Inspection on 04/10/07 for Tandy Court

This inspection was carried out on 4th October 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tandy Court 12/03/09

Tandy Court 26/07/06

Tandy Court 07/12/05

Tandy Court 11/05/05

Tandy Court 11/11/04

Tandy Court 15/07/04

Tandy Court 23/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Tandy Court Tandy Drive Kings Heath Birmingham West Midlands B14 5DE Lead Inspector Amanda Lyndon Key Unannounced Inspection 4th October 2007 09:10 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 DS0000016916.V347182.R01.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. 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. DS0000016916.V347182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tandy Court Address Tandy Drive Kings Heath Birmingham West Midlands B14 5DE 0121 430 8366 0121 430 7581 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) Anchor.org.uk Anchor Trust Mrs Patricia Ann Jackson Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40), Old age, not falling within any other category (40), Physical disability over 65 years of age (40) DS0000016916.V347182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: currently under review 1. The home is registered to accommodate 40 adults over the age of 65 who are in need of care for reasons of old age, not falling within any other category 40 OP, physical disability over 65 years of age 40 (PD(E), dementia over 65 years of age 40 (DE(E) and Mental Disorder over 64 years of age 40 (MD(E). Minimum staffing levels must be maintained to at least 4 care staff at all times during the waking day. This must be increased at peak times to meet the needs of service users. This is in addition to the manager, deputy manager, plus catering, ancillary staff and activities coordinator. The automatic fire detection system is to be extended to the roof voids by April 2006. 26th July 2006 2. 3. Date of last inspection Brief Description of the Service: Tandy Court is a well maintained two-storey purpose built Home, which opened in 1985 and is situated in a quiet cul-de-sac in the South of Birmingham. The Home is situated close to shops, a public house, post office and public transport. It provides accommodation for 40 residents over the age of 65 years for reasons of old age, dementia, physical disability or mental disorder. All flats are for single occupancy and have an en suite toilet and kitchen facility. There is a bath or shower in thirty-seven of the en suite facilities. However the baths within the flats have low-level access and may not be suitable for all residents. In addition, there are communal assisted bathing facilities situated throughout the Home, which are suitable for all residents to use and a portable bath seat that may be used in the low-level access baths. Aids and adaptations are available to assist residents with physical disabilities and handrails are provided throughout the Home. Communal areas consist of a dining room on the ground floor, which leads out onto a patio area and secure well maintained garden which is also suitable for wheelchair users. There are three comfortable lounges providing a choice of sitting area for residents. There is adequate off road parking to the front of the Home. Notice boards display any forthcoming events, CSCI reports, newsletters and other information of interest to residents and visitors. The weekly fee to live at Tandy Court is £457. Items excluded from the fee include private chiropody, hairdressing and personal toiletries. DS0000016916.V347182.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of our inspection is upon outcomes for people who live in the Home and their views of the service provided. This process considers the Care Home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving residents and one complaint received since our last visit. The Registered Manager had completed a self- assessment document, giving some information about the Home, including information about residents and staff which was also taken into consideration. Prior to the visit questionnaires had been sent to residents and their relatives and the feedback obtained was mainly positive including, “I would not hesitate to recommend Tandy Court” “The care home has supported the family and Mom well. They have made a sometimes difficult time easier” “Food is good, washing and dressing is good, most of the carers talk to Mom nicely and spend time talking to her, she feels valued”. “They let people live as normal a life as possible”. A small number of negative comments were received including, “Care staff at times seem very busy and occasionally additional staff may be helpful” “There has been the rare occasion when requests for support with hearing and glasses etc has taken a while to happen”. “Not sure whether any Christian Ministers/Vicars come to talk, pray or give communion to Mom?” The field work visit referred to in this report was undertaken over one day by one Inspector when there were thirty seven residents living at the Home, one of these was in hospital. The Home was not aware that we were visiting. Information was gathered by speaking with seven residents, one visitor, the Registered Manager, the administrator and five care staff. An additional method of obtaining information was “case tracking” two residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on their outcomes. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand the experiences of residents. No immediate requirements were made on the day of the visit DS0000016916.V347182.R01.S.doc Version 5.2 Page 6 What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to sample what life would be like to live there. One resident who had recently come to live at the Home said “I have been here a few weeks and I am settling down. My sons came to have a look around after they had got the details off the internet. I then came to see it here”. Residents are involved in the planning and reviewing of their care so that they should receive support in the way that they prefer. Residents have access to a wide range of health and social care professionals so that their health care needs are met. Residents are accompanied by the Home’s staff should they need to attend hospital appointments if family members are not available. One relative said “If I cant go with Dad to a hospital appointment a carer goes with him.” In order to ensure that the Home could continue to meet individual residents’ care needs, re assessments are undertaken prior to residents returning to the Home following hospital admissions. One relative said “ The staff came out to the hospital to reassess Dad before he came back here”. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained The staff team have a good knowledge about residents’ individual care needs and staff approach residents in an understanding and sensitive manner so that residents feel calm, confident and relaxed. Details of forthcoming events are on display in the Home so that residents can choose which activities they want to participate in. One resident is involved in producing an interesting newsletter and there are activities available for residents who are unable to join in group activities. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the Home and residents can choose where they spend their day and where they are served their meals. Residents are supported to form friendships with each other so that they can share their experiences. One resident said “I love it here, no enemies here, only friends”. DS0000016916.V347182.R01.S.doc Version 5.2 Page 7 Visitors are made to feel welcome at the Home and are encouraged to spend time there. Residents are served a variety of healthy meals that meet any special dietary requirements for reasons of health, cultural background or taste. One resident said “I enjoy all my meals here. Occasionally I have a cooked breakfast but not every day. The food is served lovely to us and the staff come and tell us what the choices are”. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. The gender mix of care staff reflects the gender mix of residents so that care is provided in an understanding manner. Comprehensive staff training is provided so that staff should have the appropriate skills and knowledge to work safely and effectively in order to provide a good standard of care to residents. Residents and their relatives are invited to group meetings in order to put their views forward about the services provided at the Home. One resident said “Sometimes I go to the residents meetings to find out what’s going on or what is going to come on”. There is a facility for the safekeeping of small amounts of residents’ money should they choose to use this facility. What has improved since the last inspection? There is a rolling programme of redecoration and refurbishment at the Home so that residents are provided with an attractive, clean, safe and comfortable place in which to live. Medication is stored safely so that the risk of it being swallowed by the wrong resident is reduced. Residents have been consulted about activities outside of the Home and there is now a wider choice of activities for residents to participate in. A “happy hour” has been introduced each afternoon providing residents with an opportunity to socialise together. DS0000016916.V347182.R01.S.doc Version 5.2 Page 8 Residents and their families are encouraged to put forward suggestions about how the Home is run and they are informed about what actions have been taken by the Home in order to address any issues raised. Residents’ clothing, bed linen and commode pots are washed in a hygienic manner so that the risk of infection occurring in the Home is reduced. Net bags have been obtained so that residents’ personal laundry is washed separately so that the risk of laundry becoming mixed with that of other residents’ is reduced. Extra staff are being allocated and minimum staffing levels are being maintained so that residents should be cared for by an adequate number of staff. A resident’s relative said “The staff all know me, they are smashing, just like family. My dad loves it here”. What they could do better: Each resident must have a personalised plan of care outlining the specific support required by staff in order to meet their care needs based on their personal preferences in respect of their daily lives, their health and their abilities. Personal risk assessments must be written in order to ensure that residents lead safe and fulfilling lives. Staff must ensure that residents receive their medication at the times that they require so that they receive any treatments as prescribed. Residents should be supported to keep their finger nails clean and of a suitable length in order to promote their health and dignity All new residents should be informed about the opportunities available for religious worship so that they can continue to practice