Inspection on 09/10/07 for Tatchbury Manor Nursing Home

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tatchbury Manor Nursing Home 22/11/06

Tatchbury Manor Nursing Home 15/11/05

Tatchbury Manor Nursing Home 13/07/05

Tatchbury Manor Nursing Home 30/11/04

Tatchbury Manor Nursing Home 24/06/04

Tatchbury Manor Nursing Home 05/03/04

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

CARE HOMES FOR OLDER PEOPLE Tatchbury Manor Nursing Home Tatchbury Lane Netley Marsh Southampton Hampshire SO40 2HA Lead Inspector Tim Inkson Unannounced Inspection 09:00 9 October 2007 th 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 Tatchbury Manor Nursing Home DS0000011447.V347640.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. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tatchbury Manor Nursing Home Address Tatchbury Lane Netley Marsh Southampton Hampshire SO40 2HA 02380 812352 02380 814779 tatchmanor@btconnect.com 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) Mr Sewah Singh Adkar Mrs Helen Diane Woodman Care Home 38 Category(ies) of Dementia (7), Dementia - over 65 years of age registration, with number (38) of places Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be at least 50 years of age. Date of last inspection 22nd November 2006 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 residents 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 a staff training room. People interested in living in the home or whose admission is planned/arranged by social and health care professionals or relatives are provided with a copy of the home’s brochure and are invited to visit to view the facilities and meet the staff. A copy of the report of the most recent inspection of the home carried out by the Commission for Social Care Inspection (the “Commission”) is available in an information pack about the home in its entrance hall. At the time of the site visit to the home its fees ranged from £443 to £850 per week. This did not include the cost of hairdressing, and chiropody. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 9th October 2007, starting at 09:00 and finishing at 16:45 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 34 people. Of these 11 were male and 23 were female and their ages ranged from 60 to 96 years and all were receiving nursing care. No resident was from a minority ethnic group. Most people living in the home were unable to communicate meaningfully because of their frailty arising from enduring mental health problems such as dementia. Consequently some time was spent watching the help and support provided to a small group of people at a mealtime. Observations were discussed with the home’s registered manager. The time spent observing the home’s daily life and staff care practices indicated that staff were very patient, empathetic and they always asked individuals questions rather than making decisions for them about what help they wanted. The home’s registered manager was available throughout the whole of the time of the site visit and she was able to provide assistance and information when required. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the registered manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 9th May 2006 such as statutory notices about incidents/accidents that had occurred. What the service does well: Detailed records were in place that gave nursing and care staff information that enabled them to provide the help that individuals’ needed and these plans included reference to essential principles such as dignity and choice. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 6 The home’s routines were flexible and this was illustrated by among other things the fact that there was no expectation that people had to be up or in bed by certain times. People living in the home and their relatives were positive about the food that the home provided and were pleased with the range of activities in which individuals could participate and the condition of the accommodation that people occupied. Anti –discriminatory practice was promoted by the home. Confidence was expressed in the home’s registered manager and management systems and procedures in the home worked well including, care planning, the administration of medication, quality monitoring, and health and safety. There was a strong commitment to staff support, training and development to ensure that they were able to fulfil their roles and responsibilities and meet the complex and diverse needs of people living in the home. 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. The summary of this inspection report can be made available in other formats on request. Tatchbury Manor Nursing Home DS0000011447.V347640.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 Tatchbury Manor Nursing Home DS0000011447.V347640.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The help that people needed was identified before they moved into the home to that the care they required could be properly provided. EVIDENCE: A sample of the records of 5 individuals accommodated at the home was examined including those concerned with obtaining information about the level and type of help a person needed. There was evidence from the documents examined, and also from discussion with visiting relatives that this information was obtained before the people concerned moved into the home. As such it was apparent that admissions to the home were always carefully planned and staff with the appropriate knowledge and skills identified the help that people needed. This was done either by visiting the person wherever they were accommodated before they moved into the home or when a potential resident visited the home. • • “I visited the home with J to look around” “They came and visited Mum in hospital”. DS0000011447.V347640.R01.S.doc Version 5.2 Page 9 Tatchbury Manor Nursing Home The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of individuals’ needs when they actually moved into the home and informed plans of the care and help that they received (see next section “Health and Personal Care”). Where the admission of a person to the home had been made through care management arrangement i.e. with the support of the adults services department of a local authority. The home had sometimes obtained copies of the assessments of the needs of the individual concerned completed by officers of the authority. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure the personal and healthcare needs of people living in the home were met and their medication was managed safely. Among other things staff working practice helped to ensure that residents’ privacy and dignity was promoted. EVIDENCE: The care plans were examined of the same sample of people as in the section above i.e. “Choice of Home”. Among the sample was an individual who had received treatment for a sore/wound. The documents examined were based on the assessments that the home carried out in order to identify what help the individuals needed. Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. Where a pressure sore assessment indicated that an individual was at risk it was noted that the corresponding plan of care identified how this would be addressed e.g. the use a pressure relieving aid. The plans examined also set out in detail the actions staff had to take and where relevant what specialist equipment was needed to provide the support and assistance each person required. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 11 Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. pressure relieving aid; Zimmer frame; hoist; pureed meal. Records indicated that care plans were evaluated every months and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Entries in care plans indicated that the home promoted the essential principles of good social and health care e.g. • “Provide x with privacy in order to maintain dignity”. • “Give Y choice to select clothes”. • “Call X by her preferred name”. There was evidence from documents examined and also discussion with relatives that individuals and/or their representatives were consulted about the development of and agreed the contents of plans of care. Staff spoken to were familiar with the specific needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and to converse meaningfully and relatives/representatives about the abilities of staff the care and support that they provided included: • • • • • “I get all the help that I want … They bathed me yesterday … they arrange for me to see the doctor if I am not well …”. “ … The people are lovely …”. “ … J is very happy here … they keep him nice and clean … “ “The staff are very helpful and very caring … “. “They look after them very well … they get the doctor if she needs one … we looked at other homes but this is where we wanted her to come because of the care …”. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for people when it was necessary. These included, doctors, podiatrists and opticians, psychiatrists and community psychiatric nurses. The home’s registered manager described relationships with local psychiatric services for older people as “brilliant” and she also referred to using other services such as a specialist “leg ulcer nurse” as necessary. Care plans examined included specific details about how the eye, dental and foot care needs of the individuals concerned would be met and where relevant there were other specific plans such as diabetes management. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 12 Individuals’ health was monitored routinely and regularly e.g. weight, blood pressure and temperature and medical equipment was regularly checked and serviced. The home had written policies and procedures concerned with the management and administration of medication. A recent copy of the British National Formulary (BNF) was available for reference and guidance. Medication was kept in locked and secured in a medicine trolley, in a locked room and where required in a medical refrigerator. There were no controlled drugs prescribed for people in the home at the time of the visit but there was a suitable cupboard for storing any should they be required. All medication was dispensed from original containers and the only staff in the home that gave out and were responsible for the management of medication on a day-to-day basis were registered nurses. Good practice noted during the fieldwork visit included: • Recording the temperature of the refrigerator used for storing some medication • Sample copies of the signatures of the Registered General Nurses that dispensed medication Staff were observed giving out medication and they were sensitive doing so and their practice was appropriate and safe. Records concerned with the receipt, giving out/administration and disposal of medication were examined and they were accurate and up to date. The home’s manager expressed the desire to reduce the use of particularly sedative medication for as many people as possible because of some of the undesirable side effects e.g. drowsiness during the day and the subsequent risk of falls. Although the home strongly promoted the independence of residents and if individuals assessed as being able and who wished to could keep, and take their own medication and at the time of the site visit no individuals did so. The privacy of people living in the home was promoted and most people were accommodated in single bedrooms. Screens were provided in shared bedrooms and staff were observed knocking on bedroom doors and waiting to be given permission to enter before going in. Individuals and relatives spoken to described the staff as being respectful and polite. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefited from relaxed routines that enabled them to exercise some choice about their preferred lifestyle. They were able to participate in a range of social and leisure activities and maintain contact with families and friends. The food provided was healthy, varied and nutritious and according to the choices and preferences and needs of individuals. EVIDENCE: The home employed activities organisers and there was evidence from photographs, craft works and a programme of organised events on display in the hall of the home that the home ensured that individuals had opportunities to participate in a range of things that could provide stimulation and interest. On the afternoon of the site visit a representative of a local church called at the home to provide communion and a group of people were observed taking part in activities that were intended to promote their physical and mental well being. The co-ordinators assessed the ability of individuals to take part in organised activities e.g. independently or with assistance, physical activities or whether they wished to do so. Activities were then arranged according to the abilities and needs of individuals. The home had a lot of material and resources that could be used to enable people living there to pursue leisure interests and promote group and individual activities e.g. playing cards, skittles, bingo, table and board games art and craft material. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 14 Visiting entertainers, trips out, pet “therapy”, a visiting library service and visits by clergy of different denominations were some of the other things that took place or were organised by the home. Relatives spoken to said that a lot of activities were arranged by the home and that some were social events to which they were invited. • • “I have been here when activities are on and it is great fun … I have played bingo and they have dogs …”. “They have get “togethers” so that relatives can get to know one another … they had a lovely garden party …”. The manager said that in the previous 12 months the number of activities organisers employed by the home had been increased from 2 to 3 and the hours a week from 32 to 62. Relatives described the routines in the home as relaxed and one resident spoken to said that he was not aware of any “rules” in the home. The manager said that day staff helped people get up in the mornings and night staff helped people to bed in the evening and that to ensure that people were not rushed that breakfast was a running buffet from 08:00 to 10:45 hours. One relative said, “J is allowed to stay in bed in the morning if he wants”. People living in the home and visitors that were spoken to during the site visit said that there were no restrictions on visiting the home. Individuals visiting the home also said that that they were always made welcome. All relatives spoken to indicated that the home was very good at keeping them informed about any issues of concern and helping people maintaining contact. • “A member of staff brought Mum to my daughters wedding and the home paid for the taxi …”. • • “Helen is always at the end of the phone …”. “ … They tell us what is happening which is lovely …”. One way of conveying information to interested parties that the home had developed was a monthly newsletter that was sent out to all relatives of people living in the home. There was information in the entrance of the home about organisations that could provide impartial advice, information and guidance to people living in the home and/or their relatives/representatives. The home did not manage the financial affairs of anyone living there. Individuals were able to bring personal items into the home including furniture and it was apparent from observation during a tour of the building that many people had taken some trouble to personalise their bedroom accommodation. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 15 Sensitive information that the home held about individuals was kept secure and the home had written policies and procedures about maintaining confidentiality and the right of people living in the home to access their personal files and case notes. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with an alternative to the “dish of the day” if that was not wanted by any individual. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals, lactose intolerant and diabetics. The menu for the day was on display in the home’s dining room. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plan documents and the information was also readily available to catering staff in the kitchen. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for pureed meals were prepared separately. Some 22 of the 34 people accommodated in the home at the time of the site visit needed help/assistance or supervision at mealtimes. Consequently the main meal of the day was provided at 2 sittings. The main meal of the day was observed and staff were seen to be sensitive, patient and respectful providing the help that individuals required. Individuals spoken to that were able to converse meaningfully indicated that the food that the home provided was good and relatives were also complimentary about it. • • • “The food is very nice …”. “ Mum enjoys the food …”. “The meals that I have seen seem very nice and they are varied …”. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was displayed in the home’s entrance hall and all people living in the home and/or their relatives were given a copy when they moved in. All visitors spoken to during the site visit were confident about raising any concerns with the home’s manager or any of the senior staff working in the home. A record of complaints made to the home was kept that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been no complaints made to the home in the previous 12 months.. The Commission for Social Care Inspection had received no complaints about the home during the same period. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 17 also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Where subsequent to a risk assessment it was considered necessary for any form of restraint to be used or a persons civil rights to be restricted in any way permission was obtained from relevant interested parties and the decision to take such action was properly recorded e.g. use of bed rails to prevent falls. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable, safe and well maintained. The home’s procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were generally in good repair. There was also no unpleasant odour anywhere in the building. The home employed a part time maintenance operative who checked many of the home’s systems including fire safety and hot water and carried out minor repairs. There were written policies and procedures in place concerned with the maintenance of the building that included procedures for reporting repairs and arranging redecoration. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 19 It was noted that the building had “railings” throughout its corridors and there was equipment available and installed to assist people with poor mobility e.g. assisted baths and hoists. There were 2 passenger lifts in the building providing access to the first floor and all radiators had been covered to provide protection. Since the last inspection of the home completed in November 2006 the number of housekeeping/cleaning staff had been increased. Discussion with people living in the home who were able to have a meaningful conversation indicated that they were content with their bedroom accommodation and the home’s other facilities. Relatives commented positively about the environment and one said: • “It is a lovely building, there is a lot of decorating that could be done, but at least it is clean and I would rather the money was spent on extra staff. My Mums room is ample for her”. There was some discussion about how the environment could be improved particularly concerning orientation aids that may help people with dementia to negotiate the building independently e.g. signs with symbols and colour schemes that can help identify different rooms. The home had started changing the décor in some rooms based on research that had indicated that some colours benefit people with dementia and help with “moods”. The registered manager indicated that planned redecoration for some public areas in the home would also be based on such research. There were some environmental issues that were identified and discussed with the registered manager such as the condition of the window frames in some rooms and the level of lighting in some communal /public areas. The home had comprehensive procedures in place concerned with infection control and it was noted that in accordance with best practice communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The recruitment, training, deployment, level and skill mix of staff ensured that the needs of people living in the home were met and their safety was promoted. EVIDENCE: The care team working in the home comprised, 8 registered nurses (excluding the registered manager) and 13 health care assistants. Out of the latter 11 (i.e. 85 ) had obtained a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2 and 2 were working towards the qualification. