CARE HOMES FOR OLDER PEOPLE
Tapton Court Nursing Home 63 Tapton Crescent Road Tapton Sheffield S10 5DB Lead Inspector
Janis Robinson Unannounced 26 April 2005 9:00
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Tapton Court Nursing Home Address Tapton Court 63 Tapton Crescent Road Crosspool Sheffield S10 5DB 0114 2660648 0114 2661345 None Amocura Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sheila Bacon N Care Home with Nursing 69 Category(ies) of DE (E) Dementia - over 65 (69) registration, with number of places Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: This home has 69 DE/E N (nursing care) beds of which 10 can instead be used for DE/E PC (personal care) Date of last inspection 2 November 2004 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 J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven hours from 8:45 am to 3:45pm. The inspector carried out a tour of the environment, sampled records, and observed interactions between staff and service users. Ten service users were spoken with, two of whom were able to share their views on living at the home. One visitor to the home was spoken with. Two staff were interviewed, and discussions with the homes manager and eight other staff took place. What the service does well: What has improved since the last inspection?
Since the last inspection the majority of previous requirements had been met. Care plans had been updated to include the signatures of staff recording entries. The services of a dentist had been identified and visits to service users had commenced, to ensure all aspects of health care were undertaken. Service users and staff confirmed that drinks were offered to service users
Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 6 upon rising, and condiments were available in dining rooms, to provide choice to service users. The homes menu was being updated to include more choices and reflect service users preferences. A humidifier had been provided in a conservatory, to improve ventilation. Further air fresheners had been put in place to eradicate odours. One lounge and several bedrooms had been redecorated to improve the environment. Enhanced Criminal Records Bureau checks were being undertaken for all staff, to ensure comprehensive and safe recruitment procedures were followed. The manager had identified some staff training needs in order that staff had the necessary skills to undertake their duties. First aid training had taken place, and further training in fire procedures and moving and handling had been booked. The manager had commenced individual appraisals for all staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4, standard 6 is not applicable at this home. Assessments prior to admission took place for all prospective service users, to ensure the home could meet all of the assessed needs of the individual. The home did not offer places to any individual whose needs they could not meet. Staff demonstrated a clear understanding of service users complex needs. EVIDENCE: Full needs assessments, to ensure the home could meet identified needs, were in place in the three files checked. These had been carried out by the homes manager. The manager visited prospective service users in their own homes, or in hospital, to carry out the assessment. For those service users with care management, a full needs assessment had been obtained prior to admission. These were in the relevant files sampled. Staff interviewed could give examples of good practice, with particular regard to communicating with people with complex needs. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 and11 Each service user 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. Some sections had not been completed. Service users health care was met. Health care was monitored and care plans were reviewed on a monthly basis. Service users privacy and dignity was respected. Service users wishes regarding dying and death required recording, to ensure these were carried out. 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. One plan seen set out very specifically the action required of staff to ensure the service user was reassured and understood. 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. Service user photographs were not in place in two of the three plans checked. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 10 The plans contained records of health assessments, such as moving and handling and pressure sores. Nutritional assessments were undertaken. Service users said that their health care needs were met. One service user said the staff were ‘proper carers’, and ‘they could not do better’. One visitor spoken with said that they were always kept fully informed by the staff at the home. Staff were observed to respect service users privacy by closing bathroom and bedroom doors. Staff were seen to knock on doors before entering. Service users preferred form of address was respected. Staff were seen to treat service users kindly and respectfully. Whilst discussions with the manager evidenced that, where possible, service users views regarding dying and death were sought, these were not recorded in one plan checked. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Service users 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 service users representatives. Contact with relatives and friends were supported. The home was reviewing the menu, to improve choice and reflect service users preferences. EVIDENCE: Service users 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. One service user refused lunch, whilst staff were observed to encourage the service user to eat, staff respected their decision and agreed to offer lunch at a later time. The homes menu was being reviewed to offer more choices. One service user spoken with said the food was ‘lovely’. They informed the inspector that they had chosen an alternative to the menu, and had chosen to eat their meal in a different room, and staff had respected this. The service user said ’nothing is too much trouble for staff ’. Staff sat with the service users that required assistance with eating, and this support was given patiently and respectfully. At the time of this inspection the home was attempting to recruit to the cooks post. A member of care staff was covering the vacancy. The bedrooms seen contained personal possessions.
Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 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. 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. These contained relevant detail. The home had received two complaints since the last inspection, both of which had been resolved satisfactorily. The staff spoken with were clear about the homes complaints procedure. Staff training in abuse had been identified within the homes training plan, to ensure staff were able to care for service users effectively. The staff interviewed could describe indicators of abuse and were aware of the procedures to follow if abuse was suspected. Any allegations of abuse were responded to promptly. The staff, visitor and service users spoken with all stated that they had confidence in the homes manager to listen and respond to any concerns raised. One service user told the inspector that they felt safe at the home. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24, 25 and 26 The home was clean and generally well maintained. Minor redecoration in a proportion of bedrooms was required to maintain a comfortable and clean environment for service users. Communal areas were homely, and in the main well decorated. Sufficient bathing facilities were provided. The majority of bedrooms seen were well personalised, in line with the service user or their representatives choices. The heating system at the home did not meet the needs of service users. 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 not available in all of the rooms used by service users. EVIDENCE: The inspector carried out a tour of the home. In the main the home was well decorated and well maintained, to provide a comfortable environment to service users. The home employed a handy person to help maintain the environment. A proportion of bedrooms seen had minor damage to the decoration. One lounge had worn and damaged decoration.
Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 14 The storage system at the home did not meet the needs of service users. Lack of appropriate storage space impinged on communal and individual space; some bathrooms were used to store equipment, and four service users ensuite toilets were used to store breakfall mattresses. The heating system at the home did not meet requirements; the level of heat could not be controlled in individual bedrooms. Some of the bedrooms had not been provided with towels, to ensure hygiene procedures were followed. Service users safety could be compromised, as a call buzzer was not available or accessible in one conservatory. The homes laundry was sited away from food preparation areas. Since the last inspection a humidifier had been provided in a conservatory to improve ventilation, and the homes systems to control odours had been improved by installing timed air fresheners in identified areas. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 Sufficient staff were provided to meet the needs of service users. Some staff undertook NVQ training. Recommended levels of NVQ trained staff had not been achieved. The home had appropriate recruitment systems in place, improvements to this system were taking place to promote the safety of service users and meet standards. A staff-training programme for the year had been organised and planned, in order that staff had the skills to meet the needs of service users. EVIDENCE: The homes rota evidenced that agreed levels of staff were being maintained. One service user spoken with said that enough staff were provided. A visitor spoken with said they were happy with the levels of staff. The cooks post was vacant at the time of this inspection. A member of care staff was covering this. Attempts to recruit to the vacancy were being maintained. Training records evidenced that of the 28 care staff employed at the home, 3 staff had achieved NVQ level 2 in care, and 1 staff had achieved level 3 in care. A further member of staff was undertaking level 3 in care. 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. At the time of this inspection the manager was undertaking enhanced CRB checks for all staff, as these had previously been obtained at the standard
Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 16 level. The inspector saw a tracking sheet confirming that this was taking place, a proportion of checks had been completed and returned. The manager had developed a staff-training plan, which the inspector saw. This included aspects of training relevant to the needs of service users, such as dementia and mental health. Staff received a minimum of 3 days paid training each year. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36,37 and 38 The managers leadership approach benefited staff and service users. The home had a quality assurance system in place, to enable service users and their representatives to express their views. Appropriate financial systems were in place, to safeguard service users. 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. Some records were not securely stored and did not promote service users rights. Health and safety systems were, in the main , maintained, to ensure service users were safe. Some mandatory staff training was out of date. One care practice observed did not promote service users 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
Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 18 and prioritised areas for improvement, to enhance the service provided. The home had a business plan. Insurance cover was in place and displayed within a communal area. The manager confirmed that questionnaires were distributed to service users, where they were able to complete, and all representatives, on an annual basis. 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. The manager was in the process of introducing formal supervision for all staff, to ensure service users were provided with appropriate care and staff were provided with relevant support. The inspector evidenced that care plans were stored in filing cabinets at nurses stations. The filing cabinets were unlocked and the door to the offices were unlocked. One filing cabinet containing care plans was damaged and unable to close. The equipment at the home was serviced and maintained. Fire records evidenced that weekly fire alarm checks took place. Some staff mandatory training in moving and handling and 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 service user in a wheelchair without footplates in place. This practice could compromise the safety of the individual. Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 2 x 2 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 3 3 x 1 2 1 Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Service user plans must contain specific detail on the staff action required to ensure all assessed needs are met Care plans must be completed in full Photographs of service users must be kept. Care plans must record the date of the last dental check (Previous timescale of 01/01/05 not met. Where possible, service users wishes regarding dying and death must be recorded in the plan of care. Representatives of the service user must be consulted where this is not possible All areas of the home must be well maintained. The lounge and identified bedrooms must be redecorated Bathrooms must not be used to store equipment (Previous timescale of 01/01/05 not met) The organisation must identify and provide appropriate storage areas within the home. Emergency alarms must be fitted
J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Timescale for action 31July 2005 2. 8 15 31 July 2005 31 July 2005 3. 11 15 4. 19 23 31 July 2005 31July 2005 5. 22 13 6. 22 23 01 June
Page 21 Tapton Court Nursing Home Version 1.20 7. 24 13,12 8. 9. 25 29 23 19 10. 11. 12. 36 37 38 18 17 13 13. 38 13 to all rooms occupied or used by service users (Previous timescale of 01/04/05 not met) Breakfall mattresses must not be stored in en-suite toilets. Towels must be provided in all bedrooms Service users must be able to control the heating in bedrooms CRB checks for all staff must be obtained at the enhanced level (Previous timescale of 02/11/04 not met) Staff supervision must take place at the required frequency. Care plans must be securely stored at all times An audit of staff mandatory training must be undertaken. Where training is identified as needed, this must be provided. All staff must participate in a fire practice drill at the required frequency 2005 01 June 2005 01 August 2005 01 June 2005 01 June 2005 26April 2005 31 June 2005 Immediate, within one week of this inspection date Immediate 26 April 2005 14. 38 13 Service users must not be transported in wheelchairs without footplates in place. 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. Refer to Standard 28 31 Good Practice Recommendations 50 of the care staff should NVQ level 2 in care by 2005 The manager should NVQ level 4 in management by 2005 Tapton Court Nursing Home J55 21812 Tapton Court V218757 26.04.05 UI Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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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