CARE HOME ADULTS 18-65
Tarrant House Perrancombe Perranporth Cornwall TR6 0JB Lead Inspector
Lynda Kirtland Announced 4 August 2005 0930 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. Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tarrant House Address Perrancombe Perranporth Cornwall TR6 0JB 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) 01872 572214 01326 375001 Mrs Maureen Joy Tarrant & Mr Steven Jon Tarrant Mrs Christine Marie Tarrant Care Home 6 Category(ies) of Learning Disability (6) registration, with number of places Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 23 February 2005 Brief Description of the Service: Tarrant House is registered to provide care for 6 service users who have personal care needs by reason of a learning disability. The registerd providers, are Mr S Tarrant and Mrs M Tarrant who have many years experience in social care. Mrs C Tarrant is the registered manager. Tarrant House is a modern purpose built property situated approximately a mile from the centre of Perranporth. Tarrant House provide transport to local activities in the community. Tarrant House presentation is in keeping with the local community and is not distinguishable as a Care Home.The building is well maintained, comfortable and homely. Tarrant House is set in an acre plot and therefore has a large garden, which is well maintained and attractive. The garden has an area for chickens and dedicated area for the home to grow its own produce. All bedrooms are for single individuals and meet the space regulations. The majority of bedrooms plus the large communal living room, attractive dining area, patio and good size kitchen are on the first floor, therefore rssidents need to be able to negoitate stairs. In addition there is a ground floor art room for in house activities. There are currently 6 service users resident at the home. Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Tarrant House Residential Home on the 4 August 2005 and spent seven hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 23 February 2005. In addition the inspector focused on the following key areas of care: choice of home, care planning, lifestyle, health care, complaints, staffing and some management areas. On the day of inspection 6 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, staff, the registered manager and registered provider to gain their views on the services that Tarrant House offer. The registered manager also completed the pre inspection questionnaire, which is similar to a survey asking for information on what services/facilities the home provide. Completed comment cards from one relative in gaining their views on the home were received and assisted in the inspection process. Tarrant House records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. The registered providers are in the process of purchasing a second care home in Cornwall, of which the application is with CSCI for consideration. This will alter the current management arrangements of the home as Mrs Tarrant aims to manage the new home and therefore the post of registered manager at Tarrant House is being advertised. In addition a current application to convert the activities room into an additional bedroom so that Tarrant House can provide care from 6 to 7 residents is being considered by CSCI. What the service does well:
Residents and relatives commented that Tarrant house provides good quality care and accommodation. Residents and their relatives are provided with information to assist them in making an informed choice before making a decision to live at the home. An introduction to the home is planned with the resident. The home undertakes pre admission assessments and care plans ensuring that care needs are identified and plans how to address them. Documentation shows that residents and their relatives are consulted about what care they need and felt this is met by staff. They felt that they were consulted about their views of the home and listened too. This was evidence by detailed care plans and a variety of documentation Documentation showed that residents have access to a variety of health professional. All residents have a weekly programme of activities which can be
Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 6 based in the home, at college or work placement. Residents confirmed that there was a varied and stimulating programme of activities that is provided by the home and local community. Visitors feel welcomed to the home. Residents and their relatives stated that they had no issues of concern and that if they had any worries or anxieties about their care that they felt able to approach the staff or manager at the home. The registered manager has ensured that she consults with residents, their representatives, staff and external agencies that use Tarrant house facilities to gain their views on the service that Tarrant House provides. Ideas for areas of improvement or developing services are readily accepted and considered by the management team as they wish to continue to improve on the service that Tarrant House provides. What has improved since the last 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.
Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 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 Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 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) 1,2,3,4,5 Tarrant House have informative documents that explain the services that the home provides, admission processes and expectations of the placement so that service users and their representatives can make a informed choice about living at the home. EVIDENCE: Tarrant House have an informative statement of purpose / service users guide which accurately details the services that the home provides. This is presented in pictorial and written manner so that a wider audience can understand it. Tarrant House residents are long-term placements and therefore admission processes/ trial visits have not needed to be used for some time. However the registered manager has developed policies that explain the homes criteria for admission, expectations of admission to the home from referring agencies and trial visits processes. The registered manager encourages residents and their relatives to be involved as much as they wish in the introduction and pre admission assessment so that all parties have made an informed choice as to the appropriateness of living at Tarrant House. All service users are provided with a satisfactory statement of terms and conditions. Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 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 Each resident has a care plan that outlines their care needs and aspirations. Resident’s health needs are identified and liaison with appropriate health professionals is undertaken. Resident’s views on the service are continuously sought. EVIDENCE: There were individual care plans for each resident covering all health and social care needs. The care plans evidenced that residents and in some instances their relatives had participated in their formation and were involved in the reviews of their care needs. Individual decision making and choice was evident from documentation and from discussion with residents and the registered manager. The home also attend reviews at residents colleges and work placements so that all are working toward promoting independence for the resident. Residents are encouraged to paricipate in the day to day running of the home and undertake some domestic and cooking tasks which promotes self caring skills. The registered manager has developed risk assessments to ensure that appropriate decisions regarding care whilst ensuring that risk is minimised are taken. The home adheres to maintaining confidentiality and all records are maintained and adhere to the Data Protection Act.
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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) 11,12,13,14,15,16,17 Links with the local community are good and support and enrich resident’s social, educational and leisure opportunities. The systems for resident’s consultations are good with a variety of evidence that indicate that resident’s views are both sought and acted upon. EVIDENCE: It was evident from discussion with residents, the registerd manager and staff, plus documentation, that Tarrant House actively encourage residents to maintain links with the community, family, education and work placements and support residents to develop personal friendships and partake in their interests/ hobbies in the community. During the inspection all cjoose to go out for a pub lunch and on return commented on how much they enjoyed this. Residents are involved in making decisions in the planning of their day and assist in some household tasks which encourages development of independent living skills. From the inspectors observation it was evident that that the staff team ensure that the principles of privacy and dignity are adhered too.
Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 11 Residents are involved in the development of menus within the home and were observed to baking cakes during the inspection. No issues regarding food were rasied. Staff were aware of any special dietary needs and had contacted various specialist if a specific diet was needed to ensure that the home catered for this correctly. Residents are able to express their views about Tarrant House at residents meetings or on a individual bases with staff. Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 12 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) 18,19,20,21 The staff team have a good understanding of the residents support needs. This is evident from positive relationship that has been formed between the staff team and residents. Medication is administered safely. EVIDENCE: From discussions with residents and the registered manager plus documentation inspected it was evident that health needs are identified accurately and appropriate medical advice sought. Access to local health and specialist services was evident as was obtaining residents wishes and views when seeing these professionals. Health notes showed that access to health services is not a difficulty. Since the previous inspection Tarrant House have audited their medication to ensure that all medications kept are stored safely and records kept are accurate. From inspection of the medication sheets these were recorded satisfactorily. All medicines were stored appropriately. Staff have attended training in the administration of medicines, and some specialist courses i.e. administration of rectal diazepam. The registered manager has sought individual wishes in the event of resident’s health deteriorating or their death. Tarrant House is not a nursing home and will seek support from community health colleges in these events and will review if they are able to continue to provide a placement as the individuals care needs change. The policy in this area was not inspected on this occasion.
Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 13 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) 22,23 The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have good knowledge of adult protection issues, the written policy needs to reflect this. EVIDENCE: Tarrant House has a complaints policy, which explains how the home will investigate any concerns raised. From observations during the inspection it was evident that residents had a positive relationship with staff. Some residents said they could share their worries with staff. The registered manager is keen to encourage residents and their representatives to raise any concerns so that she can then look into them and take appropriate action. Quality assurance surveys and residents meetings are venues were views could be expressed on Tarrant House as well as on an individual bases. Since the previous inspection the registered manager has amended the homes adult protection policy. Further amendments to this document are needed and were discussed with the registered manager. The homes adult protection policy needs to be updated to reflect current legislation and written in line with POVA guidance. The inspector gave the registered manager some advice as to where written information in respect of POVA guidance. Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 14 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) EVIDENCE: Not inspected Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 15 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 Tarrant House ensure that suitable trained staffs are employed in sufficient numbers at all times EVIDENCE: At all times there is a minimum of three carers on duty during waking hours for six residents. At night there are two members of staff who sleep in. A manager is on call at all times. In addition the home employs a domestic three days a week. Maintenance work is contracted out as the need arises. From discussion with staff they commented that they felt that there is sufficient staff on duty. The registered manager stated that the home has not needed to employ agency workers. From observations it was evident that staff have formed positive relationships with the residents and that they were competent in their work. From inspection of staff files this evidence that staff are recruited appropriately and satisfactory checks are made prior to commencing work at the home. Two care staff have enrolled to commence NVQ level 2 course. When this has been completed the home will then have over 50 of staff qualified at this level. Four out of nine care staff have completed the LDAF course; all are trained in the safe handling of medication and are attending a first aid course. The registered manager has developed individual and group training programs with staff and commenced supervision.
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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) 37,38,41,42 The registered manager provides a structure, which creates an open, positive and inclusive atmosphere. The Registered Manager is competent to manager the home. Continuous review of the homes policies is ongoing to ensure that it reflects work practices within the homes to promote residents’ safety and rights. EVIDENCE: Mrs Tarrant commenced the registered manager post in January 2004. She has the Registered Managers Award NVQ 4 and has many years experience in the social care field. She attends training to ensure that her skills are up to date and shares her knowledge with her staff team. Staff spoke positively about her skills and management style. The registered providers are in the process of purchasing a second care home in Cornwall, of which the application is with CSCI for consideration. Due to this Mrs Tarrant is aiming to be the registered manager of this new home and will resign from Tarrant House as the registered manager. Residents, relatives and
Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 17 staff are all aware of these proposed changes. The registered providers and Mrs Tarrant have over the last month inducted a family member, Mrs Taylor, to take on the registered manager responsibilities whilst the post of manager at Tarrant House remains advertised. Mrs Taylor has been a registered provider of her own care home in the past and therefore has experience in social care and learning disability care. The inspector noted that with the current registered manager in post that the home does meet the requirements of the national minimum standards. However due to the proposed changes in respect of management arrangements a requirement to this effect has been made to ensure that the registered providers contact CSCI with the necessary documentation in order for CSCI to assess the proposed management arrangements as fit/ competent. It is evident that the registered manager ensures that residents, relatives and staff are consulted about how they view the service that Tarrant House provides. From inspection of staff files, and discussion with staff they confirmed that they had been a positive induction to the home and that supervision and appraisal processes are in place. Records are kept up to date, accurate and stored in a confidential manner. Previous requirements in respect of regular fire testing, not to wedge open fire doors and for staff to attend a first aid course have all been complied with. Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 18 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 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Tarrant House Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 2 3 x x 3 3 x D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 19 no 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 23 Regulation 13(6) Requirement the registered manager must review Tarrant House adult protection policy and ensure that it includes the local authority adult protection proceedure and DOH No Secrets guidance. the registered providers must inform the Commission in writing of the proposed interim manamgemt arrangements. In addition they must send relevant details of the acting manager to enable their fitness to manage Tarrant House to be assessed. Timescale for action 30.12.05 2. 37 8 (1) (2) 9 (1)(2) 30.09.05 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 Good Practice Recommendations Tarrant House D52-D04 S9093 Tarrant House V233075 040805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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