their chosen religions whilst living at the Home. One resident said “I read my Parish book every morning. I would like a visit from the Priest as I’ve been used to having Holy Communion each week. I have spoken to the Catholic staff about it but nothing has happened”. All incidents of a possible adult protection nature must be reported to the appropriate authorities without delay in order to protect residents. Written evidence should be available at the Home to confirm that all new workers have a satisfactory criminal records check in order to safeguard residents. A fire drill should be arranged so that staff have the necessary skills and knowledge to act safely in the event of an emergency. DS0000016916.V347182.R01.S.doc Version 5.2 Page 9 On occasion, communication between the internal management team must improve in order to ensure the best outcomes for residents living at the Home. 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. DS0000016916.V347182.R01.S.doc Version 5.2 Page 10 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 DS0000016916.V347182.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and prospective residents have enough information in order to decide whether they would like to live at the Home. Residents know before admission and during their stay that the Home can meet their care needs. EVIDENCE: A comprehensive statement of purpose and service user guide had been produced and these were available for residents to refer to. These were produced in an easy to read, large print format and included information about the services provided at the Home and what residents could expect if they DS0000016916.V347182.R01.S.doc Version 5.2 Page 12 came to live there. One resident who had recently come to live at the Home stated that he had read the brochures and had found them to be very useful. Prior to coming to stay at the Home, senior staff visit all prospective residents and undertake initial assessments of their individual care needs to ensure that these could be met at the Home, to prevent unsuccessful trial visits there. Following this, prospective residents and their families are encouraged to visit the Home and spend time there in order to sample what it would be like to live there. During this time comprehensive pre admission assessments are undertaken in order to determine whether their individual care needs could be met at Tandy Court. One resident who had recently come to live at the Home said “I have been here a few weeks and I am settling down. My sons came to have a look around after they had got the details off the internet. I then came to see it here”. Residents come to live at the Home on a six week trial period and during this time a care review is held involving the resident, their family, key worker and social worker (if the resident is not privately funded). This provides all present with the opportunity to put forward their views about whether the residents’ care needs are being met at the Home and whether they wish to remain there. Within the new care planning system residents are given the opportunity to plan for their care review by recording their thoughts on a questionnaire. Any issues raised will then be discussed during the review. One resident was due to have his care review on the day of our visit however he had not been given a questionnaire to complete. This was brought to the attention of the Registered Manager who confirmed that she would address the importance of this with the staff team. It was noted, however that questionnaires had been completed by other residents prior to their care reviews. In order to ensure that the Home could continue to meet individual residents’ care needs, re assessments are undertaken prior to residents returning to the Home following hospital admissions. One relative said “ The staff came out to the hospital to reassess dad before he came back here”. DS0000016916.V347182.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision is generally good however inconsistencies of the content of care plans and personal risk assessments may prevent residents from receiving care in the way that they prefer and require. Systems in place should now ensure that residents receive their medication in a safe manner at the times that they require. Residents are cared for in a respectful manner and this ensures that their self esteem and dignity are maintained. EVIDENCE: In order to provide person centred care, a new care planning system is being introduced at the Home and staff have had training in this area. Currently there are twelve residents for whom their care plans are of the new format and during the visit we sampled both the new and old format. A care plan is a DS0000016916.V347182.R01.S.doc Version 5.2 Page 14 written plan identifying what individual residents can and can’t do for themselves and the support that is required by staff in order to meet their care needs in the ways that they prefer. On admission to the Home a “baseline assessment” is completed. This is to identify any changes in residents’ care needs since the pre admission assessment was completed. Following this there is a number of separate assessments to be completed for each resident, including a psychological/emotional assessment, mobility assessment and dietary assessment. Not all of these had been completed, however it was noted that information omitted from one assessment was available on another assessment. Care plans were then