office. There were 25 service users in the home and no vacancies. Two service users had recently returned to the home from hospital having been treated for medical conditions. The staff on duty met with the minimum staffing levels set by the previously issued Notice of Staffing, however it was noticeable that the staff were very busy, mainly due to the dependency of the service users. Staffing will need to be reviewed to respond to this demand. The management had received no complaints since the last visit and no additional visits had been made. The inspection included: • A full tour of the building including service users bedrooms • Reading of care records and care plans • Talking to some residents • Management records • Discussion with the staff on duty • Talking with a visiting community physiotherapist Pre admission assessments had been completed for all new admissions and service users were in receipt of an acceptance letter to ensure their individual needs could be met at the home. Service users had individual care records, which included their individual health, personal and social care needs. Service users when asked said they felt respected by the staff even though they always seemed terribly busy. Service users spoken to say they enjoyed the activities but did not want to be too busy all the time. They enjoyed their families’ involvement at some of the parties and events. Individuals’ specific choices were documented in the care records. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 6 The inspector observed a balanced menu record; that day’s menu was displayed in the dining room. The environment was found to be clean, pleasant and hygienic. The home was well maintained in most areas. Staffing levels were observed and duty rosters were seen. There has been a noticeable increase in the dependencies of the service users since the last visit and a fair amount of staff have left the home for varying reasons; staff sickness is also being covered. The management were spending quite some time trying to cover shifts at short notice or they cover the shift themselves, which was leaving them tired and demoralised. However, it was evident to the inspector that the care the service users were receiving was observed to be of a high standard. The registered manager and her deputy are managing the home. The provider, Mr Gupta visits the home and forwards his report to the Commission For Social Care Inspection on a monthly basis. Service users finances stored at the home were found to be correct when checked with the ledger. The health, safety and welfare of the service users and staff are monitored through the homes policies and procedures. What the service does well: What has improved since the last inspection? Some of the requirements made at the last visit were met. • Storage in the toilet areas had been put in place. • Furniture stored in the stairwells on the landings had been removed from the building. • The laundry sink area had been made good. • A new freezer had been installed in the kitchen. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 7 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. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 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 Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 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 The needs of the service user were fully assessed and documented on a pre admission form. The skilled staff were able to meet the assessed needs of the individual service users. EVIDENCE: There was evidence that service users and their representatives were encouraged to visit the home prior to admission. The admission process remains the same. All prospective service users were invited to the home on a trial period. This enables them to see if the quality that the home offers is to their liking and is suitable for their needs. Service users were issued with a signed letter from the manager to ensure that their individual needs could be met whilst in the home. Service users confirmed that they had been included in the assessment along with their families. The care records inspected were evidence that this procedure is followed for all service users. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 10 All staff on duty were evidenced to individually and collectively, have the necessary experience and skills to meet the assessed needs of the current service users. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 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, and 10. The individually assessed health and personal care needs of service users had been fully documented within the care records. There was evidence that these needs were being met but not all the documentation was identified to be up to date. It was evident that service users were treated with respect, privacy and dignity at all times. EVIDENCE: No issues were raised relating to safe administration of medicines in the home. Each service user had an individual plan of care. These plans clearly set out individual service users health, personal, and social care needs. The named nurse and key worker system was in place but had proved to be difficult to maintain due to staff leaving and sickness. Through case tracking the plans inspected on the day of the visit reflected the care that the service users were receiving. Of those care plans seen where they were not updated monthly. Each plan of care had a filing system within it, to ensure that all service users were assessed and reviewed appropriately. This documentation was found to be relevant and up to date on those inspected. One new admission had not had Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 12 her manual handling assessment, her weight recorded or her property list completed. The service users were involved in the plan of care as far as is