Inspection on 02/08/05 for Tandridge Heights, Memorial Care Home

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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

Tandridge Heights, Memorial Care... 17/12/08

Tandridge Heights, Memorial Care... 27/06/06

Tandridge Heights, Memorial Care... 06/12/05

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

CARE HOMES FOR OLDER PEOPLE Tandridge Heights, Memorial Care Home Memorial Close Oxted Surrey RH8 0NH Lead Inspector Janet Daulton UnAnnounced 2 August 2005 10:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tandridge Heights, Memorial Care Home Address Memorial Close Oxted Surrey RH8 0NH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01883 715595 01883 713990 tandridge@barchester.com Barchester Healthcare Homes Limited Mrs Joy Seymour CRH Care Home 75 Category(ies) of DE(E) Dementia - over 65 - Number 34 registration, with number OP Old Age - Number 75 of places Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 10 beds are provided for intermediate care. Date Implemented 3 May 2005 Date of last inspection Registration inspection 29th April 2005 Brief Description of the Service: Tandridge Heights Memorial Care home is a new home, and was registered with the Commission for Social Care Inspection in April 2005. It is owned by Barchester Healthcare Homes Ltd. It is registered for 75 older persons, to include service users with dementia, and the provision of 10 beds for intermediate care. Accomodation consists of 3 floors, the ground floor for service users requiring personal and nursing care, the first floor for service users with dementia, and the second floor for service users requiring intermediate care. A passenger lift accessed all floors. All the bedrooms are single and ensuite. There are large communal areas on all floors, consisting of dining and lounge facilities, and several smaller sitting areas at the end of each wing.There are pleasant secure garden areas with garden furniture, and there is adequate car parking facilities at the front of the property. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first inspection since the home opened in April 2005. The inspection lasted 5.5 hours, and was conducted by the Lead Inspector for the home, Mrs. J. Daulton. The Manager of the home Mrs. J. Seymour was present throughout the inspection. The Regional Operations Director Ms. B. Sedour was also in attendance. A subsequent pharmacy inspection was conducted on 11th August by Mrs. G. Yates, and her findings have been incorporated into this report. There were 24 service users in the home on the day of the inspection. 11 service users and 2 visitors were spoken with during the inspection. The inspector also spoke to care and domestic staff. Care plans and medication records were examined, and staff recruitment and training files were inspected. A tour of the home also took place. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the inspection. What the service does well: What has improved since the last inspection? Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 6 This was the first inspection since the home opened. 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. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 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 standard(s) 1,3,6 There was a wide range of information available about the home, however not all the prospective service users were given this prior to admission. Overall all service users had their needs assessed prior to moving into the home. The home had the staff and equipment to care for service users who require intermediate care. EVIDENCE: The home had a comprehensive Service User Guide in place. Several of the service users or relatives spoken with stated that they were not given any information prior to their admission. A requirement is made that wherever possible, all prospective service users must have the information to make an informed choice about admission to the home. Service users were assessed prior to admission, either by the Manager of the home, or by a member of the Primary Care Trust who funds the 10 intermediate care beds. One service user funded by the PCT did not have a preadmission assessment on file. The registered person must ensure that all service users have an assessment prior to admission to ensure that the home can meet the needs. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 9 During the inspection staff were seen who were there specifically to provide the specialised care required for the service users receiving intermediate care. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 11. Most of the care needs identified in the care plans were being met. Care was provided in a respectful manner. Medication was not being administered as prescribed. This was potentially putting service users health and welfare at risk. EVIDENCE: Personal care was observed to be offered in a caring and respectful manner. This was confirmed by service users, and relatives. Individual care plans were sampled. Some of the care plans did not contain adequate risk assessments, such as moving and handling and pressure sore risk assessments. The care plans must be signed by the service user or their representative as evidence that they have been drawn up in consultation with the service user. There was evidence that the care plans were reviewed regularly. All service users were registered with a GP, and had access to appropriate specialist health care services. It was of serious concern to note at the inspection that medication was not being recorded and administered correctly. A subsequent inspection by the CSCI