CARE HOMES FOR OLDER PEOPLE
Tatchbury Manor Nursing Home Tatchbury Lane Netley Marsh Southampton Hampshire SO40 2HA Lead Inspector
Sue Maynard Unanounced 13 July 2005, 09:00
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tatchbury Manor Nursing Home Address Tatchbury Lane, Netley Marsh, Southampton, Hampshire SO40 2HA 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) 02380 812352 02380 814779 tatchmanor@ic24.net Mr Sewah Singh Adkar Robert William Roberts Care Home 38 Category(ies) of Dementia (7) registration, with number Dementia - over 65 years of age (38) of places Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service users in the category DE can only be admitted from the age of 50 years. Date of last inspection 30/11/04 Brief Description of the Service: Tatchbury Manor Nursing Home is situated close to the village of Netley Marsh in the New Forest. The old wing of the building is of historic interest being over 1000 years old. The building has been extended and renovated over the years and now provides accommodation for 38 services users with dementia. The home stands in extensive grounds and the rear garden has a large pergola and patio area. Separate buildings in the grounds house the laundry and training room. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home’s first inspection for this year took place on July 13th 2005 between 09.00 and 13.45. The visit was unannounced. During the inspection discussions took place between people living in the home and their visitors, staff members on duty and the registered Individual for the home. Various records were seen by the inspector including staff recruitment records and care records for the residents. The inspector toured the building and observed staff and their working practices. The scores, requirements and recommendations made in this report reflect the findings at the time of the inspection. What the service does well:
The residents and their families can be assured that the home will be able to meet their needs. For example staff members are trained in dementia care and are well supported by the registered manager who has a great deal of experience in this area of care. Some of the residents were able to tell the inspector that they felt safe and well cared for. Visitors to the home were able to confirm this. Staff members treat the residents in their care with great respect and give support sensitively. There is a very varied programme of activities and events that are enjoyed by the people living in the home. Consideration is put into the planning of this programme to ensure that the residents will enjoy the activities. The home employs staff from overseas. The manager has compiled a very comprehensive training programme for these staff to ensure that they feel welcome and reassured in the new surroundings. The training programme includes English language awareness both written and spoken. The home has employed someone to work with the new staff to make them aware of cultural differences especially with assisting the residents to choose the appropriate clothing at different times of the year and dietary differences. The manager is very committed to providing a high standard of training to all his staff to ensure that staff who achieve their United Kingdom nurse
Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 6 registration are able to leave the home and enter any branch of health care with confidence. What has improved since the last inspection? What they could do better:
At the time of the visit the home was having problems recruiting domestic staff and the general cleanliness of the home was found to be poor. Some of the furniture in the home, especially many of the armchairs, were in a poor state of repair or were not suitable for the comfort of the residents to be seated in for long periods of time. Security of medications needs to be reviewed and trained staff must be made aware of their responsibility to ensure that all cupboards that should be locked are secure at all times. Further training for staff with regard to what must be done in the event of an allegation of abuse is needed for all staff working in the home. Some training is given during the induction period but for some staff this has not been updated. Staff must be made aware of their duty of care with regard to the correct use of gloves and aprons when delivering personal care to residents in the home. The inspector noted poor practice. Staff was not discarding their gloves and aprons before entering another residents room. This was brought to the attention of the registered manager following the inspection. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 7 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. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Standard 6 does not apply to this service. Standard 3 was not inspected at this time. A statement of purpose and service users guide are available for to provide the information that enables prospective residents and their families to make an informed choice about the suitability of the home. EVIDENCE: The registered manager makes available to all prospective residents and their families, an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home; and provides a service users’ guide to the home for current and prospective residents. These documents are reviewed annually and the information is updated to reflect the any changes in the home, for example, changes to staffing and management within the home, any changes made within the building. A copy of these documents was seen to be available in the reception area of the home.
Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 10 Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 and 9 Comprehensive assessments form the basis for care plans that ensure that all residents care needs are addressed and are met. Shortfalls in the correct storage of medications and equipment have the potential to put residents at risk. EVIDENCE: The home has robust systems of risk assessments and care planning. Psychological, nutritional, manual handling and dependency are just some of the comprehensive assessments undertaken for all residents in the home and these form the basis for the individual care plans ensuring that all residents care needs are addressed. The home liaises with other health care professions, including district nurses, tissue viability nurses, opticians and dental care providers, to ensure all aspects of the resident’s care are monitored. It was noted during the inspection that the door to the medication storage area was found to be unlocked and wide open. The storage area contained equipment and substances that would be potentially harmful to residents. A storage cupboard within this area had not been correctly secured and was also
Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 12 able to be opened. The fridge for the storage of medications, that require a low temperature, was also found to be unlocked and also required defrosting. Outside this storage area it was noted that there were two oxygen gas cylinders, which were being stored insecurely. Neither of the cylinders was prescribed for a resident currently in the home. It was noted by the inspector that the copy of the British National Formulary, which provides information for staff with regard to current medications, was out of date. This was brought to the attention of the senior trained nurse on duty and he was advised to obtain a current copy. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 The residents benefit from social activities in the home which provide daily variation and interest for them. EVIDENCE: The home employs a full time activities co-ordinator who plans a varied programme of activities with the residents to ensure that their wishes are always considered. The inspector spoke with residents who were sitting on the patio and were looking forward to having their lunch there. A visitor who was sitting with the residents commented “ there is always something going on for the residents to enjoy”. The Social and recreation department produced a newsletter explaining their aims and objectives for the activities that are to take place over the coming weeks. Links with the local community and churches have been established. The programme of activities is varied and includes visits to local places of interest, a visiting pet therapist and therapeutic massage, for those residents who consent, of their hands and feet. All activities undertaken are documented in a specific care plan. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure for the home ensures that all complaints are acknowledged and handled objectively. The vulnerable adults procedure ensures that any allegation of abuse will be addressed appropriately but would be further enhanced by updated staff training. EVIDENCE: The home has a detailed complaints procedure and records are kept of all complaints that are received by the home. It was reported that no complaints have been received by the home since the last inspection. The Commission for Social Care Inspection has received no complaints against this home since the last inspection. The home has a procedure for responding to allegations of abuse. Some staff members spoken to by the inspector did not appear to be fully aware of this procedure and the implications for not adhering to it. They stated that they had not received any recent training update, since their induction programme, with regard to abuse awareness. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The arrangements for the maintenance and cleanliness in the home have not been sufficient as to provide the residents with clean and comfortable surroundings. EVIDENCE: It was reported to the inspector that the programme of re-decoration of the home is ongoing but a number of areas within the home require some immediate attention, in particular: • Wall surfaces and skirting boards show signs of damage by wheelchairs and need to be repaired and repainted. • Water damage to an area of ceiling needs replacing and redecorating. • The main lounge requires redecoration and the curtains need cleaning and re-hanging. Carpets in this area need replacing as they are stained and there is a strong smell of urine in this area. • Several damaged and unclean arm chairs were seen in the lounge and in residents bedrooms. • Curtains in many bedrooms require attention and also need re-hanging.
Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 16 • • • • • • The toilet leading off the treatment room was very dirty, the floor needed cleaning and the door could not be closed to allow residents total privacy when using this area. The treatment room itself was generally very unclean. In the staff rest room the area was not clean. The cupboard under the sink was dirty and contained a container of prescription cream with the name label in place but with the residents name erased. The general standard of cleanliness and hygiene through the building has deteriorated, especially in bathroom and toilet areas. The floor in the dining room was very sticky underfoot and fruit drinks had been spilt and not wiped up. Wheel chairs in use by the residents in the home were noted to be unclean and had food debris stuck to them. Only one cleaner was seen during the inspection and it was reported to the inspector that the home is having a problem with the recruitment of domestic staff due to the rural location of the home. The kitchen area of the home has had undergone some refurbishment and this area was found to be very clean and tidy with all foodstuffs and cleaning materials stored appropriately. The grounds of the home are well maintained and provide the residents with a pleasant area to sit and enjoy the rural location that the home is situated in. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The number of domestic staff employed in the home is not sufficient to maintain the standards of hygiene. The recruitment procedure is robust and safeguards the protection of the residents living in the home by the employment of suitably qualified staff. EVIDENCE: At this time the home has problems recruiting domestic staff and this is reflected in the general lowered standard of cleanliness throughout the home. The home has a robust recruitment procedure. The majority of the care staff in the home are recruited from overseas. In the samples of staff records seen by the inspector there was evidence that references had been obtained, there was proof of personal identity and where required Home Office work permits had been obtained. Criminal Records Bureau checks are obtained for all staff working in the home. Some of the residents spoken to were able to tell the inspector that the staff were kind and caring. This was confirmed by visitors to the home who said their relatives were very well looked after and that the staff were always available to assist the residents. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38 Staff are appropriately supervised and their care practices are regularly monitored. All safety checks are completed on a regular basis to promote the safety of residents and staff EVIDENCE: A requirement was made from the last inspection that staff should be appropriately supervised. The staff now receive regular supervision every two months. Records of the supervision are kept in confidential staff files. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 19 Prior to the inspection concerns were raised by a member of the public about staff not removing gloves and aprons after providing care to a resident before entering the room of another resident. Staff were observed by the inspector and staff were seen carrying out this practice. When questioned about this they were reluctant to discuss this with the inspector. This practice was brought to the attention of the registered person present who stated that all the staff had received infection control awareness the previous week. She told the inspector that all staff would be reminded of the training and that staff would be observed whilst working and delivering personal care. Fire safety records were seen by the inspector and were found to be in order. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x 3 x 2 Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 21 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 OP 9.1 Regulation 13(2) Requirement The registered person must ensure that all medicines and medical equipment are stored securely at all times. The home must be kept in a good state of repair both internally and externally. The registered provider must ensure home provides appropriate seating for residents both in communal and private accommodation areas. The home must be kept clean, hygeinic and free from offensive odours throughout. The home must ensure that domestic staff are employed in sufficient numbers to ensure that the home is maintained in a cleanand hygeinic state at all times. The registered person must make suitable arrangements to prevent the spread of infection in the home Timescale for action 1-8-05 2. 3. OP 19.1 OP 24.1 23(2)(b) 16(2)(c) 13-9-05 30-9-05 4. 5. OP 26.1 OP 27.7 16(2)(j)(k ) 18(1)(a) 13-8-05 13-8-05 6. OP 38.2 13(3) 13-8-05 Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 22 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. Refer to Standard OP 9 OP 9 OP 9 OP 18 Good Practice Recommendations The fridge used for the storage of medications should be regularly defrosted to ensure that the correct temperature is maintained. A current copy of the British National Formulary should be obtained. Medical gas cylinders should be returned to the pharmacy when no longer required by a resident. Regular training updates for all grades of staff should be implemented to ensure that they are aware of the procedures and protocols to follow when an allegation of abuse is made. Tatchbury Manor Nursing Home H54 S11447 Tatchbury Manor V237884 130705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Hampshire Area Office 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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