derived from this information and there was evidence that residents were involved in the writing and reviewing of these so that they should receive care and support in the ways that they prefer. A number of care plans included good detail of the specific support required by staff in order to meet residents’ individual care needs, however others had not been personalised to reflect the wishes/abilities of individual residents. A number of care plans had not been writing for a resident who had come to live at the Home four weeks prior to our visit despite it being identified in his assessment that he had lost weight, was hard of hearing and had poor eyesight. Personal risk assessments had been undertaken and it was evident that there was some confusion about the writing of these amongst the staff team. Some risk assessments did not identify what the actual risks were or actions required by staff and were written as a care plan instead of a risk assessment. There was no written evidence available that the staff team had monitored the progress of a resident who had recently been discharged from hospital, despite her having follow up care. Her care plans had not been updated and personal risk assessments had not been reviewed and this may prevent her from receiving the care that she requires at a vulnerable time. Care reviews are undertaken every six months so that residents and their families have the opportunity to discuss the care that they are receiving and put forward any suggestions for improvements if necessary. Residents have access to a range of health and social care professionals including district nurses, community psychiatric nurses, opticians and dieticians. Residents are able to retain their own Doctor on admission to the Home (if the Doctor is in agreement). One resident said “ I have a new Doctor since coming here, I am having my flu jab in a couple of weeks”. Residents are accompanied by the Home’s staff to attend hospital appointments if family members are not available. One relative said “If I cant go with dad to a hospital appointment a carer goes with him.” DS0000016916.V347182.R01.S.doc Version 5.2 Page 15 Residents appeared to be supported to maintain their personal hygiene and choose clothing suitable for their age, gender, culture and the time of the year. An exception to this was that two female residents had long and unkempt finger nails and were in need of attention in this area. Since our last key visit there have been two incidents that have resulted in residents receiving the wrong medication and this is of serious concern. On both occasions residents did not suffer any ill effects as a result of these and work practices have since been reviewed. There have been no concerns of a similar nature recently. There is a comprehensive system in place for the auditing of the medication system and this should ensure that residents are receiving their medication as prescribed. Stock balances of the majority of medicines sampled of the day of the visit were found to be correct. An exception to this was that one medicine had been signed for when not administered and this confirms that a resident had not received their medication as prescribed. The system in place for the ordering and receipt of medication was good and medication administration charts (MAR) were generally well maintained. It was noted that remedial action was required in respect of the drugs storage room floor and wall as they were in need of repair. The preferred names of residents were recorded within their care plans and this should ensure that they are greeted by their preferred names. Some residents have chosen to have a private telephone line in their flats however there is also a pay phone available for residents’ use. A number of residents had chosen to have the key for their flat doors and this ensures that their privacy is maintained. One resident stated that there was a problem getting a key for his door despite his request for one. This was brought to the attention of the Team Leader and acted upon without delay. Residents receive their post unopened through their own letterboxes and residents confirmed that staff always knock on their doors prior to entering their flats. DS0000016916.V347182.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities on offer and opportunities for social stimulation meet the needs and expectations of residents living at the Home. Failure to consult with residents about their religious preferences may result in their needs not being met in this area. There are good systems in place to ensure that relatives have up to date information regarding residents’ care. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. EVIDENCE: A part time activities organiser is employed at the Home and in addition all staff are responsible for arranging activities at other times. Since our last visit residents had been consulted about short trips outside of the Home and efforts had been made to ensure that person centred activities are provided. Two DS0000016916.V347182.R01.S.doc Version 5.2 Page 17 residents had requested to go horse racing, and this had been recently been arranged. Other trips included afternoon tea at a local farm, a trip to the garden centre and plans are in place for a number of residents to go to “Walsall Lights”. A small number of residents choose to go out shopping on their own, however friends, families and staff accompany other residents on shopping trips. Residents are encouraged to participate in a range of “in house “ activities and a “Happy Hour” has recently been introduced. This provides residents with the opportunity to socialise with other residents and staff each afternoon, if they choose to do so. Other activities include coffee mornings, physical activity classes, library books, a knitting circle and residents’ birthdays are celebrated. One resident said “I enjoy reading my library books and now that I can walk again, I enjoy walking outside within the grounds. I use the quiet room to read my book”. One resident has recently become involved in writing a newsletter and this will be a source of information for residents, visitors and staff alike. Time is spent with residents who are unable to join in group activities. The activities organiser said “There are lots of one to one sessions here, we go to residents rooms”. Following a request made by residents, a dog “Lucky” has recently come to live at the Home. The Home is registered with The Cinnamon Trust, a national charity for the elderly and their pets. One resident said “I haven’t been to a group meeting yet but I have made one or two good friends. The activities lady came to speak to me”. Another resident said “I love it here, no enemies here, only friends”. Residents’ preferences regarding their religion are supported and respected and the staff can arrange transport and escorts to enable residents to maintain contacts with their places of worship. Church services and Holy Communion is held at the Home regularly however one resident was not aware of this despite expressing a wish to be visited by a Priest. One resident said “I read my Parish book every morning. I would like a visit from the Priest as I’ve been used to having Holy Communion each week. I have spoken to the Catholic staff about it but nothing has happened”. This was brought to the attention of the Registered Manager who promptly went to speak to the resident in order to make suitable arrangements in this area. Prior to the visit one relative stated that she wasn’t sure whether her Mother’s religious needs were being met at the Home. She said “ I am not sure whether any Christian Ministers/Vicars come to talk, pray or give Communion to Mom?” There is an open visiting policy at the Home and visitors confirmed that they are made to feel welcome there. Since our last visit ways to improve communications between residents’ family and friends and the Home’s staff have been introduced. This included a “relatives social evening” so that any future developments of the Home could be discussed and the staff had the opportunity to meet with relatives that couldn’t visit during working hours. In DS0000016916.V347182.R01.S.doc Version 5.2 Page 18 addition a survey had been sent to all relatives in order to obtain their views about the services provided at the Home and a report based on the findings of this had been produced. The analysis identified that all visitors were greeted by staff in a polite and courteous manner, most were offered refreshments and most knew who to speak to if they had any concerns. 50 said that they were not aware of residents’ meetings, therefore the “relatives’ meeting was arranged. A “catering questionnaire” had been distributed to all residents earlier this year in order to obtain their views about the meals provided at the Home. A report based on the findings of these had been produced in a large print format so it was easy to read for residents with poor eye sight. The results are to be discussed during the next residents’ meeting. The analysis identified that 91 of residents felt that staff spent time to sit, talk and assist at mealtimes, 27 enjoyed breakfast most and 86 were offered an alternative to the menu. The menus had been reviewed in response to suggestions made by residents and copies of these were on display in the dining room and main reception. Menus identified that residents were offered a choice of nutritious and wholesome meals that reflected their tastes and cultural backgrounds. Special diets could be arranged for reasons of health and religion. Staff had a good understanding of residents’ preferences regarding their food or any special requirements/ food allergies that they may have. Following assessment, a number of residents were having additional calories added to their food and nutritional “milkshakes” in order to boost their nutritional intake. A cooked breakfast is available at least twice a week and there are no rigid times for this to be served. There are both hot and cold meal options at tea time and a snack meal is available at bed time and during the night so that residents are not hungry. The main meal choices on the day of the visit were either roast beef or roast chicken with stuffing and mixed vegetables, Yorkshire pudding and potatoes. A choice of fresh fruit, rice pudding, trifle or ice cream was available for dessert. Lunch was served by the Chef from a hot trolley in the dining room so that residents could see the food on offer before choosing. Staff were available to assist residents with their meals in a sensitive manner, dining tables were laid attractively, residents were encouraged to serve their own gravy, sauces, cold drinks and there was good social interactions amongst residents and staff during this time. Plate guards were being used by a number of residents in order to promote their independence during their meal and maintain their dignity. Residents have the option of being served their meals in the dining room or tray service to their flats. One resident said “I like to have my meals in the dining room”. Another resident said “I enjoy all my meals here. Occasionally I have a cooked breakfast but not every day. The food is served lovely to us and the staff come and tell us what the choices are”. DS0000016916.V347182.R01.S.doc Version 5.2 Page 19 A “Catering Comments Book” was available in the dining room and this included many positive comments about the food provided including “Prawn curry was very tasty, makes a nice change” “Fish was marvellous” DS0000016916.V347182.