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Inspection on 30/04/07 for Tang Hall

Also see our care home review for Tang Hall for more information

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff in the home had a commitment to providing person centred care. Staff were observed to be very caring and there was a relaxed atmosphere in the home. All residents spoken with said that they were happy with the home and the support they received from staff. One resident said "I get along with staff", another said "I enjoy it here, I like the staff". There was regular staff training and monitoring of staff competence. Residents were generally satisfied with the food and choices available. 2 relatives considered that the overall standards in the home had improved. One relative wrote a letter thanking the staff for caring for their mother "so lovingly" and for providing "wonderful care". The home had a stable workforce and one member of staff described the home as having a "very happy atmosphere".

What has improved since the last inspection?

The bathroom flooring had been replaced.

What the care home could do better:

Staff spoken with had an excellent knowledge of residents` individual needs and preferences, but on occasions they needed to provide more documentary evidence of this. The medicines management needed to be improved,however, the manager took action to address the issues raised immediately after the inspection. One relative considered that the environment for residents would be improved if some areas, in particular the main lounge, were redecorated. Suitable door locks and window restrictors need to be fitted in order to provide privacy for residents and to improve safety.

CARE HOMES FOR OLDER PEOPLE Tang Hall 18 Cottage Grove Bockings Elm Clacton On Sea Essex CO16 8DH Lead Inspector Francesca Halliday Key Unannounced Inspection 09:45 30th April – 2nd May 2007 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 Tang Hall DS0000045521.V338162.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. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tang Hall Address 18 Cottage Grove Bockings Elm Clacton On Sea Essex CO16 8DH 01255 421304 01255 423079 tanghall@abc-care-solutions.co.uk 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) Mr Raju Ramasamy Mr Inayet Patel Mrs Eroulla Filby Care Home 20 Category(ies) of Dementia (20), Mental disorder, excluding registration, with number learning disability or dementia (2), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (20) Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 65 years and over, who require care by reason of a mental disorder (not to exceed 20 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 20 persons) Two persons, under the age of 65 years, who require care by reason of a mental disorder The total number of service users accommodated must not exceed 20 persons Future admissions to the shared room must be as a result of active choice of service users to share a room 20th December 2006 Date of last inspection Brief Description of the Service: Tang Hall is a detached two-storey care home, situated in a quiet residential road in Clacton-on-Sea. The home is within walking distance of local shops and a few minutes drive from the town centre and the sea. The property has been extended several times but remains in keeping with the appearance of other houses in the surrounding area. Accommodation is provided on two floors, access to the first floor is by means of a passenger lift. The home has 18 single bedrooms and one double room; many of the rooms have en-suite facilities. Communal areas include a large lounge, dining room, small lobby and a quiet room set aside for meetings or private visits. There is a small and secure garden to the rear of the property, with access via patio doors from the dining room. There are parking spaces to the front of the property. The home charges between £367 and £500 per week with additional charges for toiletries, private chiropody and hairdressing. This information was provided to the commission in April 2007. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included a site visit on 30th June 2007 and a short second visit on 2nd May 2007 to conclude the inspection. A thematic inspection was carried out in December 2006, and reference is made to some of the findings in this report. The thematic inspection was a focused inspection, which looked at the quality of information given to people about the home, the assessment process prior to admission, the home’s complaints process and whether the contracts were fair. The information gained from the thematic inspection will help CSCI respond to the recommendations contained within the Office of Fair Trading market study “Care Homes for Older People in the UK”. Throughout this report the term resident has been used to describe people living in the home. 5 residents and 1 relative were spoken with during the inspection and 3 relatives were telephoned following the inspection visits. 5 staff including the registered manager were also spoken with during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Staff spoken with had an excellent knowledge of residents’ individual needs and preferences, but on occasions they needed to provide more documentary evidence of this. The medicines management needed to be improved, Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 6 however, the manager took action to address the issues raised immediately after the inspection. One relative considered that the environment for residents would be improved if some areas, in particular the main lounge, were redecorated. Suitable door locks and window restrictors need to be fitted in order to provide privacy for residents and to improve safety. 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. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 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 Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 not applicable) Quality in this outcome area is good. The home ensures that prospective residents are assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a range of information for potential residents and their representatives. The manager had carried out all the pre-admission assessments seen. They were of a satisfactory standard, and were used in conjunction with assessments from the Primary Care Trust when assessing the suitability of the potential resident for admission. The manager confirmed that a potential resident would not be admitted unless the home could meet their needs. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is good. Residents’ health and care needs are met. The manager is taking prompt action to improve medicines management. Residents are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives spoken with were very satisfied with the standard of care provided in the home. The care records sampled contained detailed assessments, and demonstrated that staff had a good understanding of residents’ individual needs and preferences. A discussion was held about ensuring that the care plans covered all needs and problems and staff took immediate action to address this. The daily care records were generally satisfactory but on occasions needed to provide more evidence that staff were monitoring residents’ psychological health on a regular basis. The home had a key worker system in place. Relatives said that they had good communication with staff about residents’ health and care needs. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 10 There was evidence that staff in the home acted as advocates to ensure that residents’ health needs were met both in the community and by referral to hospital when needed. The manager confirmed that the home had good support from local mental health services. Staff monitored the condition of residents’ skin and had an active programme to prevent pressure sores. Residents had access to regular chiropody, optical tests and dental checkups. Medicines management needed to be improved. There was no lock on the door of the room where medicines were being stored and the medicines trolley did not have an appropriate fixing to the wall. Following the inspection the medicines trolley was moved into the manager’s office until a lock could be fitted to the room where medicines were usually stored. There was not a clear audit trail for receipt, administration and disposal of medicines in the home. The manager confirmed that new systems were introduced following the inspection. The labels on a few medicines were not legible and one medicine had the label removed. The manager was advised to return these medicines to the pharmacist. A number of medicines with a limited shelf life on opening did not have the date of opening recorded on the bottle. One resident was self administering some of their medicines. Staff said that they monitored the resident but no documented risk assessment or formal system of monitoring was in place. Staff had purchased medicines as stock and retained medicines prescribed for residents as stock to be used for other residents. The administration of these medicines was not being recorded. Residents must only be given medicines that they have been prescribed. If the home wishes to have homely remedies in the home, for example for pain or indigestion, this must be agreed in writing with all residents’ GPs, be appropriately recorded and be covered by the home’s medicine policy. Clear instructions for care staff needed to be available for all medicines that could be given as required. Staff had been accepting verbal orders to initiate treatments with prescription only medicines, as a few GPs had refused to visit the home and examine the resident. The manager confirmed that this practice had ceased following the inspection. If a GP gives a verbal order for a change to an existing medicine, written confirmation of the change should be requested by fax. The manager had provided staff with information about the medicines used in the home. The manager took prompt action to address the issues raised during the inspection and confirmed that the quality assurance audit due to be carried out covered medicines management. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is good. The home has a range of activities for residents and links to the local community. Staff encourage residents to make choices and retain independence. Residents are satisfied with food offered in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff were involved in providing stimulation and activities for residents and there was a programme for each day of the week. Themed parties were held, birthdays were celebrated and on occasions Chinese takeaways were obtained for residents who wished to be included. Family and friends were encouraged to visit and said that they were made to feel welcome at the home. The home had links with the community and some residents had regular trips out of the home. Outside entertainers visited the home a few times a year and a religious service was held in the home each month. One of the carers was undertaking a National Vocational Qualification (NVQ) in activities for older people and confirmed that they would share the information with other staff in the home. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 12 Staff had a good understanding of residents’ individual needs and there was evidence that they tried to promote choices and independence. Staff gave a number of examples of how they were able to respond flexibly to residents’ individual needs. Residents spoken with were generally happy with the menu and the food provided. Residents were given a choice at mealtimes. There was evidence that staff were aware of their preferences and tried to find alternatives if they did not like what was on the menu. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 13 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): Standards 16, 18 Quality in this outcome area is good. The home has systems in place to respond to concerns and to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure. There was evidence that staff were reporting any residents’ concerns to the manager and that action was taken to address issues raised. All staff had received protection of vulnerable adults (POVA) training and the manager confirmed that staff were due to receive an update in the near future. Staff spoken with had an understanding of the different types of abuse that could occur and the action to take if any abuse was suspected or poor care observed. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 14 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): Standards 19, 26 Quality in this outcome area is adequate. The overall décor of the home is in a fair condition and some areas would benefit from redecoration. Locks and window restrictors need to be reviewed. The home is clean and odour free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ rooms had generally been personalised to reflect their interests and personality. One relative considered that some areas of the home, in particular the main lounge, needed to be redecorated as they looked “rather dark”. Some residents’ rooms did not have a lock on the door, and other locks were not of the type that could be easily used by residents and be accessible to staff in emergencies. One room on the first floor did not have window restrictors; the manager said that the windows would be locked until restrictors were fitted. A discussion was held about the quality of the Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 15 restrictors and whether a stronger type of restrictor would be more appropriate for the current client group. The home was clean on the day of the unannounced inspection and no unpleasant odours were noted. The cleaner had recently left and one of the carers was covering the work with some additional hours. The manager confirmed that soap dispensers and paper hand towel holders were in the process of being put up in all areas where carers would need to wash their hands. Staff spoken with were able to demonstrate an understanding of infection control. The laundry had an impermeable floor but the walls were not cleanable. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 16 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): Standards 27, 28, 29, 30 Quality in this outcome area is good. Recruitment processes are generally satisfactory. Staff are competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels at the time of inspection were 5 care staff from 08:00 to 14:00, 3 care staff from 14:00 to 22:00 and 2 care staff from 22:00 to 08:00. The manager was included in these numbers but had 15 hours of supernumerary time for administrative duties. Additional staff were employed for catering and cleaning. The records of three staff were examined. There was evidence of Criminal Records Bureau (CRB) and POVA list checks. The manager confirmed that two references were always requested and that all the required information was obtained prior to staff being offered a post. However, some of the information was missing from the files seen. The manager said that an audit of staff files would be included in the quality assurance audit (which was due to be undertaken soon after the inspection) and any shortcomings would be addressed. All care staff had either completed an NVQ or were overseas trained nurses waiting for their registration in the UK. There was a commitment to training in Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 17 the home, evidence that staff competence was monitored and that additional on the job training was provided when needed. The manager provided staff training on dementia care and confirmed that this covered the management of challenging behaviour. Staff also accessed training provided by the local primary care trust and community nurses. The home had an induction programme and ongoing training. However, the training did not formally cover the Skills for Care common induction standards. The manager was advised to use these standards as a basis for assessing competence of staff and for assessing the need for any additional training. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 Quality in this outcome area is good. The manager provides excellent leadership in the home. A quality assurance programme is being developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had completed the registered manager award. She had also undertaken additional training in dementia care and moving and handling to enable her to be the trainer for the home. The manager demonstrated a very high level of commitment to providing a person centred service. Staff said that they found her “very supportive”. Relatives considered that the standards in the home had improved and one relative described the manager as “very good”. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 19 The manager said that the proprietors had visited the home on a regular basis; however, no Regulation 26 reports had been completed since November 2005. The manager confirmed that an audit was due to be carried out as part of the new quality assurance programme for the home. There were appropriate systems in place to handle residents’ monies. The balances were correct in the sample seen and receipts were available for all transactions. The home had a training programme to ensure that staff all received training in safe working practices. The manager confirmed that there was always a member of staff with a first aid certificate on duty. The induction covered safe working practices and the majority of staff had received formal training. The manager was aware of the staff who required additional training or an update and said that this was being organised. Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13(2) Requirement The manager must ensure that there is a clear audit trail for all medicines, including medicines being self-administered, so that regular checks can be made on whether residents have received their prescribed medication. The manager must ensure that medicines are stored securely at all times so that there can be no access to the medicines by unauthorised persons. Suitable window restrictors must be fitted to all windows on the first floor for the safety of residents. Timescale for action 15/06/07 2. OP19 13(4)(a) 01/07/07 3. OP24 12(4)(a) Locks must be fitted to residents’ 01/08/07 bedroom doors, which are suited to their capabilities, are accessible in emergencies and provide them with some privacy in a communal setting. The quality assurance report must be sent to CSCI with evidence of the action taken to address any shortcomings DS0000045521.V338162.R01.S.doc 4. OP33 24 01/09/07 Tang Hall Version 5.2 Page 22 identified. 5. OP33 26 Monthly Regulation 26 reports must be completed in order to provide evidence that standards in the home are monitored regularly. 01/07/07 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 OP19 Good Practice Recommendations There should be a rolling programme of redecoration so that the environment is maintained in a good condition for residents living in the home. The walls of the laundry should be provided with a washable surface in order to reduce the risk of cross infection in the home. All information obtained during the recruitment process should be kept on file in order to provide evidence that the process was thorough and that residents are protected. The Skills for Care common induction standards and knowledge sets should be used as the basis for induction, in order to ensure that the induction is comprehensive. 2. OP26 3. OP29 4. OP30 Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tang Hall DS0000045521.V338162.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!