CARE HOMES FOR OLDER PEOPLE
Tara`s Retreat Residential Care Home High Street Sandridge St Albans Herts AL4 9DQ Lead Inspector
Patricia Rogan Unannounced Inspection 20th - 30th March 2007 10:00 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 Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Tara`s Retreat Residential Care Home Address High Street Sandridge St Albans Herts AL4 9DQ 01727 850527 01727 853927 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) B & M Care Limited Mrs Annette Sudbury-Smith Care Home 46 Category(ies) of Dementia - over 65 years of age (46), Old age, registration, with number not falling within any other category (46) of places Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection First inspection Brief Description of the Service: Taras Retreat Care Home is a spacious, purpose built care home and was opened in 2006. It is situated in the rural Hertfordshire village of Sandridge and is surrounded by open countryside. It is near local amenities and close to the city of St Albans. The home can be reached by public transport or by road with a good sized car park in the grounds. The M1, M25 and A1 motorways are all approximately 15 minutes drive away. Taras Retreat has been designed with a choice of communal areas for the residents. All single bedrooms have ensuite shower facilities and there are also specially equipped bathrooms which are used when additional assistance is required. The home is wheelchair accessible throughout, with a lift to the first floor. The well-kept gardens have ample gazebos and seating areas for use by residents and their visitors. Care fees range from £610 to £700. Copies of the Service User Guide and the most recent report on the home published by the Commission are available in the home. Additional fees for such services as hairdressing and chiropody are explained in the individual service user contract. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This first inspection of all the key standards took place during two days and was carried out by one inspector. Time was spent meeting privately with service users and their families and members of staff in order to ascertain their views about the care which was provided. An additional part of the inspection included gathering the views of some health and social care professionals who are familiar with this home and this was carried out face to face or via telephone and postal questionnaires. A separate visit was made to spend two hours in the part of the home where people who have dementia are accommodated. The interaction between residents and staff was observed during those two hours in order to assess the quality of dementia care. Some policies and procedures were inspected and a random sample of records and care plans were inspected. Extensive, discrete observations were made of the way care was provided in the communal areas and the administration of medication was also observed. This was a positive inspection and the outcome for service users is good. What the service does well: What has improved since the last inspection?
Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 6 This is the first inspection. 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. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are involved in a full assessment prior to moving into the home and comprehensive information is provided to all prospective residents and their representatives. EVIDENCE: Any prospective resident or representative is provided with an information booklet and a Service User Guide setting out what is provided in Taras Retreat. The manager invites the prospective resident to visit the home and spend time meeting residents and staff. Two members of staff carry out a comprehensive pre-admission assessment. An inspection of the most recent admissions showed that a comprehensive assessment had been carried out. Discussion with those residents confirmed that they had been involved in the assessment and had visited the home before moving in. One resident said I was made to feel most welcome by all concerned. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are generally well written and individualised. Daily records did not always reflect what was written in the care plan. All service users have full access to health professionals. Medication administration is correct and is overseen by a pharmaceutical organisation. Service users are treated with respect. EVIDENCE: The care plan reflects the initial assessment and was updated on a regular basis and as care needs changed. On some files, the daily record did not reflect what was written in the care plan and only had basic information. This meant that it was not always possible to confirm that care needs were being met. Feedback from health and social care professionals was positive. During the inspection, staff were seen to knock and wait before entering residents rooms and were discrete when speaking about personal matters. Several residents said they found the staff soon understood their likes and dislikes and this helped them to feel settled.
Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are varied activities in the home and opportunities for residents to go to the local village. Access to the garden is restricted. Contact with family members and friends of the residents is encouraged. The menu is varied with a choice offered. EVIDENCE: An inspection of a random selection of care plans showed that residents are given an opportunity to follow their interests where possible. During the inspection, a reminiscence and music therapist was with residents on the ground floor and a person from Pets as Therapy brought her dog into the home for residents to see. The activities co-ordinator spends part of her time with the residents who have dementia and offers such activities as art and music. During the inspection, the weather was mild and two residents said they would like to be able to sit in the garden and get some fresh air. They said they didnt bother because the alarm would go off. A member of staff confirmed that the alarm was usually only turned off when the doors were left open in the height of the summer. She did not offer to go and turn the alarm off.
Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 11 Residents with dementia have no access to the garden unless a member of staff is made available and escorts the residents downstairs. On both days of the inspection, one resident was walking from one end of the corridor to the other, repeatedly trying to open the doors and becoming increasingly agitated. A member of staff did take the residents into the garden but the resident who likes to walk around a great deal was caused daily anxiety by not being able to walk outside in the garden unless a member of staff was available. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Feedback from those consulted showed a confidence that complaints would be treated with respect and that the appropriate action would be taken. The policies and training, which has taken place, should ensure service users are protected from abuse. EVIDENCE: Several residents and family members were asked for their views and all said if they had a complaint, they would have no hesitation in speaking to the manager and felt that she would listen to them and try to resolve things. The staff have adult protection training and there are stringent policies and procedures in place regarding reporting and action to be taken if there was an incident of poor practice Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This recently built home is in good decorative order and was clean and pleasant throughout. EVIDENCE: All areas of the home were found to be light and fresh with ample furniture and seating areas. There is a maintenance person to carry out regular checks and there is a maintenance programme in place. The home is cleaned regularly and kept in a pleasant hygienic condition. Several residents and visitors commented that they liked the decor. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are good. The recruitment policies are robust. Staff training is wide ranging, communication skills with people who have dementia could be improved with more training. EVIDENCE: An inspection of the staff rotas and observation of the time staff spent with the residents showed that there were sufficient staff on duty. A resident said I rarely have to wait very long if I need anything. Staff were seen to be kind towards the residents. Some members of staff appeared to lack the specialist skills needed to communicate with people with dementia. The recruitment policies and procedures are efficient and robust. There is an induction programme for all staff and new members of staff work alongside another member of staff until they are considered competent to work alone. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is skilled in the care field. She has a good understanding of her responsibilities and demonstrated her intention to run the home in the best interests of the service users. EVIDENCE: The manager has shown a sensitivity to how residents can feel when moving into a new home. She is also regarded favourably by families, staff and professionals involved with the home. All required policies and procedures are in place and are up to date. Staff supervision takes place on a one to one and by observation of practice. The health and safety of residents and staff is regarded seriously and the policies and record keeping reflect this.
Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 17 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP14 Regulation 13(8) Requirement Environmental restraint should not occur and currently does so for service users with dementia and for service users who cannot access the garden independently due to the garden doors being alarmed. Timescale for action 30/06/07 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 OP30 Good Practice Recommendations Person centred dementia care training should include communication skills for staff to enhance the support for residents with dementia. Tara`s Retreat Residential Care Home DS0000068418.V333821.R01.S.doc Version 5.2 Page 18 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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