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are confident that any concerns raised are acted upon for their benefit. There are systems in place that should protect residents from harm however a failure to follow procedures on one occasion may have placed a resident at risk of harm. EVIDENCE: A number of “Thank You” cards were on display in the Home and a number of compliments were recorded within one of the “Comments Books” located around the Home. A residents’ Doctor had recently made an entry into the book praising the staff about the good care provided at the Home. A “Suggestions Box” is located outside the dining room. This was last opened on 28/09/07 and a report was produced and displayed identifying the actions taken/or to be taken in response to the two suggestions made. The complaints procedure was on display in a large print format for residents and their visitors to refer to if they needed to make a complaint. DS0000016916.V347182.R01.S.doc Version 5.2 Page 21 The “Comments, Compliments and Complaints Book” identified that the Home had received nine complaints or concerns since our last visit and a written record of actions taken in response to these was available. These included issues regarding the cleanliness of a resident’s flat, poor communication between staff and a relative and alleged thefts of residents’ money. In all cases the appropriate actions had been taken by the management team to the satisfaction of the people raising the concerns. In addition, we have received one concern about Tandy Court since our last visit and this was regarding poor communication between the Home’s staff and a prospective residents’ relative. This was referred to the Provider to investigate and all appropriate actions had been taken by the Home’s management team regarding this. There is a rolling programme of staff training regarding adult protection in place and this was found to be up to date. Staff met during the visit appeared to have a good understanding of adult protection procedures however it was of concern that the appropriate authorities had not been notified of one incident of a possible adult protection nature involving a resident. This may not protect residents from harm, however there was evidence that this was a “one off” lapse in procedures arisen from poor communication between the senior staff team. The Registered Manager advised that work practices would be reviewed as a result of this in order to prevent an incident of a similar nature occurring again. DS0000016916.V347182.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a clean, safe and secure living environment in which they feel relaxed and their privacy and independence are promoted. Residents are involved in decisions about improvements regarding their living environment and they are confident that their suggestions are acted upon. Aids and adaptations provided meet the needs of residents. EVIDENCE: DS0000016916.V347182.R01.S.doc Version 5.2 Page 23 Work is currently ongoing to upgrade the garden and build a new patio area giving residents safe access to the grounds. New garden furniture has been ordered for this area and residents are involved in the planting of flowering bulbs. Since the last visit a number of flats and communal areas of the Home have been decorated to improve the living environment for all residents. Corridors and doors have been colour coded to assist in orientating residents who have dementia. New lounge furniture and carpets have been purchased and residents were involved in choosing these. Plans are in place for SKY and digital television to be installed. There are a choice of lounges and sitting areas for residents and these are comfortable and decorated in homely styles. Residents met during the visit confirmed that they were happy in these areas. There are a number of aids and adaptations provided to promote the independence of residents whilst maintaining their safety. Handrails were available in corridors and near to toilets, raised toilet seats were provided as required and there was suitable hoisting equipment to assist residents with impaired mobility in order to safeguard both residents and staff. Professional advice was being sought in respect of one resident who required a specialist sling to be used with the transfer hoist. Appropriate pressure relieving equipment was available for those residents deemed to be at risk of developing sore skin due to their limited mobility. Residents generally provide their own furniture and furnishings for use within their flats and these were decorated to reflect the tastes and interests of individual residents. Each flat had an en-suite facility consisting of a toilet, wash hand basin, low-level bath or shower and a small kitchen area. One resident met during the visit stated that he had been advised by