Inspection on 20/06/07 for Tapton Grove Nursing Home

This inspection was carried out on 20th June 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tapton Grove Nursing Home 09/05/06

Tapton Grove Nursing Home 13/02/06

Tapton Grove Nursing Home 25/07/05

Tapton Grove Nursing Home 16/03/05

Tapton Grove Nursing Home 13/10/04

Tapton Grove Nursing Home 22/03/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Tapton Grove Nursing Home Grove Road Brimington Chesterfield Derbyshire S43 1QH Lead Inspector Bridgette Hill Key Unannounced Inspection 20th June 2007 09:20 Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 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 Grove Nursing Home DS0000002079.V339747.R02.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 and Care Homes for Adults 18 – 65*. 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 Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tapton Grove Nursing Home Address Grove Road Brimington Chesterfield Derbyshire S43 1QH 01246 274178 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) kellygartland@sunhealthcare.org www.sunhealthcare.co.uk Sun Healthcare Limited Mrs Patricia Willey Care Home 47 Category(ies) of Dementia (10), Mental disorder, excluding registration, with number learning disability or dementia (37) of places Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2006 Brief Description of the Service: Tapton Grove provides nursing and personal care for up to 47 persons of both sexes, which includes up to 10 persons with dementia and 37 persons with mental disorder (excluding dementia and learning disabilities). There are separate nursing and care staff groups for each category with centralised hotel services (with satellite kitchens provided to each unit) and an overall registered manager. Service users with dementia are accommodated separately to those with a mental disorder. The home is located approximately 1.5 miles from Chesterfield town centre with a secluded setting approximately a half-mile from the nearest bus route. Details of room sizes are given in the statement of purpose for the home. There is level access to garden areas for service users. Good relationships and networks are establishing with outside health care professionals with regard to the specialist health care needs of those service users accommodated. The range of fees charged at the home is £506.00 - £1400.00 per week. The Manager provided these figures. Extra charges were made for chiropody, hairdressing, personal newspapers, toiletries and some trips. Local authorities funded the majority of service users in the home. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one which took place on the 20th June 2007. The purpose of this inspection was to assess all key standards and compliance to previously listed requirements. The Inspector was accompanied for part of the Inspection by an ‘Expert by experience’ Marion Aslan. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience spent time during the visit speaking to residents regarding the lifestyle of the home and ascertaining their views of the service. Various records including care planning records were examined the findings are recorded in the body of this report. Discussions were held with residents, staff and visiting professionals during the visit. The Manager Pat Willey was on duty during the inspection. The scoring of outcomes page has not completed as it covers only younger adults National Minimum Standards. Where standards have not been met requirements and recommendations are listed. What the service does well: What has improved since the last inspection? New dining furniture has been purchased. The large table in the dementia unit was also used for activities. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 6 The previously listed requirements relating to medications have been addressed and at this visit the storage and administration of medicines met all required standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP standards assessed 2,6 YA standards assessed 2 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. The admissions procedure implemented enables residents to visit the home and make positive decisions regarding admission. Contracts are provided to residents to give them information regarding the home and what is offered. EVIDENCE: The system for arranging admissions was detailed in the administrative office. This advocated assessment by staff from the home and visits to the home being made. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 9 After initial assessments had been completed letters were written by the Manager detailing the assessed needs and the fees to be charged for providing care. The letters were addressed to the funding authorities as the majority of residents fees were paid by different local authorities. Care files viewed also included assessment information and risk assessment profiles for residents. One resident spoken to said they had visited the home and spent time their before moving in permanently. In care files Terms and conditions of residency contracts were available which had been signed by residents. These included the fees, what was included and notice periods to be given. The room number to be occupied was not included. Some residents spoke very positively of the home and their experience stating that being supported at the home had enabled them to have longer periods that they have normally had without being re admitted into hospital. One visiting professional spoken said the home had been successful in managing the care of residents with complex needs. It was aid that the staff were prepared to work slowly with gentle encouragement to work with residents with complex needs. The home does not offer intermediate care as defined by National Minimum Standards 6. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP standards assessed 7,14,33 YA standards assessed 6,7,9 Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. The care plans in place were found to be variable in the quality of information recorded with some not wholly recording assessed needs and how these were to be met. This had the potential for residents needs to be unmet. EVIDENCE: Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 11 A sample of four service users care files was examined to assess how standards were being met. This included a care file from each unit to assess how a varying range of needs was being met. There was some inconsistencies in the level of personalisation of care plans. Some were very individual which gave an excellent account of the resident and their assessed needs. Other care plans were brief in describing assessed needs. Deficits were also found in care plans for example one resident required a special diet and ongoing monitoring. The monitoring aspect was being completed and fully documented however there was not a care plan in place to record the assessed need and detail the action which staff were implementing. For younger adults there tended to an overview of social activities for each resident. This was not found for older adults and had not been considered as part of the care planning process. Another care plan was found to be poor in describing mental health needs. Staff completed log records on a regular basis and also one to one records. Records of care plan and multi agency reviews were also evident. One resident spoke of monthly meetings and said he was very much involved in their own care planning. “They always give me a copy in advance of meetings / reviews. Everything is fore planned – when social services or whoever come in they see that I know what is planned re my care for the next few months” One resident said they felt involved in their care but said they hadn’t seen their notes or care plan, though they knew he could if he wished. Care files viewed typically contained signatures from residents to evidence that they had been involved in the care planning process or a record from staff to state residents had refused to sign the plan of care. A key worker system was in place. One resident spoke of having a positive relationship with their key worker but expressed some reluctance to approach other staff. They said the relationship with the key worker was one where they were encouraged to do things. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 13 YA standards assessed 12,13,15,16,17 OP standards assessed 10,12,13,15 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. The lifestyles of residents at the home are varied and opportunities and choices are offered which respect them as individuals. EVIDENCE: This group of standards was largely assessed on what residents said about the home to the expert by experience. Some records were also viewed which recorded individual sessions with residents. Communication with some residents with dementia was found to be difficult and the majority of the quotes below are from younger adults. There was therefore less evidence available to establish how far the needs of residents with dementia were being met. Social care records for a range of service users were examined. The quality of the records relating to individual sessions varied. Largely on the dementia unit there was no content recorded on what had been offered in the session or how the resident responded to and enjoyed the session. Some sessions recorded included bathing time which is part of required personal care. One resident said “It’s lovely here. They are good to you. They help me with my bath, the food is nice” One resident spoken to said “I like it so much I want to stay. I like the people, everybody’s brilliant. They’ve helped me in every way possible. They talk to you, they encourage you to do things. At one time I would never go out, now I get out, go on holiday, do loads” All residents spoken to talked about their being an excellent social life – choices and variety of events, e.g. pub nights, pool nights, bowling, cinema in Chesterfield and trips further away. Activities within the house were advertised on notice board which appeared to be consistent with what was offered according the residents spoken with. Residents said they pulled together toshare task and there was a rota for kitchen dutieas, sweeping the drive, laundry, cleaning etc. In care planning documents there were overviews of the residents week and how they spent their time including the domestic activities. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 14 One resident was employed by the Providers and said they thanked the staff at the home for supporting this. One resident said staff had supported a eating healthy plan and they had lost weight. The resident said they had been encouraged to eat smaller portions, good choice of healthy food and do more exercise. One resident told the expert by experience that he was quite happy here. There were plenty of groups and activities going on in the house and people could attend as many or as few as they wished. There was a good range of subjects on offer – computers, cooking, occupational therapy, plus lots of trips out and occasional holidays. He felt he had a lot of freedom –residents could use the small kitchen to cook his own meals if he wished to, with some supervision. One problem encountered was that the microwave and kettle in that kitchen were not working properly, but the oven and fridge were fine. The resident spoke of the meals being excellent and enjoying living here. One resident said they felt that their spiritual needs were well