Inspection on 10/03/09 for Tamar House

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Good service.

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

Tamar House 16/03/07

Tamar House 07/02/06

Tamar House 01/08/05

Tamar House 31/01/05

Tamar House 25/08/04

Tamar House 23/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tamar House Tamar House 175 Old Ferry Road Saltash Cornwall PL12 6BN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Tamar House 175 Old Ferry Road Tamar House Saltash Cornwall PL12 6BN 01752843579 01752843579 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Mark Beaumont,Mrs Mary Yvonne Beaumont Name of registered manager (if applicable) Mrs Paula Barbara Hannon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Service users to include up to 21 adults of Old Age (OP) Service users to include up to 3 adults with Dementia (DE[E]) Service users to include up to 3 adults with a Mental Disorder (MD[E]) Service users to include up to 3 adults with a Terminal Illness (TI[E]) Service users to include up to 6 adults with a Physical Disability (PD[E]) Care Homes for Older People Page 4 of 26 care home 21 Over 65 3 3 21 6 3 0 0 0 0 0 Total number of service users not to exceed a maximum of 21 Date of last inspection Brief description of the care home Tamar House is a Care Home, with nursing, and is currently registered for 21 service users within the category of old age not falling into any other category;physical disability 6. dementia 3 and mental disorder 3. Tamar House is situated in a residential area of Saltash close to the shops, public transport and the facilities of the town centre. Tamar House is a detached corner site in Old Ferry Road. Limited parking is available. Accommodation is provided on the ground and first floor with a passenger lift for easy access Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place from 10.30am to 1.45pm on 10th March 2009. The inspection was conducted with the manager with the support of the provider. A tour of the home was carried out and people who live at the home were spoken to and observed. Care staff were also observed during the inspection. This report also contains information taken from the completed Annual Quality Assessment (AQAA) document and Service User (10) and staff surveys (6) submitted to the Commission prior to the inspection. There were 20 people living at the home on the day of the inspection. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have up to date information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The acting manager said that people are always assessed prior to moving into the home to ensure their needs can be met, we saw a completed pre admission assessment form. She said that if people are to be admitted they and their representatives are given as much up to date information about the service as possible, invited to look around and spend some time at the home and ask any questions they may have. All 10 completed Service User Surveys indicated that they received enough information about the home before they moved in so they could Care Homes for Older People Page 10 of 26 Evidence: decide if it was the right place for them. One comment was we were given a full tour of the home and any difficulties were given great care and consideration. The home is not registered to provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will generally be fully met. Evidence: The care plans seen were up to date and contained a lot of relevant information about the person and their health, personal and social care needs. The nursing staff complete daily records (Kardex)about a persons welfare and detail what care has been provided. The AQAA states that each service user has three written reports entered into the Kardex for every 24 hour period, which reflect their physical and emotional well-being. Handovers are comprehensive and input is encouraged from carers and nurses alike. One comment made on a completed staff survey was the care plans are always up to date and are always there if you need them. Information was included about visits made by or to health care professionals such as GPs, opticians and dentists. A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available to meet peoples current needs. It Care Homes for Older People Page 12 of 26 Evidence: is clear from the AQAA that the nurses work with a variety of health care professionals as required to ensure that a persons needs are being fully met. The home uses a blister pack system for administration of medicines. They are kept in a locked trolley in a locked room. The drugs fridge has its temperature measured and recorded daily. The nursing staff administer medications and receipt, storage and disposal of unwanted medicines is in line with laid down legislation. Nursing staff should ensure that the medication administration sheets are fully completed at all times to ensure it is clear what medication has been taken or not. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. All 10 completed Service User Surveys indicated that the staff listen to and act upon what they say. One comment was staff are always on hand and happy to help with anything. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and the local community mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: We were told that people are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups and are facilitated by the care staff. The AQAA states that the home practices person centred care, treating each service user as an individual with individual tastes, preferences and needs. They have had a variety of experiences, with different working and family lives. People spoken to during the inspection said that they like to read books and magazines and sometimes like to watch the TV. The care plans are designed so that information about peoples interests and hobbies is recorded and can be used when using person centred care. Six of the ten completed Service User Surveys indicated that there are usually activities arranged by the home that they can take part in, three indicated that they sometimes arrange activities and one commented that their relative preferred to stay in their Care Homes for Older People Page 14 of 26 Evidence: room and not take part in any activities. The AQAA states that weather permitting, we are still hoping to be able to organise excursions to the waterside nearby next summer, with staff taking individual service users in wheelchairs to get the benefit of the views and the fresh air. Visitors are welcomed at anytime and a number were seen coming and going during the inspection some were seeing their relatives in the lounge others prefer to see them in their own room, the AQAA states that staff can move people to their own rooms to ensure they have privacy if they wish. The manager said that some people regularly go out often with friends or relatives. There is level access to a patio area with seating provided that can be used during good weather. Some people have their meals in the dining room, some in the lounge and others like to stay in their rooms, people spoken to said they have the choice. The acting manager said that staff are available at mealtimes to give people any help or support they may need. People are offered 3 meals a day and drinks and snacks are available at all times. Specialist diets are catered for and nutritional assessments are undertaken as part of a persons care plan. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the Statement of Purpose. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission since the last inspection and the AQAA states that the home have received 2 complaints in the last 12 months that have been upheld and resolved to everyones satisfaction. The acting manager and provider said that people are seen by senior staff or herself daily and hopes that any issues or concerns would be bought up at then. All 10 of the completed Service User Surveys indicated that they know how to make a complaint and all 6 completed staff surveys indicated that they know what to do if a resident, relative or friend has any concerns about the home. One comment was that We always try to get it right, we have a very good relationship with the service users and their relatives. We invite all to voice any needs or concerns. Staff files examined had evidence that some staff have undergone safeguarding Care Homes for Older People Page 16 of 26 Evidence: training, they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. The policies and procedures seen were up to date and available to staff at all times. The AQAA states that more training in Protection of Vulnerable Adults will be accessed during the next 12 months. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment and redecoration people have a comfortable, homely and safe environment in which to live. Evidence: Tamar House is currently registered to take up to 21 people most of whom have been assessed as needing nursing care and some needing personal care only. On the day of the inspection 20 people were resident at the home. Most of the rooms are single occupancy and 3 are double rooms. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. People spoken to said they were happy with their current accommodation. Communal space consists of one lounge and a separate dining room both of which are comfortable and homely. Toilets and bathrooms are adapted as required, there is a shaft lift and ramps throughout the house to allow for level access and handrails where appropriate. Improvements made over the last 12 months include a new carpet in the dining room, the call bell system has been upgraded, adjustable beds and electric mattresses have been bought to meet peoples needs and the garden area has been cleared and replanted. Care Homes for Older People Page 18 of 26 Evidence: On the day of the inspection the home was clean, tidy and hygienic. Nine of the ten completed Service User Surveys said the home is always fresh and clean and one indicated that it usually is. Policies and procedures around infection control seen were up to date and available to staff at all times. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: The manager, nursing and care staff are supported by catering, domestic, laundry and maintenance staff. The manager and the duty rota seen confirmed that there are sufficient staff on duty for the number of people who currently live at the home (20) and is based on their dependency levels. The manager said that new staff have an induction that covers health and safety, fire safety, safeguarding and person centred care. They are then supervised as required until they feel confident and competent to work unsupervised. Five of the six completed staff surveys indicated that their induction covered everything they needed to know very well and one said it mostly did. The AQAA states that seven (7) care staff have NVQ level 2 or above (in care). Training opportunities were seen displayed in the office area during the inspection. On Care Homes for Older People Page 20 of 26 Evidence: the afternoon of the inspection one of the nurses was attending a syringe driver update. All of the completed staff surveys indicated that they are being given training that is relevant to their role. Training certificates for completed courses and study days were seen in staff files examined. Tamar House has a robust recruitment procedure that includes 2 written references and a CRB check. The manager and provider interview prospective staff and follow a standard interview format. The staff files seen had all the required information included in them and were stored securely. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures in place are designed to meet the needs of the service as they strive to improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The registered manager retired recently and the acting manager has put an application in to CSCI to be the registered manager. She is a level 1 trained nurse and has been working at the home for some time. Although this is her first managers post she was able to have a full handover from the previous manager and has the full support of the provider. She said she will register to do a registered managers award in the near future. The AQAA states that Service Users surveys are carried out yearly and relatives and Care Homes for Older People Page 22 of 26 Evidence: friends are encouraged to contribute to them. Any verbal comments are also taken on board and acted upon if necessary. The AQAA states that Service Users money is kept securely in the office safe and a record is made of all outgoings and deposits. These records can be shown to Service Users and or their relatives at any time if requested. Money management was not looked at in detail during this inspection. The acting manager said that all staff have supervision (one to one) sessions regularly and an annual appraisal. Records were seen that confirmed this. She said that all staff have statutory training that includes health and safety, first aid, lifting and handling and fire safety. Certificates were seen in staff files examined that confirmed this. A number of routine servicing and maintenance documents and the fire log book were examined and found to be up to date. The maintenance man carries out ongoing in house and outdoor routine maintenance tasks. Staff put information about any maintenance required in the defect book that is checked each time he is on duty. Numbers of emergency contacts are available to staff should they need them out of hours. The care plans examined had personal risk assessments included in them that were up to date and had been reviewed as necessary. The provider said that general risk assessments are carried out and updated as required. The provider said that the kitchen roof recently had to be replaced and risk management was in place throughout the process to ensure the safety of the residents and the ongoing smooth running of the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Nursing staff should ensure that medication adminsistration sheets are always fully completed. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!