CARE HOMES FOR OLDER PEOPLE
Tamarix Lodge 142 Queen Street Withernsea East Yorkshire HU19 2JT Lead Inspector
Mrs Rosalind Sanderson Unannounced Inspection 20th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tamarix Lodge Address 142 Queen Street Withernsea East Yorkshire HU19 2JT 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) 01964 615707 01964 612092 Humberside Independent Care Association Mrs Lynn Allwood Care Home 33 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (33) of places Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th February 2005 Brief Description of the Service: Tamarix Lodge provides personal care and accommodation for people some of who may have memory impairment. The home is owned and operated by Humberside Independent Care Association (HICA), a not for profit organisation. The home is located on a main street in the seaside town of Withernsea, East Yorkshire. Service users have easy access to a variety of local shops, pubs, services and local transport. Tamarix Lodge occupies a purpose built property with accommodation on two floors with access to the upper floor via a passenger lift. The majority of bedrooms are for single occupation, many having en-suite facilities. Service users have the benefit of a large garden area with lawns, fruit trees and flowerbeds. The home has recently increased the number of registered beds and is awaiting final documentation in order that the new registration certificate can be issued. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted for eight hours including preparation time. Service users, their relatives and staff were spoken with during the inspection. Their views are incorporated in the body of this report. Service user care plans were looked at along with staff recruitment and training records. Documentation relating to Health and Safety checks within the home was also looked at. The inspectors were able to look freely around the home and at service users private accommodation with their permission. What the service does well: What has improved since the last inspection?
Since the last inspection the manger has completed her NVQ level 4 qualification in care. This means she is now qualified in care and management and fully qualified to carry out her role. Service users are now fully informed about who they are able to approach if they have a complaint and have been supplied with the Commission for Social Care Inspections contact details for this purpose.
Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 6 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. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 not applicable) The assessment process carried out by the home ensures service users needs will be met. EVIDENCE: Records looked at showed that service users needs are assessed prior to admission. The home manager undertakes home visits to carry out the assessment where possible. Care plans showed that this information is utilized For those service users admitted through the care management approach, a copy of the care management plan was available to further inform the staff. Service users and relatives spoken with felt they had been given sufficient information about the home to make a choice. Comments received included “We feel lucky to have found somewhere nice” and “I am happy living here.” Opportunities to visit the home are made available prior to admission. Relatives spoken with stated that they had visited the home to look around and they had been impressed “that the staff were approachable and friendly”.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 An inconsistent approach to care planning could lead to staff being poorly informed of service user needs Medication practices at the home have the potential to place service users at risk. EVIDENCE: Service users are happy with the care they receive at Tamarix Lodge. Those spoken with made the following comments: “ The best thing about living here is letting you have your independence, they don’t make you do things you don’t want” “ They knock before entering the room, always” “I have made friends here, the staff are lovely, and I was lucky to find somewhere nice.” It was noted that service users were able to lock their rooms.
Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 10 Each service user has details of their care needs contained in individual folders. The documentation was present within care plans but further input and review by staff was required to ensure that assessments are up to date and reviewed to reflect service users changing needs. In one instance a service user had suffered an injury, staff had taken the relevant action, medical treatment had been sought and an accident form completed. However there was no plan in place to indicate how care would be given. Service users who were able to self medicate were allowed to do so and the relevant risk assessments were in place for this. Medication is administered correctly however the recording, handling and storage arrangements have the potential to put service users at risk. The print used on the Medicine Administration Record was of poor quality and difficult to read. New stock received into the home was not added on to the stock balances, this included controlled drugs, which were also stored inadequately. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 Service users enjoy their lives and are able to exercise choice, control and flexibility in their daily routines. Meals provided at the home are nutritionally sound and varied. EVIDENCE: Service users spoken with enjoyed the lifestyle they experienced at the home. Activities are available and recent events included bingo and social evenings on weekends. Activities are displayed on a notice board in the dining room to inform service users. During the summer months service users have been able to enjoy rides out and wheelchair outings. Visitors are welcome at the home anytime as long as it suits the service user. Visitors are able to make hot drinks for themselves and their relatives if they wish and these facilities are available in the dining area. Visiting clergy to the home enable those service users who choose to take part in religious services. The cook provides a four-week menu and ensures that all diets and tastes are catered for. There is a choice of meals to ensure variety and alternatives are also on offer. One service user said ‘the food is marvellous, it is like a hotel’ Another commented, ‘the best thing about living here is being able to do as you please and not made to do what you don’t want. I like to eat meals in my room’
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users are protected and their complaints are listened to. EVIDENCE: The complaint policy is available within service users rooms. Service users spoken with and relatives stated that they were happy with the care received and that they would not hesitate to speak with staff or the manager if they had any complaints or concerns. One service user said, ‘Lynn (the manager) is marvellous, she listens to you if you have any worries’ A recent incident had been dealt with regarding the protection of vulnerable adults. This had been handled appropriately and the client and family concerned were happy with the process and outcome of the investigation. The relative stated “ they are so good with…….since this has been resolved, I am very happy with how the incident has been handled and the manager has been very supportive and thorough.” The manager has undergone training in Protection of Vulnerable Adults and staff receive training during their induction period and at intervals following this so that they are aware of their responsibilities. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26 Service users live in a home that is clean, comfortable and homely although some elements could put service users safety at risk. EVIDENCE: The home is purpose built and is suitable for the purpose for which it is used. There is on going renewal and maintenance of decorations and furniture. The gardens are pleasant and well kept and service users stated that they enjoyed sitting out when possible. The building complies with any requirements made by the fire officer to ensure service users safety. There are no unpleasant odours in the home and staff are provided with information and equipment to aid in preventing infections and cross infections. Laundry facilities are sited away from food preparation areas and there is a dedicated laundry assistant. Service users were all dressed nicely in well-laundered clothes. The carpet in the dining servery area requires cleaning and the boards underneath are loose. The carpet in the corridor outside the kitchen is wrinkled and has tears in it. The smoking room is not fully enclosed at the ceiling level and so allows smoke to filter into the dining area.
