Inspection on 21/01/08 for Tamar House

This inspection was carried out on 21st January 2008.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tamar House 16/06/06

Tamar House 20/12/05

Tamar House 29/06/05

Tamar House 24/11/04

Tamar House 18/05/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Tamar House 5 Riseholme Road Lincoln Lincs LN1 3SU Lead Inspector Sue Hayward Unannounced Inspection 12:00 21 January 2008 st Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 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 Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tamar House Address 5 Riseholme Road Lincoln Lincs LN1 3SU 01522 524093 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) info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd Sarah Martin Ms Sarah Martin Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (2) of places Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only - Care home only - code - PC to service users of the following gender - Either - whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. Learning disability - Code LD(E) 2. The maximum number of service users who can be accommodated is 13. 16th June 2006 2. Date of last inspection Brief Description of the Service: Tamar house is one of a number of services owned by Prime Life Limited. It is an adapted and detached two-storey Victorian property situated on the edge of a residential area, in the northern part of the city of Lincoln. A small secluded garden is situated at the back of the home with an enclosed garden at the front both which can be used by people who use the service. A large extension to the property has provided eight single bedrooms. The home offers care and accommodation for up to 13 people with a learning disability. They have opportunities to attend a number of day care facilities within the local area and Prime Life Limited provides transport. Bedrooms are located on both floors. Access to the first floor is via stairs. There are two lounges and a dining room on the ground floor. The home has a few car parking spaces to the side of the house. Information about the service is available at the home. This includes the latest inspection visit report, which is on display on the notice board. Information provided by the manager at the time of the site visit indicated that the current weekly fees are £407 per week. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This was an unannounced visit and it formed part of a key inspection. It started at midday and lasted 5 hours. It took into account information we already hold on our files, which was used to plan the visit and produce this report. This included a self-assessment questionnaire, which had been completed by the manager and the chairman of the company, the previous inspection report and records of any incidents notified to us since the last inspection. “Have your say questionnaires” were received from five service users and three staff members and information and comments from these are also included in the report. The site inspection focussed on key standards, which have the potential to affect the health, safety and welfare of people who use the service. The main method used for this was “case tracking” a sample of three people via their records and assessing their care. Two people were spoken to individually and groups of people who use the service were also spoken with on a more general basis. Three people were happy to show us their bedrooms. In addition we spoke to a visitor who gave us their opinions about the service and a staff member. The manager was present throughout and was given general feedback at the end of the visit. What the service does well: A clean, comfortable and homely environment is provided for the people living here. A range of activities, leisure and recreational pursuits are provided which people can join in with if they wish. People who use the service said they liked living at Tamar House and had good relationships with staff. They said that they had opportunities to make their views known through individual discussion with staff and at meetings, which they can attend if they wish. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 6 A visitor described the service as “the best thing since sliced bread”. Staff were said to be caring, good communication existed between relatives and staff and visitors were always made to feel welcome. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 5 (Adults 18 –65) and 1 and 3 (Older people). Standard 6 (Older people) is not applicable as the service does not provide intermediate care. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. There are good systems in place to introduce and assess people who use the service to ensure their care needs are identified and can be at the home met prior to admission. EVIDENCE: The statement of purpose, which gives important information about the service was provided prior to the visit. It was dated February 2005 but has since been updated in January 2007 to show the recent changes to who is managing the Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 9 service. It does need further review, which the manager agreed to do to ensure that it reflects changes to the commission’s inspection process, to ensure service users have accurate information about the frequency this happens. Information about the home is available in different formats enabling people who use the service who may have specific communication needs to have information in a more understandable form for them. Some information about the service was on display, such as the most recent inspection report, for people who use the service or visitors to read if they wished. It was clear from discussion with people who use the service and a visitor that they had been able to visit the service and talk to staff to enable them to make the decision whether it was the right place for them to be. Comments from people who use the service confirmed they “liked living at Tamar House”. The records of two people were checked on this occasion. Both contained information about terms and conditions of their stay at the home. It was understood from information provided prior to the visit and from discussion with staff that all people who use the service have a trial period to decide whether or not Tamar House is right for them. However, the terms and conditions makes no mention of what timescale this covers and it is recommended that this information is included so that people can be clear about it. Records checked contained information, which showed that each person had had an assessment completed by staff of the home and also based on information from other relevant people such as social workers. From this care plans are developed and where necessary risk assessments documented. The recording of this information enables people who use the service and staff to know what needs have been identified and how they are to be met. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 (Adults 18 - 65) and 7, 14 and 33 (older people). People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from being involved in the planning and review of their care. Staff have a good knowledge of peoples needs and how to meet them which contributes to ensuring peoples health and welfare. However, in some instances care plans are not consistently reflecting sufficient detail about peoples needs which has the potential their needs may not be met. EVIDENCE: Records checked contained care plans and risk assessments, which took into account various aspects of peoples lifestyles and needs. Discussion with Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 11 people who use the service confirmed that they knew about their care plans and that their “key worker” (a specific staff member) met with them regularly to discuss them. Those plans checked, had been signed by people who use the service. Formal reviews are also held involving other professionals. Care plans and risk assessments checked varied in the amount of detail they contained. For example, clear information had been recorded as to what actions staff should take in the event of a missing person but aspects of other needs identified were less well documented. For example, it was recorded that a person who uses the service needed staff support to manage their medication but no care plan had been developed about this. This has the potential that some peoples’ needs may not be effectively met. An instance was also noticed where a behavioural need had been identified but the care plan not updated until sometime after this. Whilst staff were well aware of peoples needs in these instances, it is important that care plans are kept as up to date as possible so that all necessary information is available to be referred to if needed. This was discussed with the manager who agreed at the time of the visit to address these matters. Comments from people who use the service and from surveys completed indicated that they generally make their own decisions and are enabled to be as independent as possible. For example, a service user said that she went shopping when she wanted. During the visit people were seen to have a choice about where they wished to spend their time when they returned from their daytime activities. They also talked about attending house meetings where they have the opportunity to discuss matters and make their views known. Staff said there are some people who are not able to communicate well verbally and showed how pictures are used with people to assist them to express their feelings. There was discussion with the manager and a staff member on duty about ensuring that care plans clearly demonstrate any areas where peoples capacity to make decisions has been considered and ensure any outcomes are clearly recorded. It was discussed that staff had not yet had training about the Mental Capacity Act but this was to be arranged via the organisations training co-ordinator. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 13 Standards 12, 13 and 15 – 17 (Adults 18 – 65) and Standards 10, 12, 13 and 15 (Older people). People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have opportunities to participate in a range of activities and recreational interest both within the home and the community, which promotes their independence and enables them to maintain relationships. The meals provided are well balanced and cater for people’s individual preferences and specific dietary needs. EVIDENCE: People’s comments and records checked confirmed that there is a range of activities and leisure interests, which they can participate in and they have opportunities to keep in touch with family and friends. Hobbies and interests of people were recorded on individual records seen. All but two people returned home during the visit after attending a day centre and their comments demonstrated this was something they enjoyed. A visitor said he runs an archery class and his relative and some of the other people who use the service also liked to attend this session. Photographs were on display of people who use the service visiting different places such as parks. People said that they had day trips once month, go out for meals and celebrate birthdays and they enjoyed these activities. There is the use of a minibus in the evenings or weekends but also a seven-seated vehicle as well to take people out. Records kept of house meetings held demonstrated that people who use the service are asked for their views and ideas about holidays. Last year people who use the service said they had a choice of taking a short break from two different destinations. One person who uses the service showed us a list on the notice board about special events coming up, such as Shrove Tuesday and Valentines Day. Comments from staff and a person who uses the service confirmed there have been opportunities in the past for service users to be involved in voluntary work although no one is currently. A relative spoken to was very complimentary about the care and accommodation provided and said was always made to feel welcome when visiting. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 14 Records demonstrated that staff check to ensure that people who use the service are happy with the meals provided and comments from people ere complimentary about the meals. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 (Adults 18 – 65) and standards 8 – 10 (older people). People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People who use the service receive the support and care they need to be as independent as possible and to promote their physical and emotional wellbeing. There are satisfactory systems in place for the storage and administration of medication in the home, which helps to keep people safe. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 16 EVIDENCE: Comments from people who use the service were complimentary about the care and support they received such as “I like living here”, “I can talk to staff” and “the staff help you”. Comments in the surveys received included opinions that staff treated them well and generally listened and acted on what they said. People also said they were able to make choices and decisions about their lives. All but one staff member currently working at the home is female. Information provided prior to the visit indicated that people who use the service have a choice of who delivers care to make sure that it is “gender sensitive” but those care plans checked did not include peoples preferences about this. However, there were no comments from people to indicate that this was an issue for them. Care records checked included information about peoples particular health needs and demonstrated when people had attended appointments to medical professionals such as doctors, opticians and chiropodists. We have received information in the form of notifications, which has told us about some appointments people have attended for medical treatment indicating that the health and welfare of people who use the service is promoted. One person using the service said appointments were made at the doctors when requested. Staff comments indicated they were aware of the needs of people and there are policies and procedures in place about health care matters such as medication, accidents and missing persons procedures for them to refer to if needed. It was confirmed that neither people who use the service at home on the day of the visit was prescribed any lunchtime medication and therefore staff were not observed giving any out. However, a staff member confirmed that she had received training about how to administer medication and was seen to be following a satisfactory procedure in relation to completing records of medicines ready to be disposed of with the pharmacist. There are satisfactory facilities available to store medication. There is a system in place where the majority of medication is pre-packed individually for people who use the service by a local pharmacist. This helps to ensure medication is administered safely. The manager confirmed that the last pharmacy visit occurred on 19/12/07 and no recommendations were made at that time. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) and 16 and 18 (Older People) People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are satisfactory procedures in place for handling complaints and allegations of abuse and staff understand their responsibilities to refer promptly any safeguarding matters. This helps to ensure the safety of people who use the service. EVIDENCE: The organisation has satisfactory policies and procedures about how people can raise a concern or complaint and what to do if an allegation or issue arises which may necessitate a referral under safeguarding adults’ procedures. Since the last inspection there have been some matters notified to the commission, which indicated that referrals needed to be made to social services to determine whether they needed consideration under safe guarding adults procedures. There have been two instances where these matters were not referred as promptly as they could have been, which has the potential to Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 18 put peoples welfare at risk. However, a recent matter was referred promptly and discussion with the manager and a staff member indicated that they fully understood their responsibilities to do so. Staff have also had recent training in relation to adult protection. Of the matters referred one is currently being considered under safeguarding adults procedures and action has been taken to protect the service user concerned whilst the matter is being looked in to. There were varied comments from surveys completed by people who use the service as to whether they knew how to make a complaint and a staff member was unsure whether the complaints procedure was available in any other forms. However, discussion with people who use the service indicated they knew who was in charge and would feel able to tell staff if they were unhappy or had a problem. It was also noticed that they had a good rapport with the staff on duty. A visitor to the service felt that communication with staff was good and he had never heard any comments from people who use the service to suggest they were unhappy at Tamar House. Records checked demonstrated that one complaint had been raised in the past twelve months and satisfactory action had been taken to look into the matter. The manager confirmed it had been satisfactorily resolved. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 (Adults 18-65) and 19 and 26 (Older People). People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides comfortable and clean accommodation for people who use the service, which meets their needs and personal preferences. EVIDENCE: Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 20 The bedrooms of three people who use the service were seen on this occasion at their invitation. Their comments indicated that they had been able to choose the colour schemes and were able to make their rooms more homely with their own personal effects. Bedroom doors are lockable if people choose to do so which promotes their privacy. People made comments, which indicated they enjoyed being able to take responsibility for looking after their own rooms and are supported by staff to do so. This promotes their independence. All parts of the home seen including bedrooms, the lounge, dining room, kitchen, laundry and bathrooms were clean and tidy. A staff member confirmed that a new shower had recently been installed which has a thermostatic mixer valve to control the hot water temperature. Records indicated that checks are carried out to ensure they are operating at a safe temperature. There were no obvious safety issues noticed. Risk assessments of the environment have been carried out and outcomes recorded. People who use the service said they found their rooms comfortable and had been able to arrange them as they wished. Comments from surveys confirmed that people who use the service considered the home to be always fresh and clean. There is an on-going programme of maintenance. Prime Life has satisfactory policies and procedures relating to good hygiene practices and stocks of equipment such as gloves were seen. Staff confirmed that aprons were also available for them to use if needed. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 (Adults 18-65) and 27 – 30 (Older People) People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A satisfactory staff recruitment process protects people who use the service. Staff participate in a range of training to ensure that they have the knowledge and skills to provide care, which meets the needs of people who use the service. EVIDENCE: People who use the service were noticed to have a good rapport with staff. Comments from people who use the service were that staff always treated Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 22 them well and felt they usually listened and acted on what they said. A visitor was of the opinion that staff were “caring” and had a “good attitude” to the people who use the service”. The current staffing arrangements are two staff members during the day and at weekends there is an additional person who is able to work flexibly for twelve hours, depending on the needs of people who use the service. At night there is one wakeful staff member on duty. It was noted from a record checked a staff member had raised a concern about working in the home alone, a visitor also wondered what would happen if the staff member on duty at night had an accident. The manager said she is always on call although it would take her 25 minutes to get to the home if called out, therefore staff who live closer could be contacted to provide support at night if it was needed sooner. A staff member also confirmed this. However, it was understood that this was a goodwill arrangement and in order to ensure the safety and welfare of people who use the service it is recommended that the “on-call” system be operated on a more formal basis and included as part of the staff rota. There have been few changes to the staff team in the past twelve months, which helps to ensure that people receive consistent care. There is a staff training programme in place and a staff member gave examples of training she had participated in such as infection control, basic food hygiene and fire safety training. Over 50 of staff have also achieved a nationally recognised vocational award in care, which helps to ensure they have the knowledge and skills to meet peoples needs. The staff recruitment process was checked in relation to the most recent employee. This was satisfactory and records demonstrated that relevant checks had been followed up such as obtaining references and a criminal record bureau check. This helps to ensure the welfare of people who use the service. Discussion with the manager confirmed that there have been changes to the way in which new staff are inducted into the work. This includes a mentorship scheme where a more experienced staff member works alongside a new employee over a period of time. A staff member who carries out this role confirmed she had had training to do so and could contact Prime Life’s training department for support and guidance if needed. On the day of the visit the training co-ordinator was visiting the home. The manager said that part of their discussions was about identifying and planning future training for staff. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 (Younger Adults) and 31,33, 35 and 38 (Older People). People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed and there are satisfactory arrangements in place to obtain the views of people who use the service and staff in order to develop Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 24 the service. However, the system in place for auditing money in safekeeping is not sufficiently robust to fully protect people. EVIDENCE: There has been a change of manager since the last site visit. Comments from people who use the service indicated that they knew who was in charge and that staff would listen to any concerns they had. Comments from staff indicated they felt supported in their work, for example “I feel very comfortable in my role and I am well supported in fulfilling it” and “I work closely with the home manager and have a meeting fortnightly”. There are various systems in place to check on the quality of the service provided. This includes visits by a representative of the organisation who completes a report, house meetings and staff meetings. The last quality assurance review was carried out in November 2006 and included the views of people who use the service, staff and a health professional. As it is now over a year since it was undertaken it is recommended that another audit be undertaken. There are satisfactory storage arrangements in place for the safekeeping of valuables and money. However, the system for auditing money held in safe keeping on behalf of people who use the service needs to be improved as of the two checks made of peoples money in safe keeping at the time of the visit, one record was accurate the other was not. There are a range of policies and procedures regarding health and safety available to guide and instruct staff. There is also a programme in place to service and maintain equipment in the home on a regular basis for example certificates were available to demonstrate that checks had been carried out on the emergency lighting system and fixed electrical wiring system in place. This helps to ensure that the health and safety of people who use the service is promoted. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No 22 23 Score 3 3 3 3 X 3 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 2 42 3 43 X DS0000002433.V358508.R02.S.doc Version 5.2 Page 26 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 Tamar House Score 3 3 3 21 X Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1 YA41 Regulation 17 (3) Requirement In order to ensure that the welfare and safety of people is well protected. Records kept of any money held in safe keeping on behalf of people who use the service must be kept up to date and accurate. Timescale for action 18/03/08 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 YA1 Good Practice Recommendations It is recommended that information contained in the services statement of purpose be reviewed to ensure that it reflects changes to our policy on the frequency inspections will be carried out. This will ensure that people who use the service have up to date and accurate information available to them. It is recommended, in order to ensure that people who use the service are clear about the terms and conditions of DS0000002433.V358508.R02.S.doc Version 5.2 Page 28 2. YA5 Tamar House 3 YA6 4 YA7 5 YA33 occupancy at the home that timescales for trial periods are specified in this information. It is recommended that care plans be reviewed to ensure that they are consistently in sufficient detail to ensure the needs of people who use the service and how they are to be met are fully identified. It is recommended that care plans contain information, which shows that consideration has been given to people who use the service, ability to make decisions and any outcomes have been clearly recorded. This will ensure that their welfare and safety is promoted. It is recommended that the staff “on-call” system clearly indicate on the rota the staff “on-call” arrangements. This will ensure that should additional staff be needed in an emergency to ensure the welfare of people who use the service arrangements will be clear. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Tamar House DS0000002433.V358508.R02.S.doc Version 5.2 Page 30 - 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!