possible. There was evidence that relatives were shown the individual plan of care and asked to sign the relevant risk assessments. The inspector evidenced that signatures had been obtained on most of the care plans and on risk assessments. Service users spoken to by the inspector again expressed their great satisfaction in the care they received at the home. They told the inspector that all the staff was friendly and caring. They felt that the staff were sometimes too busy to do things for them and sometimes felt rushed. Those spoken to say the staff take care with the service users appearance. The staff showed them respect in many ways including knocking before they enter their bedroom. A few ladies spoken to in the end lounge stated they remained really happy in the home and saw their friends, joined in the activities and sometimes just sat and listened to their talking books or music. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 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) 12,13,14 and 15 Service users were more than satisfied with their lifestyle in Talbot House. Full contact had been maintained with relatives and friends, they explained that this was very important to them. Local community groups were invited to the home to give displays and entertain the service users. Catering was evidencing to be very good with balanced nutritious meals being planned and served. Service users were able to exercise their individual choice and influence decisions affecting them. EVIDENCE: Two carers assist the service users with their personal hobbies, recreational needs and they also arrange events. An activities plan is displayed around the home with events being recorded in albums. One to one activities and group activities are arranged. There was evidence that the daily routine remains flexible; this allows the individuals to exercise their own choice and preferences. Individuals’ likes and dislikes relating to activities and diet were documented in the care records. The Roman Catholic Priest and the Church of England Vicar Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 14 visit the home. Some service users spoken to attend the local church services weekly. Relatives and friends are encouraged to attend all the functions and these are clearly displayed on posters around the home. Plans for the summer were being organised. There was evidence that service users receive a varied and nutritious diet in a congenial setting. One service user commented that they would prefer more variety of vegetables and this was passed to the kitchen staff. The dining room is light and airy and service users were encouraged to have their meals there. However service users may have their meals in their bedrooms if they so wish. When asked service users were generally very complimentary about their meals and the amount of drinks and snacks they were offered. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 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, 17, and 18. A simple, clear and accessible complaints procedure is sited in the home. No complaints had been received since the last inspection. Service users legal rights were considered and they were safeguarded from abuse, of all types, by the robust policies and procedures followed in the home. EVIDENCE: Service users and their relatives and friends were made fully aware of the complaints procedures on admission to the home, verbally and some written information was given. The complaints procedure was displayed in the entrance hall. When asked by the inspector, the service users stated they would tell their relative or a member of staff if they were not happy about something. Service users were able to vote at the forthcoming election either by postal vote, which had been organised by the manager or by attendance at a local polling station, escorted by a member of staff. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 16 Training had been given to all staff on abuse awareness. All NVQ students completing Level 2 or 3 complete units Z1, part of the NVQ documentation relating to abuse. A safe is available in the home for the safe storage of any valuables or monies. Receipts are issued for all transactions. Staff do not become involved with any of the financial matters of the service users. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 17 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 and 26 Service users live in a safe and comfortable communal facility. Talbot House prides itself on it clean, pleasant and warm environment. EVIDENCE: There was evidence that the service users lived in a safe and well-maintained environment. Controls in place ensure the safety and comfort of those who live in the home. A routine maintenance programme was on going and the maintenance man and the staff in the home make daily environmental checks. The gardens continue to be enjoyed in the better weather by those service users who wish to. The lawn area is accessible by ramps. Fire risk assessments have been completed. Staff annual fire training had recommenced. An Environmental Health check was carried out in February 2004 and found to be satisfactory. The hotel services in the home were again seen to be of a very high standard, the service users told the inspector that they found the home very pleasant, always nice and clean. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 18 All clinical areas, the laundry room and the kitchen were seen to be exceptionally clean and tidy. Fifteen staff had completed an Infection Control Protocol Training Course in house. The infection control policies and procedures were available. It was identified again at the inspection that some of the toilet roll holders were broken and toilet rolls were being stored on top of the toilet cistern. This unsatisfactory practice must cease, with the toilet roll holders either repaired or replaced. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 19 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, 29 and 30. Staff skill mix and numbers was found to be in line with the previously issued notice of staffing, however considering the assessed needs of the service users and the layout of the home it was evident to the inspector that more staff were required to be on duty. Service users spoken to said the staff were marvellous but very busy and sometimes too busy to talk to us when they would like to. Service users were evidenced to be receiving high quality of care and support. Staff were suitably trained to carry out their duties and the homes recruitment practices were in line with the National Minimum Standards. EVIDENCE: The duty rota was available. The needs of the residents were addressed as soon as possible and the service user spoken to felt they were attended to quickly even though the staff were always very busy. • The care staff team is required to be increased to meet the needs of the service users. The domestic team ensure the home is kept clean, hygienic, and free from unpleasant odours. This was achieved with suitable cleaning products and with the assistance of the staff. A domestic is on duty daily between 7.15 and 1pm. The laundry is staffed daily between 9am and 1pm. Kitchen assistant and cooks were on duty in the home every day. Trained nurse shifts overlap and there was a senior carer rostered for each shift. Service users were protected and supported by the home’s strict recruitment policy, which is clearly set out and adhered to for each new employee. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 20 All members of staff were employed on three months probation. During this time they complete a full induction, which is signed off as completed. Each member of staff is given a contract, setting out terms and conditions. Staff were all fully trained in their area of their work and they demonstrated competency within it. The staff received training from in house training sessions. An individual training record was kept up to date for each member of staff. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 21 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) 33, 35 and 38 The manager had recently completed a service user quality monitoring exercise and the results were favourable to the home. Service users financial interests were safeguarded by the systems in place. The health, safety and welfare of the service users and staff were promoted and protected as far as reasonably practicable. EVIDENCE: A Quality assurance system was in place and met with the National Minimum Standards. This new system is used at intervals throughout the year to monitor quality and consistency. Service users informed the inspector that the staff in the home respected and increased their quality of life. The service users’ financial interests were evidenced as being safeguarded by the strict systems in place within the home. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 22 Service users were encouraged to look after their own financial affairs with the support of their families or representative. However if the service user requires some assistance this will be offered and the procedure for dealing with monies will be operated. Each bedroom is fitted with a lockable drawer and the home has a safe. Receipts were issued for all transactions and a ledger was kept. This system was seen on the visit and found to be in order. A new system to store and record service users monies had been introduced last year and this was found to be working much better. The registered manager continues to ensure safe working practices within the home including; moving and handling training and fire safety training, first aid training, food hygiene training and basic food hygiene qualification. Training on infection control is also undertaken in house. Policies and procedures for these subjects were evidenced as working documents in the home. The health and safety of service users and staff were promoted with safe storage of hazardous substances, regular servicing of electrical and gas appliances, and regulation of the water system. Vigilant staff employed in the home assist with the security of the home, along with the security policy and procedure. The accident book was seen and found to be in order. Health and Safety notices could be seen throughout the home and a Health and Safety manual was available. Issues identified again on the unannounced inspection: • All staff employed at the home requires an individual place of safe keeping for their personal property whilst on duty. • Bumpers must be purchased to cover all cot sides. Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 23 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 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 3 x 3 x x 2 Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 24 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 Requirement That all care records were updated at least monthly and personal documnetation completed in care records. The cracked basin identified must be replaced Toilet roll holders must be replaced or repaired. There must be sufficeint staff on duty to meet the care needs of the service users and the staff responsibilities. Cot sides in place must have protective bumpers in place. Staff employed at the home must have available suitable safe storage for personal items. Timescale for action 05/07/05 2. 3. 4. 19 26 27 23 (2b) 23 (2i) 18 (1a) 05/07/05 21/06/05 05/07/05 5. 6. 38 38 13 (4a) 23 (3ii) 21/06/05 05/07/05 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 Good Practice Recommendations Talbot House Nursing Home E51-E09 S42862 Talbot House V224298 030505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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