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The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Service users are cared for by staff that are well trained, safe and enthusiastic about their roles. EVIDENCE: The manager follows the organisations robust recruitment process to ensure that all staff employed are appropriate and safe to care for the service users. All staff attend a block induction week at the companies headquarters and until this is completed the staff work under supervision. Each member of staff has a training plan and this ensures that all mandatory training is completed and current. The organisation also provides training for staff that is relevant to the service user group including understanding dementia. The percentage of staff that hold an NVQ qualification at level 2 and above currently stands at 30 . The staff rotas showed that there are sufficient staff on duty with a good skills mix. Staff spoken with were enthusiastic about their roles and knowledgeable about the service users in their care. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The home is managed in a way that fosters openness and respect and ensures residents, relatives and staff feel valued and their safety and welfare are protected. To ensure that this continues the requirements made in this report must be addressed. EVIDENCE: The manager is experienced and competent to manage the home. She has gained the registered managers award and NVQ 4 in care. All certificates relating to health and safety are current. All mandatory training for staff is current ensuring residents are cared for by safe staff. Relevant legislation is complied with and specific and generic risk assessments are in place and reviewed to promote safety within the home.
Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 16 The quality assurance systems in place ensure that the manager takes into account the views of all residents, relatives, professionals visiting the home and staff. Results of surveys are analysed and the results published. These assist the manager to develop the annual development plan. The process ensures that residents and other stakeholders feel involved in the running of the home and that they have a say in it. The home holds personal monies for a number of residents. The monies are held in a bank account under the umbrella of ‘Tamarix Resident Account’. Computer records in the home are able to show how much each resident has in the account. On occasions service users monies may fall into negative balances. There was a COSHH substance left in the hairdressing salon that was unlocked. An unguarded freestanding radiator that was in the communal lounge was removed during the inspection as it posed a potential risk. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X X 1 Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) 15(2(b)) Requirement The registered manager must ensure that, for each service user, a comprehensive care plan is in place and that it is reviewed to ensure that all current care needs are addressed. The registered manager must: • Ensure that all medication received into the home is recorded and totals added on to the stock balance • Review the storage arrangements for controlled drugs • Liaise with the pharmacist to ensure that all MAR sheets are clear and legible. The registered manager must liaise with the fire authority regarding the suitability and safety of the smoking room. The registered manager must: • Make arrangements for the carpet in the servery area to be cleaned. • Make arrangements for the carpets identified at the inspection to be repaired or replaced.
DS0000019732.V257644.R01.S.doc Timescale for action 30/11/05 2 OP9 13(2) 31/10/05 3 OP19 23(c(i)) 07/11/05 4 OP19 23(2(d)) 31/10/05 Tamarix Lodge Version 5.0 Page 19 5 OP35 13(6) 6 OP38 13(4(a)) The registered manager must make sure that when monies are held on service users behalf, these accounts must not fall into a negative balance. If difficulties are encountered obtaining personal allowances referral should be made to social services. The registered manager must: • Make sure that all COSHH substances are kept secure. • Carry out a risk assessment for the loose boarding under the carpet in the servery and put in place control measures to reduce any identified risk. • Make arrangements for repair or replacement of the carpets identified at the inspection that were wrinkled and torn. • Make sure that no unguarded free standing radiators are used at the home. 28/10/05 28/10/05 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 OP28 Good Practice Recommendations The percentage of care staff holding an NVQ qualification in care should be 50 by the end of 2005. Tamarix Lodge DS0000019732.V257644.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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