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 07:00 to 19:00 2 6/7 8/9 19:00 to 07:00 1 3 4 Registered Nurses Care Assistants Total In addition to the rota set out above there was a care assistant on duty from 16:30 until 22:00 to assist during the late afternoon and evening and to help people going to bed. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 21 The registered manager also indicated that when all the home’s beds were occupied that additional care staff would be on duty. Information provided by the home before the site visit took place indicated that 9 care and nursing staff had left the home in the previous 12 months. A number of the individuals that left were nurses that had trained abroad and who were doing overseas nurses adaptation courses at the home. On completion of that training and getting their nursing registration in the United Kingdom they had to find employment elsewhere. This accounted for most of the staff turnover. Other staff employed in the home included: • Activities co-ordinators • Administrator • Chefs • Kitchen assistant • Cleaners • Laundry assistants The home’s registered manager worked 5 days a week and this included weekends and evenings in order that she could be available to meet visitors and relatives. The manager was supported by an Operations Manager who also carried out statutorily required monthly visits to the home on behalf of the owner of the home. Records were examined of 4 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 22nd November 2006. It was apparent that in all cases the necessary pre-employment checks to ensure among other things that they were suitable to work with vulnerable adults had been completed before they had unsupervised access to people living in the home. All new staff received comprehensive induction training and health care assistants completed a common induction standards programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care. It was apparent from discussion with the home’s registered manager that she was wholly committed to staff development and training and provided and led a lot of training in the home herself. The home had a staff training and development programmes based on individuals training needs that were identified through appraisals and individual supervision sessions. Conversation with staff and records that were examined indicated that in addition to their induction training they had all attended training in dementia care and adult protection as well as a range of health and safety subjects They also attended training in subjects that ensured that they kept their clinical Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 22 knowledge (where relevant) and other skills up to date and were able to meet the specific needs of people living in the home. Staff comments about their induction and further training opportunities included: • “We do lots and lots of training and it keeps us up to date”. • “The training is very good, very useful and it makes me feel confident about working with the older people”. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’ registered manager was a registered nurse and had several years experience of working in and managing nursing homes. She ensured that she kept up to date with developments by attending study days and seminars. She had a relevant management qualification that indicated that she had the knowledge and skills necessary for the role. From discussion with staff, people living in the home and visitors it was apparent that the registered manager was; knowledgeable; organised; highly motivated; enthusiastic; concerned; held in high regard; and understood her role, responsibilities and legal obligations. Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 24 Comments from individuals about the registered manager’s approach and qualities included the following: • “Since Helen has been here it has improved a lot … she is always at the end of a phone … last year I came and the central heating was down, but within the hour Helen and her husband had it sorted …” (visiting relative). • • • “Helen is good, she helps us if we have a problem … I could speak to her in confidence … “ (member of staff). “She is good … she understands well and helps us … we can go to her and ask questions … she has good knowledge … ” (member of staff). “She is very nice …” (person living in the home). The home had systems in place for monitoring the quality of the service that it provided including the use of audits of its systems (e.g. care plans, medication system, accident analysis and wound care reviews) and regular canvassing of interested parties for their views about the home. There were also regular meetings for staff working in the home enabling them to air their views about they way the home was run. The home had a range of written policies and procedures that informed staff working practices including the following: • Infection control • Whistle blowing • Equal opportunities • Sexuality and relationships • Religion • Maintenance of the home In its brochure the home included its aims and objectives the home referred to some areas covered by its policies and among other things stated the following: “To provide an environment in which residents emotional and spiritual needs can be met … to ensure anti-discriminatory practices are encouraged and followed within the establishment in terms of race, religion, age and gender”. The home did not look after any money on behalf of people living there. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. Staff said that they attended regular and compulsory fire and other health and safety training and records examined confirmed this. There was a fire risk Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 25 assessment for the premises and regular safety audits of the premises were carried out. The home’s registered manager was an accredited moving and handling trainer and there were hoists, and other equipment in the home to promote safe working practices Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 26 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X N/A X X 3 Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tatchbury Manor Nursing Home DS0000011447.V347640.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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