specialist Pharmacy inspector was carried out on 11th August, when a Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 11 detailed inspection of all the medication policies and procedures was carried out. The findings of that inspection are included in the details below. There was evidence that service users had not received their prescribed medication after admission. An immediate requirement was made at the inspection of 2nd August. It was disappointing to note that there was continued non-compliance with this requirement at the subsequent pharmacy inspection of 11th August 2005 . Medication was not being administered in line with Nursing and Midwifery Guidelines and Pharmaceutical Guidelines, in that service users must be observed taking their medication before the chart is completed. Medication administration charts and controlled drug administration records were not adequately completed. It was disappointing to note that there was continued non-compliance at the subsequent pharmacy inspection of 11th August 2005 . There was no evidence that service users who were self medicating had had a risk assessment completed. Immediate requirements were made at inspection. It was disappointing to note that there was continued noncompliance at the inspection of 11th August 2005, and a further immediate requirement was made. All medication was stored securely for the protection of service users, in locked cupboards and drug trolleys within locked clinical rooms. Drug fridges were available on each unit and temperature monitoring records showed them to be operating within the correct range. Administration records were mainly handwritten as most service users were new to the home. Handwritten charts were not signed, checked nor dated. A recommendation was made that handwritten charts are signed, dated and signed by a member of staff who checks this record. At the inspection of 11th August Controlled Drugs cupboards were available on all units but had not been secured to the wall and did not therefore comply with The Misuse of Drugs (Safe Custody) Regulations 1973. A requirement was made. At the inspection of 11th August it was noted that when a variable dosage of medication was prescribed the actual dosage given was not being recorded. A recommendation was made. At the inspection of 11th August Corporate policies were seen. Some local procedures were available for storage, administration, supply, receipt, returns and errors. These would benefit from more detail to ensure a clear and consistent approach from the staff team Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 12 A further monitoring visit will be carried out in the near future by the lead inspector and pharmacy inspector, and continued non-compliance will result in the CSCI taking legal advice regarding enforcement action. The home has a policy for caring for the dying, and procedures to follow after the death of a service user. Currently there was only one member of staff with specific palliative care training, and a recommendation was made that staff should have specific training in caring for service users with a life limiting illness. The manager stated that support and guidance would be sought from the Marie Curie Association. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The activities provided by the home were varied, and stimulating. Service users were encouraged to maintain their interests. The dietary needs of the service users were being met with a varied and well balanced diet. EVIDENCE: There was an activities organiser in place. A programme of activities was displayed offering a range of pursuits, and service users spoken with were satisfied with the activities offered. Service users may receive their visitors at any reasonable time. The manager informed the Inspector that the home was intending to purchase a minibus so that the service users could be taken out on trips. The manager was also arranging visits from local church vicars and priests. The comments from the service users about the quality of the food were generally very positive. The food served on the day of the inspection was well presented and appeared nutritious. The dining tables were nicely prepared with napkins and tablecloths. The menu was displayed on all floors. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Service users generally felt satisfied with the complaints procedure. Service users were protected from abuse by the homes policies and procedures. EVIDENCE: The complaints procedure was displayed. Service users who were spoken to were confident that any concerns they expressed would be dealt with in a proper way. The complaints file was examined at inspection. There were no complaints in this file, and to date the CSCI has not received any complaints about the home. The homes vulnerable adults procedure protects service users, and some staff have attended vulnerable adults training. The date for remaining staff to attend had been arranged. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 The location and layout of the home was suitable for its stated purpose. The accommodation for the service users was very well presented. EVIDENCE: On the day of the inspection the second floor had been closed due to a water leak, and the intermediate care service users were being looked after on the ground floor. This did not cause any inconvenience to the service users. The Service users rooms were comfortable and very well furnished, and the standard of decoration and soft furnishings was high. The maintenance man had a programme of routine upkeep and maintenance. The grounds were well kept, and accessible for service users. Heating and lighting were satisfactory, and radiators were guarded. Water was delivered at a safe temperature, and checks were made regularly by the maintenance man. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 16 The premises were very clean. Staff were observed to carry out their procedures with good infection control measures, and wore gloves and aprons where appropriate. Laundry facilities were satisfactory. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 The staffing levels of the home were sufficient to meet the service users needs. The recruitment procedure was not being fully adhered to. EVIDENCE: The staff rota was examined at inspection. There were sufficient staff on duty to care for the service users. The Manager was aware that the staffing levels required constant reviewing as the home became more established and the number of service users increased. The recruitment procedure was not being fully adhered to, as not all the information required by Regulation was on every new staff members file, including 2 references, and evidence that a CRB disclosure had been applied for. The staff training records were examined at inspection. Further development of the training files is needed, as the Registered person was unable to evidence that all staff had received moving and handling training. Induction was in line with NTO (National Training Organisation) specification. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35,38 Policies and procedures were in place to ensure as far as possible the health safety and welfare of the service users EVIDENCE: Records were seen of financial transactions relating to service users, and were in order. A Fire drill log was kept, and records were seen of fire bell testing. The accident/incident book had been completed, and incidents reported to the CSCI as required by regulation. The home has appointed first aiders. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 x x 3 Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 20 NA Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 (2) Timescale for action All prospective service users With must have adequate information immediate about the home to enable them effect 2nd to make an informed choice. August 2005 Prospective service users must With have a pre-admission Immediate assessment to ensure that the effect 2nd August home can meet the assessed 2005. needs. Care plans must contain risk With assessments where appropriate. immediate effect 2nd August 2005 The Registered Person must With ensure that robust supply and immediate ordering systems are put in effect 2nd place so that service users do August not run out of medication and 2005. Not that adequate supplies are complied received on admission. Ensure with at that systems are in place so inspection that service users receive the 11th August medicines prescribed for them by 2005 their doctor. Inmmediat e requiremen t made. Ensure that the medication With administration records are immediate Version 1.40 Page 21 Requirement 2. 3 14(1) 3. 7, 8 15(1) 13(4)c 4. 9 12(1)(b) 5. 9 17(1)(a) Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc 6. 9 13(4) 7. 9 13(2) 8. 9 13(2) 9. 29 19(1)(b) 10. 30 18(1) signed when medication is given to service users in order that the records accurately detail what medication was given to the service users, and if medication is not given the reason why not is recorded When variable doses of medication are prescribed a record must be made of the actual dose given. All service users who hold and administer any of their own medicines must have a documented assessment of risk covering this activity. The Controlled Drugs cupboard must be correctly secured to a solid wall in order to comply with the Misuse of Drugs (Safe Custody) Regulations 1973.1 Clear and comprehensive procedures for the receipt, recording, storage, safe handling, administration, selfadministration and disposal of medicines, specific to the home, must be produced. The registered person must ensure that the recruitment procedure is adhered to, and all information required by regulation is obtained prior to employment. The Registered Person must ensure that staff receive appropriate training for the work that they are required to do. effect. 2nd August. Not complied with at inspection 11th August Immediate requiremen t made. 16th August 2005 8th September 2005 6th October 2005 With immediate effect 2nd August 2005 September 30th 2005 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 9 Good Practice Recommendations It is recommended as good practice that when it is H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 22 Tandridge Heights, Memorial Care Home 2. 9 3. 11 necessary to handwrite on a medication administration record chart in the home that the member of staff writing the chart signs and dates the chart and that a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescriber’s name. The registered person is strongly recommended to produce a clear care plan for each service user who is prescribed medication ‘to be given as needed’, to provide detailed instructions to staff as to when to give the medication. This will ensure that medication is administered in a clear and consistent way for the benefit of service users. It is recommended that Staff have training in caring for service users who have a life limiting illness or requiring terminal care. Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tandridge Heights, Memorial Care Home H58 H09 s62221 Tandridge Heights v242883 020805 Stage 4.doc Version 1.40 Page 24 - 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. 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