the staff that he could not use his en suite shower facility and this had been ongoing for a long period of time. This was brought to the attention of the team leader who confirmed that the en suite flooring had been replaced, however the glue should now be dry and the facility could be used. A call bell was located in each flat for residents to use if they require assistance from staff and this ensures that they feel safe and secure in their surroundings. A new fire alarm system had been installed in the Home and this included a light sensor in order to notify people with impaired hearing that the fire alarm had been activated. Following risk assessments, residents are able to smoke in their flats, however staff and relatives are only permitted to smoke outside in designated areas in order to safeguard residents. One resident had requested to move to a flat on the first floor of the Home and the staff had arranged for this to happen. The Home was found to be clean and fresh on the day of the visit. Hygienic hand washing facilities were suitably located throughout the Home and residents were satisfied with the standards of cleanliness in their flats. DS0000016916.V347182.R01.S.doc Version 5.2 Page 24 A hygienic system for the cleaning of residents’ personal clothing and bed linen was in place. Individual net bags had recently been obtained in order to reduce the risk of residents’ clothing becoming mixed up during the laundry process. Three residents choose to use a commode during night time hours and since our last visit an infection control procedure has been written in respect of the hygienic manual cleaning of these in order to protect staff and prevent the spread of infection at the Home. DS0000016916.V347182.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are generally supported by an adequate number of appropriately recruited and trained staff so that they should receive care and support at the times that they require. Systems in place for staff consultation should continue to improve staff moral at the Home. EVIDENCE: The Registered Manager stated that extra care hours are planned within the next budget year for the Home in order to ensure that residents receive person centred care. In addition she has requested that a housekeeper is employed on alternate weekends to ensure that the Home is kept clean and fresh during these times (although no concerns have been raised regarding cleanliness at these times). The Registered Manager stated that there are four care assistants and one team leader on duty during day time hours and 2 waking night staff with on call support from senior and management staff. Housekeeping and laundry DS0000016916.V347182.R01.S.doc Version 5.2 Page 26 staff provide ancillary support during week days and a laundress is on duty during weekends. Since our last visit a “Bank” of temporary staff has been developed in order to cover periods of staff sickness and holidays so that the Home should not be short staffed. Agency staff are not used and this should ensure continuity of staff for residents. There are few staff vacancies and the gender mix of the staff team reflects that of residents so that care and be provided in an understanding manner. One resident said “The staff are attentive and help me every time that I want to have a bath”. A resident’s relative said “The staff all know me, they are smashing, just like family. My Dad loves it here”. Staff met during the visit appeared to be happy within their job roles however a staff satisfaction survey had recently been undertaken in order to obtain their views about working at the Home and what could be done to improve their working lives. A report based on the findings of the surveys had been produced and the feedback was mixed in nature. Some staff did not feel supported or valued within their job roles. As a result of this, the feedback was discussed during the most recent staff meeting and ways to improve staff moral were discussed. Suggestions made by staff were put in the “Suggestions Box” and acted upon for the benefit of staff and residents. Prior to the survey, “Thank you letters” had already been sent to individual staff members praising them for their hard work in order to recognise good practice. Staff recruitment files contained the majority of information required by regulations with the exception that we were unable to check the outcome of criminal record checks for new workers as written evidence of this was not available at the Home. There was, however, evidence that a satisfactory protection of vulnerable adults check had been obtained for new workers prior to commencing employment at the Home and the management team advised that enhanced criminal record checks had been undertaken for all workers. Pre employment health declarations are undertaken for all new workers however risk assessments had not always been undertaken in response to information derived from these. These should be undertaken as deemed necessary in order to protect the health and safety of both residents and staff. Staff undertake comprehensive training specific to their job roles and a rolling programme of training in mandatory areas was found to be up to date. All new workers undertake comprehensive induction training so that they should have the necessary skills and knowledge to work in a safe manner. 