CARE HOMES FOR OLDER PEOPLE
Tapton Court Nursing Home 63 Tapton Crescent Road Crosspool Sheffield South Yorkshire S10 5DB Lead Inspector
Mrs Janis Robinson Unannounced Inspection 1st November 2005 09:00 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 Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tapton Court Nursing Home Address 63 Tapton Crescent Road Crosspool Sheffield South Yorkshire S10 5DB 0114 266 0648 0114 266 1345 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) Amocura Limited Ms Sheila Bacon Care Home 69 Category(ies) of Dementia - over 65 years of age (69) registration, with number of places Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home has 69 DE/E N (nursing care) beds of which 10 can instead be used for DE/E PC (personal care) 26th April 2005 Date of last inspection Brief Description of the Service: Tapton Court is a purpose built home situated in the Crosspool area of Sheffield. The home was first registered in 1996. The home provides nursing and residential care for up to 69 older people of both sexes with mental health problems. The home has easy access to local facilities, such as shopping centres, public houses and bus routes. The home is a two-storey building with a passenger lift, and is fully accessible to service users. Communal lounges and dining rooms are situated on each floor. All of the bedrooms are single, and all are provided with en-suite toilet facilities. Sufficient bathing facilities are in place. The home is served by a central commercial type kitchen and laundry. The home has a car park. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 7.5 hours from 8:30 am to 4:00pm. The inspector carried out an inspection of a proportion of the environment, sampled records, and observed interactions between staff and service users. Eight service users were spoken with, two of whom were able to share their views on living at the home. Two visitors to the home were spoken with. Discussions with the homes manager and the majority of staff on duty took place. What the service does well:
All of the comments made to the inspector were positive. Residents said the staff were ‘marvellous’ and “the home is well run”. A statement of purpose and service user guide were in place, to provide information about the home to prospective and existing residents. Contracts, statements of terms and conditions, were undertaken with each resident. Staff displayed an understanding of the needs of the resident group, both in interactions observed and during discussions. Care plans were in place for all service users, these set out in some detail the staff action required to ensure all aspects of care were met. Health care was monitored and needs met. Systems were in place to ensure the safe storage and administration of medication. The interactions observed between staff and service users appeared respectful. Choices were offered and the routines at the home were flexible. Service users were free to walk around the home. Visitors were welcomed at any time. Two visitors spoken with said they were ’very happy’ with the care their relative received. The homes menu was varied, and choices were offered. The home had a complaints procedure, to ensure any complaint was taken seriously. Residents were supported to obtain advocacy services, where needed. The staff spoken with were clear about Adult Protection procedures. The majority of the home was well decorated and well maintained, to provide a pleasant environment. Most service users bedrooms were individually personalised. Sufficient staff were provided to care for service users. Staff undertook periodic training to keep them up to date. Systems were in place to ensure Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 6 the safe storage and administration of resident’s monies. All of the people spoken with had confidence in the homes manager. What has improved since the last inspection? What they could do better:
The care plans contained a range of information. However, further detail on the staff action required to ensure assessed needs were met was needed. Records of dental appointments needed to be undertaken, to ensure all health care was monitored. Photographs were not kept for all service users. Residents were unable to control the heating in their bedrooms. The inspector acknowledges that a programme to commence the provision of these had been agreed during this inspection. Staff files did not evidence that gaps in employment history had been explored. The recommended 50 of the care staff team qualified to National
Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 7 Vocational Qualifications (NVQ) level 2 in care had not been achieved. Staff supervision, to develop and support individuals, did not take place at the required frequency. Some mandatory staff training was out of date. Staff training records had not been fully completed and were poorly organised. Staff were observed to mobilise some service users in wheelchairs without footplates in place. Fire drill records had not been completed in full. 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. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 8 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 Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 4 The home had a statement of purpose and service user guide, to inform residents and their representatives about the home. Contracts, statements of terms and conditions, were in place. Staff undertook periodic training to keep them up to date and access to specialist services was provided by the home, in order that all needs were met. EVIDENCE: Each resident and their representative had been provided with a service user guide and a copy of the homes statement of purpose, to inform him or her about the home. These contained the full range of information required. A copy was on display in the entrance area of the home, for general use. Individual contacts, statements of terms and conditions, had been undertaken. The resident or their representative had signed those sampled by the inspector. The contacts included all of the required information and specified the fees payable and by whom, the rights and obligations of both parties and the period of notice.
Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 10 The residents that were able to voice an opinion said the home met their needs. The visitors spoken with said their relative was “very well looked after”, and “the home keeps us well informed”. Access to relevant specialists was supported by the home. This was evidenced in care plans. Staff undertook periodic training to keep them up to date and equip them with the skills needed to care for residents. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Each resident had a plan of care. The care plans contained a range of information. However, detail on the staff action required to ensure assessed needs were met was not sufficient in some sections of the plans. Resident’s health care was met. Health care was monitored and care plans were reviewed on a monthly basis. Policies and procedures were in place to ensure medication systems were safe. Resident’s privacy and dignity was respected. Wishes regarding dying and death had been recorded. EVIDENCE: The inspector examined three care plans. Some sections of the care plans seen were comprehensive and contained detail of the staff action required to ensure needs were met, for example, methods of communication. Other sections of the plans sampled contained insufficient detail to inform staff how assessed needs were to be met. For example, two plans seen stated ‘staff assistance with washing and dressing required’. The plans did not set out how this was to be carried out. Resident’s photographs were in place in two of the three plans checked. The plans contained records of health assessments, such as moving and handling and pressure sores. Nutritional assessments were undertaken. Residents and visitors said that health care needs were met.
Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 12 Qualified staff administered medication. Medication was stored securely. Medication administration records were fully completed and up to date. The details recorded corresponded with the medication stored. Staff were observed to respect service users privacy by closing bathroom and bedroom doors. Staff were seen to knock on doors before entering. Residents preferred form of address was respected. Staff were seen to treat service users respectfully. Resident’s views regarding dying and death were sought, where possible, or this information had been obtained from relatives. These were recorded in the plans checked. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 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 the following standard(s): 13,14 and 15 Residents were enabled to make choices. The routines at the home were flexible and service users were able to choose how to spend their time, in line with health and safety and assessed risk, to maintain and improve the quality of life. The home had an open visiting policy, in order to develop and maintain good relationships with resident’s representatives. Contact with relatives and friends were supported. The homes menu was varied. EVIDENCE: Residents were seen to walk freely around the home. A visitor spoken with said ‘I am always made to feel welcome, and have no concerns at all about the care of my (relative), I am very happy with the care provided’. Staff supported service users choices, and were overheard to offer individuals choice of breakfast. Since the last inspection a new cook had been employed. The homes menu was varied and choices were offered. One resident spoken with said the food was ‘lovely’. Staff sat with the residents that required assistance with eating, and this support was given patiently and respectfully. The bedrooms seen contained personal possessions. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 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 the following standard(s): 16,17 and 18 The home had a clear and accessible complaints procedure, to ensure service users rights were protected and any concerns listened and responded to. Information on access to advocacy services was available. An adult protection procedure was in place, to ensure service users safety was promoted. EVIDENCE: The homes complaints procedure was on display in a communal area of the home. This contained relevant information and provided the reader with details of who to contact outside of the home, to ensure any complaints were taken seriously. The home kept a record of complaints. The home had not received any complaints since the last inspection. The staff spoken with were clear about the homes complaints procedure. Information on access to advocacy services was on display in the entrance area, stating the manager would support residents to access these if required. Staff training in abuse had been identified within the homes training plan, to ensure staff were able to protect residents effectively. Any allegations of abuse were responded to promptly. The staff, visitors and residents spoken with all stated that they had confidence in the homes manager to listen and respond to any concerns raised. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21,22,24,25 and 26 The home was clean and generally well maintained. Communal areas were homely, and well decorated. Sufficient bathing facilities were provided. The majority of bedrooms seen were well personalised, in line with the resident or their representatives’ choices. The heating system at the home did not meet the needs of residents. On the day of the inspection the home was free from offensive odours. Systems for the control of infection were in place. A lack of appropriate storage space was evident. A call system was available in all of the rooms used by residents. EVIDENCE: The inspector carried out an inspection of a proportion of the environment. The home was well decorated and well maintained, to provide a comfortable environment to residents. The home employed a handy person to help maintain the environment. A rolling programme of redecoration and replacement was in place. Several areas of the home had been redecorated. Two lounges had been redecorated and refurbished. Six bedrooms had been
Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 16 provided with new carpets. A proportion of bedrooms and the hairdressing room had been redecorated. Ten bedrooms had been provided with new tables. Bathrooms were not used to store equipment. A call point was available in the ground floor conservatory. Plans were in place to commence work on an upstairs conservatory the week after this inspection took place. The storage system at the home did not meet the needs of residents. Lack of appropriate storage space impinged on communal and individual space. The heating system at the home did not meet requirements; the level of heat could not be controlled in individual bedrooms. The homes laundry was sited away from food preparation areas. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, and 29 Sufficient staff were provided to meet the needs of residents. Some staff undertook NVQ training. Recommended levels of NVQ trained staff had not been achieved. The home had appropriate recruitment systems in place, however, records did not evidence that gaps in employment history had been explored. EVIDENCE: The homes rota evidenced that agreed levels of staff were being maintained. One resident spoken with said that enough staff were provided. Two visitors spoken with said they were happy with the levels of staff. Some staff undertook NVQ training. Four staff had achieved NVQ level 2 in care, and one care staff had achieved level 3 in care. A further five members of care staff were due to commence the training. This does not meet the recommended minimum of 50 of the staff team trained to NVQ level 2 in care. Discussions with the manager evidenced a recruitment procedure was in place. Two staff files were inspected. These contained all of the required documentation. Gaps in employment were evident in both files examined. The records did not evidence that these had been explored. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36,37 and 38 The manager’s leadership approach benefited staff and service users. Systems were in place to ensure resident’s monies were safely managed. Annual appraisals were taking place. Staff supervision systems required improvement, to ensure service users interests were maintained by best practice. Appropriate policies and procedures were in place. Records were stored securely. Health and safety systems were, in the main, maintained, to ensure residents were safe. Some mandatory staff training was out of date. Staff mandatory training records required improvement. One care practice observed did not promote residents safety. EVIDENCE: All of the staff spoken with said that the manager was approachable, supportive and a good listener. The manager evidenced that she had identified and prioritised areas for improvement, to enhance the service provided. The manager had completed NVQ level 4 in management and care.
Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 19 Resident’s monies were stored securely. The inspector examined two finance records, the amounts kept tallied with the records held. Informal supervision took place on a daily basis. However, formal staff supervision, to support and enhance staff skills, did not take place at the required frequency. A range of policies and procedures were in place to promote good practice and ensure resident’s needs were met. Staff had access to all of the homes policies. Records were securely stored. The equipment at the home was serviced and maintained. Fire records evidenced that weekly fire alarm checks took place. Staff training records were difficult to navigate and monitor. A proportion of records had not been fully completed. Fire drill training records had not been fully completed. Some staff mandatory training in food hygiene was out of date. A proportion of staff had undertaken training in first aid and the homes training plan evidenced that training in fire procedures and abuse had been organised to ensure all appropriate training had been undertaken. One member of staff was seen to mobilise a resident in a wheelchair without footplates in place. This practice could compromise the safety of the individual. Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 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 3 3 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 2 3 2 Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 21 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 Requirement Service user plans must contain specific detail on the staff action required to ensure all assessed needs are met. Photographs of service users must be kept. (Previous timescale of 31.07.05 not met) The organisation must identify and provide appropriate storage areas within the home. Written plans to provide bedroom radiators with thermostats must be undertaken, within the homes rolling programme. Records must evidence that gaps in employment history have been explored. Staff supervision must take place at the required frequency. (Previous timescale of 01.06.05 not met) An audit of staff mandatory training must be undertaken. Where training is identified as needed, this must be provided. All staff must be provided with food hygiene training.
DS0000021812.V262573.R01.S.doc Timescale for action 31/01/06 2 3 OP22 OP25 13 23 31/01/06 31/01/06 4 5 OP29 OP36 18,13 18 31/01/06 01/01/06 6 OP38 13 01/01/06 Tapton Court Nursing Home Version 5.0 Page 22 7 OP38 13 8 OP38 13 9 OP38 13 Staff training records must be maintained up to date and fully completed. A system to efficiently record and monitor staff training must be developed. Service users must not be transported in wheelchairs without footplates in place. (Previous timescale of 26/04/05 not met) Fire drill records must be completed in full. 31/01/06 01/11/05 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations 50 of the care staff should NVQ level 2 in care by 2005 Tapton Court Nursing Home DS0000021812.V262573.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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