addressed – communion from a visiting priest. Another resident spoke of going to church each Sunday. Holidays for residents were enjoyed as a group of residents and staff from the home and one resident spoke of staff helping them arrange an holiday which was to be taken with a friend. The expert by experience was offered a meal and the standard was regarded as good. The staff served the residents at table and the atmosphere was relaxed and easy, the dining hall was clean and well maintained. The choice of menu offered was recorded on a board near the kitchen and residents pre ordered the day before their choice of meal. The expert by experience observed that the dining tables were being set at 11.00am in the dementia unit and little staff/resident interaction was evident at this time. The expert by experience from their observation considered that there was an apparent overall respect and dignity between staff and residents and between residents themselves on the younger adults and elderly wings. It felt like a country “home” and several residents spoke of the lovely walks they regularly took. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP standards assessed 8,9,10 YA standards assessed 18,19,20 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. There are arrangements and established relationships with visiting professionals in place to ensure that residents can access healthcare support that meets their needs. Medications management was found to be in good order and considerate of residents abilities to self medicate. EVIDENCE: Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 16 A sample of four service users care files was examined to assess how standards were being met. This included care files from each unit to assess how a varying range of needs was being met. The care plans viewed recorded interventions from healthcare professionals. Two GP surgeries were typically used by the home. The Manager said one resident had retained their own GP. Established arrangements were in place to provide chiropody, dental and optical care. The care plans included records of these visits and optical prescriptions. Local Consultant Psychiatrists visited the home on an approximately 6 weekly basis to undertake multi disciplinary reviews. Residents spoken to were aware of the scheduling of this and said they took part. A range of risk assessment tools were being used with different ones being completed according to need. On the dementia unit the risk tools in place considered tissue viability, moving and handling and nutrition. On the younger adults unit the risk assessments were centred around mental health and covered a wide range of aspects. Generally all risk assessments seen were reviewed on a monthly basis. Risk assessments regarding smoking were in many residents’ files. Plans were being considered to ensure compliance to new anti smoking laws. One resident spoke positively of a medical condition being identified that had been missed by staff at a previous placement. One resident said they self medicated and had control of her own medications. Staff spoken said that programmes were also in place were gradual self administration was promoted with support from staff being initially given, 3 residents were said to have begun this process. A number of residents spoke positively of being supported through periods of deteriorating health where previously hospital admissions had been required. One resident said they had enjoyed the longest spell out of hospital in any years since being at the home. One shared room is used for the storage of medications for both units. Medication administration records and storage were examined. Specimen signatures for staff were available. Medication administration records had some photo’s on but some residents had declined to have their photo Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 17 taken which was respected. Medication administration records were fully completed and handwritten records were doubly signed. An audit trail of receipts and disposal was possible. A controlled drug disposal pot had been obtained since the last visit. A sample of controlled drugs records indicated that balances recorded correlated with stocks held. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA standards assessed 22,23 OP standards assessed 16,18,35 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure that complaints or allegations of abuse were handled consistently with residents being able to air their views and were listened to. Not all staff had received training in safeguarding adults though appeared to be knowledgeable regarding procedures. EVIDENCE: The complaints procedure was on display on notice boards in the home. This gave all relevant details of who to complain to and how the complaint would be handled. Over the past 12 months there had not been any complaints to the Commission for Social Care Inspection or the home. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 19 Over the past twelve months there had not been any safeguarding adults referrals made. The staff were conversant with the procedures and there had been one incident which was considered for referral until facts were established which changed the management approach adopted. The training records indicated that whist most staff had received training in safeguarding adults some had not. The home was reliant on dates being provided from Social services for training and there was a waiting list for these. Some progress had however been made. One resident said that meetings were held monthly and any issues could be raised, but if there were any problems additional meetings could be called and the issues dealt with more or less immediately. “We are listened to, and the decisions are taken by staff/ residents together” One resident spoke of the monthly meetings as being the place where issues could get aired and resolved, but said in the 5 years they had been here there were no real complaints. Some residents had financial assessments in their file these were mainly the younger adults in the home. A new system for storing monies had been implemented since the last inspection. Some computerised records were not accessible during the visit as the administrator had finished for the day. The new system was a residents bank account had been opened and an amount of cash held collectively at the home. Residents then accessed cash from this pool and signed the records for the amount which was then deducted from the amount they held in the account. It was not possible to case track accounts and check balances due to the computerised records not being accessible. The paper records held always recorded two signatures one of which was typically the resident. Where purchases had been made receipts were retained. One resident said that staff helped them by getting purchases from shops and bringing them in to save them paying for taxi’s to go out. One resident said “We always have access to the manager for social or financial problems”. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP standards assessed 19,26 YA standards assessed 24,30 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. The home was found to be comfortable and generally well maintained forresidents to live in. EVIDENCE: Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 21 Tapton Grove is a home converted from a large period property set in its own extensive grounds. The home is split into two units one accommodating 10 older persons and 10 younger adults. The second unit accommodates 27 younger adults 18 – 65. Separate staffing groups are arranged for each area. The grounds of the home had paved seating areas which residents were viewed to be using. The dementia unit had a secure paved patio area with seating, umbrellas and planters that were well tended with flowering plants. A range of communal areas are available on each unit. These were found to be comfortable and well maintained. The fire records indicated that regular checks of the alarm system were made and fire drills were organised regularly. Fire training had been held though this was video based and not always facilitated by any staff so the opportunity to ask questions/clarify issues was not always offered. A workplace fire risk assessment was in place. Stickers on the fire equipment indicated that they had been serviced in the past year. A full time handyman is employed who undertakes maintenance and decorating. Audits of the homes environment were completed on a 3 monthly basis. As the home was a period building this highlighted ongoing issues with maintenance with a range of jobs identified. Not all the jobs were completed by the time the next 3 monthly review was completed. Since the last visit missing ceiling tiles had been replaced and radiator covers had been painted. New furniture in the dining rooms had been purchased for both units. The dementia unit now had a large table for all service users to sit around to eat which was also used for activities, this was bingo and dominoes on the day of the visit. A sample of bedrooms were viewed with residents permission. These appeared to be in decoratively reasonable order and were personalised with residents belongings. Some residents had kettles in their rooms to enable them to make drinks when they wished. A number of bedrooms were shared rooms and care files contained consent forms that residents had agreed to share. Partitions were in place to provide some privacy. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 22 The expert by experience considered that the home was clean and comfortable apart from some odours being evident in the dementia unit. One residents said the quality of life here is very good – in this sort of environment there’s always going to be some difficulties but the staff talk to you, it’s clean, tidy, smells beautiful all the time. The laundry area was fitted with one washer and dryer and an additional domestic type washer which residents on the younger adults used to do their own washing. Laundry staff were employed and the manager said they considered the provision of the equipment appropriate. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA standards assessed 32,34,35 OP standards assessed 27,28,29,30 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. An effective staff team were in place and positive relationships were evident with examples given of how residents had progressed with the support of staff. EVIDENCE: The different units of the home had different staffing groups. The Manager worked on a supernumerary basis typically 10am – 6pm. Qualified nurse worked on each of the two units supported by care staff. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 24 The staffing levels were consistently recorded on the rota and appeared to be meeting the needs of residents. A theme picked up by the expert by experience was that all the residents spoken to was the fact that staff were always there to talk to and listen. The homes staff group at the home were highly regarded by residents. A sample of two staff personnel files were examined. These contained all the required checks which included written references, Criminal Records Bureau checks application forms with dates of employment and proofs of identity. The dates of these indicated that all checks were in place prior to employment commencing. From the pre inspection questionnaire there were 32 care staff employed at the home of which 23 held NVQ (National Vocational Qualification) level 2 in care qualifications. Discussions with the Acting Manager confirmed that 6 staff had begun NVQ (National Vocational Qualification) courses. One resident spoke highly of the home. “We’ve got such a great mix of staff and residents, we all get on well. The staff are brilliant. There’s nothing I would change. I couldn’t believe the freedom when I first came. Pat the manager – you couldn’t ask for better!” The expert by experience considered there to be a pleasant, happy atmosphere, people were friendly towards each other, staff interacted well and there was good humoured banter between staff and residents. The recording of staff training had improved since the last inspection and an overview of what staff had completed was available. Discussion regarding who provided staff training confirmed that some was in house trainers for example mental health, some was by video for example fire training, and some was by external providers an example being safeguarding adults provided by Social services. The majority of care staff had completed Basic Food Hygiene from a video work pack. Records indicated that some staff had not yet completed safeguarding adults training. 9 staff had completed first aid training. Infection control had been completed as a video. Some but not all staff had completed moving and handling training. This was discussed and the Manager said that on the younger adults side there was not any duties required that involved moving and handling. As staff may be called Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 25 on to work anywhere in the unit this may not ensure that staff are sufficiently trained. Some role specific training had been completed for example on the dementia unit nursing staff had completed training in catheterisation and venepuncture. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP standards assessed 31,33,35,38 YA standards assessed 37,39,42 Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 27 The home was found to be well managed with a positive regard made for residents in the home. EVIDENCE: The management of the service was considered as a whole. The Manager of the home is a qualified Mental Health Nurse has worked at the home for more than 20 years and has achieved a relevant managerial qualification. The manager was warmly and positively regarded and humorous banter and leg pulling was observed with residents. One visiting professional aid the Manager was “responsive, knowledgeable and supportive of the staff”. There were deputy managers appointed for each of the two designated units and other delegation of tasks to staff including quality assurance and supervision thereby giving accountability to managerial tasks. The quality assurance processes in pace were discussed and records examined. Some care plans were audited on the younger adults side but not on the dementia side where staff were unaware of the audit tool being available. Residents and staff meetings were held and minuted. The residents meeting minutes confirmed that decisions regarding outings, smoking and domestic duties were discussed. Some relatives questionnaires had been sent out since the last inspection. 2 of these were returned giving generally positive feedback mainly in tick box form on the questionnaires. One resident said they felt involved and “heard”, a monthly meeting led by staff gave people the opportunity to raise issues and they would be dealt with. Monthly visits were being made and recorded on the Providers behalf. Some of these were forwarded to the Commission for Social Care Inspection. A valid public liability certificate was on display. Records for establishing financial liability were not requested at this visit. A sample of servicing check documents were examined. These indicated that systems were in place to ensure equipment and installations were well maintained. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 28 Accident were documented and records were retained within residents care files where these had occurred. The lounge where residents smoked on the first floor was found to be open without a restrictor being fitted. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x CONDUCT AND MANAGEMENT Standard No Score 37 x 38 x 39 x 40 x 41 x 42 x 43 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tapton Grove Nursing Home Score x x x x DS0000002079.V339747.R02.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Care plans must be in place for all assessed needs and detail how care is to be delivered to the service user Previous timescale 30/09/05, 31/03/06 & 31/07/06 2 OP26 23 The method of odour control on the dementia must be reassessed and a plan implemented to eradicate odours effectively There must be regular training updates in relation to the safeguarding adults and associated procedures. Previous timescales 30/06/05, 30/10/05 & 30/06/06 Some but not all staff have completed this. 4 YA35 18 A skills based induction package must be implemented for each DS0000002079.V339747.R02.S.doc Timescale for action 31/07/07 31/07/07 3 YA23 13 18 30/08/07 31/08/07 Page 31 Tapton Grove Nursing Home Version 5.2 new staff member This applies for all units and the induction must be one tailored for the care needs of the residents being cared for The window in the smoking lounge on the first floor must be fitted with a restrictor to prevent the risk of falls 5 YA42 13 30/07/07 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 YA20 Good Practice Recommendations Maximum and minimum temperatures of the fridge used to store medication should be recorded daily. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Tapton Grove Nursing Home DS0000002079.V339747.R02.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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