70 of care staff have achieved a minimum of a NVQ Level 2 in Care Award and other staff members are currently working towards this and NVQ Level 3. Other recent staff training included dementia care, end of life, accredited medication training, diabetes, accident reporting, tissue viability and nutrition. DS0000016916.V347182.R01.S.doc Version 5.2 Page 27 Fire safety records identified that not all staff had participated in a fire drill this year and this must be arranged so that all staff have the appropriate knowledge to act safely in the event of a fire. DS0000016916.V347182.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is generally run in the best interests of the residents living there, however poor communication between the internal management team may prevent best outcomes for residents on occasion. The systems in place for quality monitoring and resident consultation are good so that residents are involved in the running of the Home. Residents’ health and safety is protected by regular maintenance checks of equipment used at the Home. EVIDENCE: DS0000016916.V347182.R01.S.doc Version 5.2 Page 29 The Registered Manager has had much experience of working within a managerial role in a care environment and she holds appropriate qualifications in both management and care. The Deputy Manager has had much experience in working at Tandy Court and has taken the lead in respect of staff training, as well as other designated responsibilities. The Administrator had a good knowledge of her job role. It was apparent that there were clear lines of accountability between the senior staff team, however this requires further consideration in order to ensure that the Registered Manager is aware of all accidents and incidents involving resident at the Home. Quality monitoring visits are undertaken by External Senior Managers on a regular basis and reports of these visits were available. Residents and staff are involved in these visits in order to discuss their experiences of living and working at the Home. Residents’ meetings are held regularly and a copy of the minutes of these are distributed to all residents, including those residents that could not attend. The most recent group meeting was an impromptu meeting to update residents on the grant the Home had received from Birmingham City Council for improving the garden so that residents could be involved in this. One resident said “Sometimes I go to the residents meetings to find out what’s going on or what is going to come on”. In addition to resident, relative and staff questionnaires, a formal comprehensive annual quality monitoring audit is undertaken by an external source on a annual basis and a report based on the findings of this was included in the service user guide. As previously agreed with us, residents’ personal allowances are paid into one general bank account and individual electronic and paper records of this are maintained. The policy for the safekeeping of residents’ money was on display so that residents could choose whether they wanted to use this facility or not. A “Safe Site Award” had recently been undertaken at the Home to ensure that the Home was a safe place for residents to live in. Maintenance checks of equipment are undertaken so that they are safe to use. DS0000016916.V347182.R01.S.doc Version 5.2 Page 30 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 3 DS0000016916.V347182.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? yes 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) Requirement Each resident must have a care plan outlining the specific support required by staff to meet their current care needs so that they receive care in the way that they prefer. (time scale of 30/09/06 not met) 2. OP7 13(4) 15(1) Each resident must have a written plan outlining risks specific to their daily lives and the support required by staff in order to maintain their safety. Systems must be in place to ensure that residents receive their medication at the times that they require. Systems must be in place to ensure that all appropriate authorities are informed about any incidents of actual or possible abuse in order to protect residents from harm. A fire drill must be arranged so that staff should have the necessary skills and knowledge to act safely in the event of a fire. DS0000016916.V347182.R01.S.doc Timescale for action 05/10/07 31/12/07 3. OP9 13(2) 10/11/07 4. OP18 13(6) 10/11/07 5. OP30 23(4) 30/11/07 Version 5.2 Page 32 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. 2. 3. 4. 5. 6. Refer to Standard OP8 OP9 OP12 OP29 OP29 OP31 Good Practice Recommendations Attention must be given to ensure that residents are supported to keep their finger nails clean and of a suitable length in order to promote their health and dignity. Remedial action should be taken so that the medication storage room is in an acceptable state of repair for it’s purpose. All residents should be provided with the opportunity to practice their chosen religions whilst living at the Home. A system for risk assessing the health of staff members should be developed in order to protect both residents and staff. Written evidence should be available at the Home to confirm that all new workers have a satisfactory criminal records check in order to safeguard residents. A review of the systems in place for communication within the internal management team should be undertaken in order to provide the best outcomes for residents. DS0000016916.V347182.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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