Inspection on 23/06/05 for Tarn House

This inspection was carried out on 23rd June 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Tarn House 02/06/09

Tarn House 30/06/08

Tarn House 30/08/07

Tarn House 26/06/06

Tarn House 24/11/05

Tarn House 05/01/05

Tarn House 13/09/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 Tarn House Mill Lane Walney Barrow in Furness Cumbria LA14 3XX Lead Inspector Ray Mowat Unannounced 23 June 2005 07:10 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tarn House Address Mill Lane Walney Barrow in Furness Cumbria LA14 3XX 01229 471798 01229 470125 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) Cumbria Care Bernadette Eileen Calldine Care Home 14 Category(ies) of LD - Learning Disability registration, with number PD - Physical Disability of places LD(E) - Learning Disability, over 65 Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 14 service users in the learning Disability (LD) category to include: - Up to three service users in the category Physical Disability (PD) - 1 service user in the category Learning Disability (Elderly) (LD(E) - Maximum number registered 14 2. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Younger Adults. 3. When single rooms of less than 12 sqm become available they must not be used to accommodate wheelchair users and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 4. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 05 January 2005 Brief Description of the Service: Tarn House is a care home providing personal care and accommodation for fourteen adults with learning and or physical disabilities. The home is owned by Cumbria County Council and managed by Cumbria Care, an independent business unit of the County Council. It is situated in a residential area of Walney Island and is close to local amenities and a local bus route that services the island and the nearby town of Barrow-in-Furness. The Home is on two storeys and is divided into four distinct units. These are called hillview, seaview, greenlands and beachwood. Three of the rooms are used for short term respite care. Each of the rooms has a lounge and a seperate kitchen with dining area. All the bedrooms are single occupancy, some of which are fully accessible for people with physical disabilities. To the rear of the building are two fenced garden areas with seating. To the front of the building are open plan garden areas and a large car park, which is shared with the adjoining day service. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place at 7.10 am on 23rd June 05. This enabled the inspector to observe the morning routines and see people preparing for their day. The inspector spent time with many of the residents, in addition to meeting with the manager and care staff on duty. Two care staff were formally interviewed. Resident’s care plan files were examined in detail, also personal information and records required for inspection and the efficient running of the home. What the service does well: What has improved since the last inspection? What they could do better: The key areas for improvement relate to the home ensuring all staff absences are covered. This will enable residents to pursue a lifestyle of their choice both in the home and in the community. The formal supervision and annual appraisals of staff will support and guide good practice, which will ultimately benefit the residents. A review of information relating to residents and the introduction of “person centred plans” that help people to achieve desirable outcomes, will improve the quality of people’s lives. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 6 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. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4. The information supplied to prospective residents was detailed and well presented in an accessible format, however the information was not up to date. The admission process was clear and ensured needs were assessed and met. EVIDENCE: The home was in the process of reviewing the statement of purpose and service user guide, to incorporate recent changes to the structure of the service and staffing information. All the residents were placed at the home as a result of care management assessments. The home works closely with residents and significant others to ensure a thorough assessment is compiled, from which a care plan can be developed to meet individual needs. Many of the residents had used the respite services prior to moving into the home on a permanent basis. This gave them an opportunity to “test drive” the home. Alternatively the home arranges short visits for a meal or an overnight stay, as a gradual introduction to the routines of the home and their fellow residents. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10. On the whole residents needs were well documented within the care plan, with people getting good support to make informed choices in their lives. EVIDENCE: The care plans examined were informative and documented individual needs and preferences, which guides staff in providing appropriate support to people to achieve their goals. Unfortunately due to staff shortages, the ability of staff to support people, in particular with community activities, has been limited. Staff said this situation was “improving”, which was reflected in the staff rotas and should improve further with the new appointments to the vacant posts. Care plans contained up to date assessments called “support provision records”, this documents the type and level of support people require to participate in everyday activities and independent living skills. This is invaluable to staff in providing an individualised package of care. There was evidence care plans were kept under regular review. Residents were involved in many aspects of home life suitable to their abilities. On the day of the inspection this included everyday chores such as hoovering, cleaning, laundry and making a packed lunch. Independent living skills were promoted and supported by staff both in the home environment and in the community. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 10 A wide range of risk assessments have been developed to support residents to lead independent lifestyles and to participate in activities of their choice. All confidential and personal information was securely stored but accessible to both residents and staff when required. Staff were aware of their responsibility in maintaining confidentiality at all times, with policies in place to support good practice. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16. Opportunities for personal development and community participation were sometimes restricted because of staff shortages. However residents were leading fulfilling lifestyles, when appropriate support was available and were happy living in the home. EVIDENCE: Two groups of residents had recently enjoyed a holiday and a third group had one planned. Residents spoke enthusiastically about their holidays, which obviously was important to them and had been a rewarding experience. All the residents, bar one, attend one of the local day services Monday to Friday each week. This provides people with a range of vocational, educational and leisure opportunities with their peer group and in the local community. Some people attend the local college of further education for both leisure and educational courses. Community participation is encouraged, residents were members of the local church and social groups, however opportunities for residents who require staff support in the community have been limited due to staff shortages. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 12 One resident spoke to the inspector about a “people first” advocacy meeting they had attended the previous day. They explained to the inspector what was discussed at the meeting, relating the issues to their own life. Promotion of such activities is good practice and will have obvious benefits for residents in development of an independent lifestyle. There was evidence of residents having regular contact with relatives and friends, with staff, in particular key workers, taking a lead role in supporting residents to maintain contact. Information was contained in the care plan such as a list of significant people in resident’s lives and significant dates, such as birthdays, which enable people to stay in touch with people who are close to them. This type of support is vitally important for people who are not able to maintain contact themselves. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. 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. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Personal and healthcare needs were well documented, with staff providing appropriate support, to meet individual and specialist needs. Completion of medication records could be improved. EVIDENCE: The “support provision record” referred to earlier provides staff with detailed information relating to all aspects of personal care and preferences in how this should be delivered. Care plans recorded relevant information regarding both routine and specialist healthcare needs. There was evidence of regular routine health check ups taking place with outcomes recorded and pertinent information shared with others. Referrals to specialist healthcare services had also been appropriately made, such as the dietician, occupational therapy and the community health team. All the residents were registered with a GP of their choice, with the home having good links with the local GP practices. Thus ensuring personal and healthcare needs were being appropriately met. The home supports people with all aspects of their medication encouraging and supporting independence. There were good examples of multi-disciplinary risk assessments in place to support people who self-administer medication. In addition there were clear guidelines for the use of PRN medication and epilepsy management plans, which is good practice. Although all the medical records (MAR charts) examined were up to date, the correct codes had not been used, Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 14 which can cause confusion. It is recommended appropriate codes be used at all times. Records of individual and family, cultural and religious beliefs were maintained on the care plan. This also included people’s wishes upon illness and death, which enable staff to deal sensitively with situations as they arise. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The policies, procedures and practice within the home safeguard residents and staff. EVIDENCE: All residents had been issued with the home’s complaints policy, which was held on personal files. This was in line with the requirements of the Care Home Regulations. Through induction and ongoing training staff were made aware of pertinent policies and their responsibilities in handling complaints and being aware of and reporting mistreatment and abuse. Staff spoken to were familiar with policies and procedures. The home does not act on behalf of any residents, some are under the court of protection, whilst family members or solicitors represent others. The home does support people with managing personal monies, maintaining detailed records to safeguard residents and staff. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30. The programme of repairs and maintenance currently underway, will create a safe and comfortable home environment. EVIDENCE: As a result of the last inspection a statutory notice was served on the home, meaning they were liable to prosecution, without further notice, if the decoration and maintenance issues raised, were not responded to in the agreed timescale. This came about as a result of the home repeatedly not responding to previous requirements. Some of the outstanding work had been completed, whilst other projects were in progress. The logistics of completing the work, while maintaining a safe environment, meant the work being carried out in stages. The manager confirmed the projects that were planned, which will meet the requirements made at the previous inspection. Further monitoring visits will take place to ensure full compliance. There was evidence on file of the home liaising with relevant professionals regarding advice and guidance relating to aids and adaptations. A good example of this was the report on file relating to the planning for the Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 17 refurbished bathroom, thus ensuring it will meet the individual needs of all the residents. On the day of the inspection the home was clean and hygienic. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36. Staff shortages have meant the quality of service has at times been poor, with only basic needs being met. There was evidence this situation was improving. EVIDENCE: The organisation has robust recruitment policies and procedures in place, which are in line with good practice and safeguard residents. CRB checks for domestic staff should be reviewed. Staff spoken to were clear about their roles and responsibilities and had received relevant information and documentation in line with the NMS. They were aware of the importance of promoting independence and had a good insight to individuals needs. Although the home had continued to experience staff shortages, it was evident the staff in place were committed to maintaining a good quality service. On the day of the inspection staffing levels were adequate in each unit, with one staff on induction, shadowing a permanent member of staff. All new staff had completed the LDAF induction and foundation training. On examining the recent staff rotas, these confirmed that staff absences had not been covered, resulting in shortages of staff on individual units. Interviews were taking place throughout the day recruiting to the vacant posts, which will ensure adequate numbers of staff will be in place to meet resident’s needs in the future. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 19 Staff spoken to felt they got “good support” from the manager and supervisors. However on examination of the staff supervision records, some of these were not up to date, including a night support worker, a supervisor and care staff. It is also recommended all staff have an annual appraisal, to review their performance and agree career development plans. In addition to core training provided to all staff, the home also provides training in specialist areas such as epilepsy management and physical intervention when needs are identified. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. 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 home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42. The home benefits from having a stable management team, who provide good leadership and manage the home effectively. EVIDENCE: Based on discussions with the residents and staff and from the inspector’s own observations, the manager has a “very committed, hands on approach”. Residents and staff said the management team were “always available, approachable and listen to our concerns”. The results from the last resident’s survey were displayed in the hall. These identified improvements and suggestions made and what the home had planned in response to them. Consultation and feedback in this way empowers residents and gives them a clear message that their views are valued and consultation is meaningful. On the day of the inspection the maintenance of hoists and lifting equipment was taking place, it is recommended the insurance cover is reviewed to ensure Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 21 it is current for all appliances, as the certificates examined were due for renewal. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 22 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. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 3 3 3 Standard No 11 12 13 14 15 16 17 2 3 2 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 2 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tarn House Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 x F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 23 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 13 Regulation 16(2) m, n 18(2) 14(1)2 Requirement The home must provide support to residents, to engage in local, social and community activities of their choice. The home must ensure all staff are appropriately supervised. Adequate numbers of staff must be on duty at all times Timescale for action 1st October 05 1st September 05 1st August 05 2. 3. 36 33 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. 3. 4. 5. 6. Refer to Standard 20 36 34 42 6 11 Good Practice Recommendations It is recommended the correct codes are used at all times when completing medication records. It is recommended staff have an annual appraisal to review their perforamce and agree personal development plans. It is recommended the home review CRB disclosures for domestic staff. It is recommended the insurance cover for the equipment in the home is reviewed ensuring it is current. It is recommended person centred plans are developed, particularily for people with more complex needs. It is recommended appropriate training takes place with F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 24 Tarn House relevant staff and residents, to develop and improve communication strategies and methods of communication. Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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 Tarn House F58 F10 s36626 tarn house v229279 230605 ui stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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