CARE HOMES FOR OLDER PEOPLE
Tamarix Lodge 142 Queen Street Withernsea East Yorkshire HU19 2JT Lead Inspector
Mavis Pickard Unannounced Inspection 25th January 2006 11:30 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.V277058.R01.S.doc Version 5.1 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.V277058.R01.S.doc Version 5.1 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 37 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (37) of places Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Tamarix Lodge provides residential care older people some of who may have a dementia type illness. The home is owned and operated by Humberside Independent Care Association (HICA), a not for profit organisation and is located on the main street of Withernsea, East Yorkshire. Residents have easy access to the seafront, local shops, pubs, services and public transport. Tamarix Lodge is a purpose built property with accommodation on two floors. There is a passenger lift. Most rooms have en-suite facilities. All are designed for single occupancy. Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. 1 inspector undertook this unannounced inspection over a 4-hour period. The inspection was facilitated initially by one of the home’s duty managers and latterly by the registered manager. The home was running well, people accommodated and staff noted to be going about their daily lives in a relaxed and comfortable way. Several residents were observed to be going out or arriving back in to the home either alone or with friends or relatives. The home presents as a comfortable, open and welcoming environment for older people some of who may have a dementia type illness. What the service does well: What has improved since the last inspection?
The way that residents case files were maintained at the time of the previous inspection was in the process of being changed this may have prompted a requirement that care planning needed to improve. This process now almost completed gives evidence of sound, detailed and appropriate case file maintenance. Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 6 The storage of controlled medication is now appropriate and records maintained are legible, detailed and complete. A tour of the building was undertaken during which it is noted that all COSHH products are stored safely. The manager ensures that any financial transactions undertaken on behalf of residents by the home are up to date and appropriately recorded. The manager confirmed that there are no concerns presently that residents are not receiving their appropriate level of personal allowance, should there be concerns the manager understands the steps that she needs to take. 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.V277058.R01.S.doc Version 5.1 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.V277058.R01.S.doc Version 5.1 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): 1 The information provided in the homes Statement of Purpose and /or Service User Guide does not make reference to the home’s smoking policy for residents. EVIDENCE: It is noted that the home’s policies do not make reference to the home having a smoking policy nor is any guidance available regarding the limitations in respect to smoking in the home by residents and/or visitors. [Please refer to standards 19 and 38 with reference to fire safety.] Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Resident’s health, personal and social care are set out in a comprehensive care plan. People are safe in respect to the home’s medication policy however the medication policy is not wholly followed. EVIDENCE: A number of recently accommodated resident’s case files were examined. All were detailed and comprehensive, giving evidence that individual care needs are recorded and showing the action to be taken to meet the need. Individual risk assessments gave evidence of risks being identified and how residents and staff could work together to minimise and/or eliminate the risk. The home’s medication records were examined and were found to be appropriately maintained. The receipt, administration, storage, handling, and disposal of medication is recorded appropriately. Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 10 However concerns are raised that the way in which controlled medication is recorded in the home does not meet with the home’s own policy. The reason seems to be that the document provided by the organisation for use by staff in the home is different from the guidance the policy provides. The registered manager said that she would bring this to the attention of her line manager. In the meantime it is recommended that the organisation and the manager take professional guidance with respect the type of document that is necessary for the recording of controlled medicines. Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 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): 13 & 15 Residents maintain contact with friends and/or relatives and the local community Residents are provided with an appropriate diet. EVIDENCE: From direct observation it was clear that residents were free to come and go from the home within their capability. Residents and their friends and/or relatives were observed to be comfortable in the environment of the home. People spoken with said that they are part of the local and wider community. Records of meals provided were not examined at this visit, however the inspection took place over a mealtime and residents were noted to be provided with choice and with a well balanced, attractively presented meal. Where required residents were assisted by staff to take their food in the dining room or in a private area. The kitchen was visited briefly and it presented as being tidy and clean.
Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected at this visit. EVIDENCE: Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 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): 19,21,22 and 26 The home is in general safe and well maintained. However there are concerns regarding uneven floor surfaces and some poorly maintained carpets. The home provides sufficient toilet and bathing facilities. Residents have specialist equipment to meet their assessed needs. The home is in general clean and free from unpleasant odours. EVIDENCE: A tour of the home was undertaken which showed that it is generally well maintained. However there are areas on a ground floor corridor and in the dining room where a requirement previously issues stated that The registered manager must: Make arrangements for the carpet in the servery area to be cleaned.
Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 14 Although the carpets in the home are regularly cleaned, the carpet identified presents as old and difficult to keep clean. The manager says it is to be replaced along with a ground floor corridor carpet in the same condition. A requirement of this report will be made requiring that the provider send written timescales for the completion of this work to the Commission by 15 February 2006. An area in the dining room is a trip hazard as the floor is uneven. A timescale is required for the completion of remedial work to rectify this situation. [Refer to standard 38] It was discussed with the manager that an unused bathroom could be changed into a hairdressing salon but that previous Inspectors felt that to ‘loose’ a bathroom would be detrimental to residents. This could be the case, the person registered may decide that without this unused bathroom residents would not be disadvantaged or that they would be better served by the provision of an upgraded hairdressing salon. The Care Home for Older People, National Minimum Standards [standard 21(4)] gives guidance to providers and/or managers about the recommended numbers of bathing facilities for the numbers of residents. With reference to the residents smoking room the previous inspection report made a requirement that: The registered manager must liaise with the fire authority regarding the suitability and safety of the smoking room. This requirement remains unmet. Concerns are raised that because the smoking room walls do not reach ceiling height smoke is free to drift into the sitting and/dining areas. The manager says that residents do not smoke in the room when meals are being served. No one has complained about the smoking room or any smoke that may drift into other areas. However concerns are raised that because the wall does not reach ceiling height there may be a fire containment issue should a fire start in this area. A requirement is made that the person registered in consultation with the fire authority make proper provision for the containment of fire. Additionally it is noted that the home’s Statement of Purpose and Service Users guide make no reference to the resident smoking policy for the home. [Please refer to Standard 1] The home presented as being fresh, clean and free from unpleasant odours.
Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 These standards not inspected on this occasion. EVIDENCE: Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35 and 38 Residents and staff benefit from the leadership qualities and management approach identified in the home. Resident’s finances are appropriately dealt with. There are some health and safety issues identified. EVIDENCE: The registered manager was impressive in her approach to residents and staff she was observed to communicate a clear sense of direction and leadership, that residents and staff understood and appreciated. The way the home is run is observed to be open, positive and welcoming. This is to be commended.
Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 17 There was a requirement of the previous report that referred to residents personal finances and that the registered manager must ensure that residents personal monies stored in the home must not fall into a negative balance and that if difficulties are encountered in obtaining personal allowances referral should be made to social services. Standard 35(1-6) of the Care Homes for Older People, National Minimum Standards recommend the way in which resident’s personal finances should be safeguarded. Regulation16 (2)(l), 20 and Schedule (4)(9) show requirements that a home must meet if individual residents money is handled. Personal finance records were examined and all the above recommendations and requirements are currently met. The manager said that there are no concerns that any present resident does not receive their personal allowances either in cash or kind. There is and will be times when their personal allowances record will be in the negative whilst family and/or solicitors are contacted and cash is brought or sent. If this is for a minimal time and not to the detriment of the resident there should be no need for concern. An area in the dining room is a trip hazard as the floor is uneven. A timescale is required for the completion of remedial work to rectify this situation. [Please refer to stands 19-26] Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X 3 3 X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 4 X X 3 X X 1 Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(b) Timescale for action The registered person must 28/02/06 ensure that the information provided in the homes Statement of Purpose and Service User Guide makes reference to the home’s smoking policy for residents. The person registered must 15/02/06 forward to the Commission a timescale for the planned replacement of carpets identified by the previous report as being in need of replacement. The person registered must 15/02/06 forward to the Commission a timescale for the remedial work necessary to be carried out regarding the uneven floor surface in the dining room. The person registered must 15/02/06 following consultation with the fire authority make adequate arrangements for containing fire. In particular respect to the designated residents smoking room. Requirement 2. OP19 13(4)(a)( b)(c) 3. OP38 13(4) 4 OP38 13(4)(c) (i) Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 20 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. This is a recommendation carried forward from the previous inspection 20 October 2005. 2. 3. OP9 OP9 The person registered should ensure that the policies and procedures laid down by the home are adhered to. The person registered should take professional advice in respect to the type of document to be used when recording the movement of controlled medication within the home. Tamarix Lodge DS0000019732.V277058.R01.S.doc Version 5.1 Page 21 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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