CARE HOMES FOR OLDER PEOPLE
Taymer Nursing Home Barton Road Silsoe Beds MK45 4QP Lead Inspector
Ansuya Chudasama Announced 26 April 2005 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. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Taymer Nursing Home Address Barton Road Silsoe Beds MK45 4QP 01525 861833 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) Pressbeau Ltd Linda Jordan Care Home with Nursing 33 Category(ies) of OP - Old Age (33) registration, with number PD(E) - Physical Disability - Over 65 (33) of places Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd August 2004 Brief Description of the Service: Taymer is a purpose built Nursing Home situated in the Bedfordshire village of Silsoe which lies off the A6 road between the towns of Bedford and Luton. The home is situated in rural grounds overlooking the Bedfordshire countryside. The home has been extended to accommodate 33 service users. The home provides care for elderly people with physical disabilities and medical conditions. The home is staffed with qualified nurses and carers who provide a range of services to aid and improve the physical wellbeing of the service users. The home provides eight single bedrooms with en-suite facilities, 17 single bedrooms without en-suite facilities and five double bedrooms. Each room was fitted with an electronic nurse call system. The home had a Parker bath, an Arjomechanaids air bath and standard baths. The three main reception areas consisted of a TV lounge, a quiet study room and a conservatory. The home had attractive surrounding gardens with parking facilities available. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was undertaken by two inspectors and started at 09.30am. It took place over 8 hours. The manager spent a few hours in the morning with the inspectors to discuss the changes and work that had been undertaken in the home. However the manager had to leave early due to unforeseen circumstances. The inspectors spent the majority of the inspection observing practice and speaking to service users, staff, and a visitor. The care records of three service users and other documents were also examined, and a tour of the premises took place. Feedback was given to the nurse in charge and to the co-proprietors. What the service does well: What has improved since the last inspection?
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 6 The home had reduced some of the bathrooms and toilets and a lounge to increase the number of single bedrooms being offered to potential service users. Single rooms offered service users privacy and independence and the option to have their rooms individualised to meet their needs. The numbers of shared bedrooms were reduced from 8 to 5 rooms. The communal areas in the home had been decorated and re-carpeted and looked very pleasant and provided a homely atmosphere. A fire plan had been developed and provided staff information on how to deal with any emergencies. The manager had developed a new moving and handling assessment form to ensure that each service users needs were recorded in detail and met by the staff. 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. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The home’s brochure and service user guide and introductory visits provided potential service users, and their representatives with details of the services and facilities the home provided. This enabled them to make an informed decision about admission to the home. EVIDENCE: The home’s brochure/statement of purpose and a service user’ guide were displayed on the notice board. The manager stated that these documents were sent out to perspective service users or their representatives and they were also encouraged to visit the home. Some of the service users spoken to confirmed that they had visited the home but they were not aware of the service users’ guide or had seen a complaints procedure. It was suggested by the inspectors that the home needed to hold service users’ meetings to make them aware of these documents. Both documents needed developing further to include all the information stated in Standard 1and Schedule 1 of the Care Homes Regulations 2001. There was evidence of needs led assessments being carried out by experienced staff on service users admitted to the home. The home did not admit any service users whose needs they could not meet. Relevant information was also obtained from other professionals involved in the care of the service users.
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 9 Each service user had been provided with a statement of terms and conditions when they moved into the home and they or their representative had signed the agreement. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 910 The care plans illustrated that service users received good standards of care with a need for further development in some areas. Conversations with service users showed that their needs were being met. EVIDENCE: Individual plans of care were available for all service users who were case tracked. The plans were drawn up by nurses and reviewed on a monthly basis. The format used for recording the information was good. The detail, content and quality of recording differed between files. Some plans were very detailed but some needed more personal details and needed to be inclusive of needs identified on the care plan index. It was also found that some information identified in the assessment was not recorded in the care plan. One service users’ care plan did not state how the person’s dementia was being managed. However care records inspected showed that a community psychiatrist nurse had been involved in the care of the service user. The information recorded in the care plans was good. Service users spoken to were not aware of what care plans were and they had not been involved in process. One of the care staff spoken to had also not seen a care plan. However, one member of staff gave good detailed examples of how the care needs of a service user that she worked closely with were
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 11 being met. The care staff stated that they were able to write in service users daily contact sheets and the nurses signed this. The care staff did not have their own communication book but a communication book was available for nurses to record messages. Records showed that the healthcare needs of service users were promoted and maintained by the appropriate involvement of health professionals. The service users informed the inspector that the staff treated them with respect and they also knocked on their doors before entering their rooms. The service users appeared well dressed and it was confirmed by them that they wore their own clothes and their clothes were nicely laundered. The medication records seen were satisfactory. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 12 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) 12,13,14,15 Service users were offered excellent home made varied and nutritious meals to ensure they remained healthy. The home provided weekly activities and monthly social events so service users could enjoy a normal range of activities. EVIDENCE: The inspectors had lunch with the service users. The lunch was eaten in a relaxed atmosphere. The food sampled was delicious and all service users spoken to confirmed that the meals provided were excellent. The care staff were observed feeding service users in a sensitive and encouraging manner. One service user dropped their knife on the floor three times and the person stated that they found the knife heavy to hold. Ten service users sat in the dinning room to eat their lunch. However the rest of the service users sat in their chairs and had their lunch. The reasons for this needs to be stated in the service users care plans. One member of care staff provided two hours activities in the afternoons. However a weekly activities list was not displayed in advance for service users to know what activities were going to be undertaken. A social events calendar for monthly events was displayed and it was stated that these were very good events. Service users’ comment cards received, and some of the service users spoken to, stated that they wanted to go out on outings and wanted more suitable activities to be provided. The activities organiser spoken to had
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 13 started collecting information on all service users likes and dislikes of activities by asking families, friends and the service users. The activities information file shown was very detailed. The activities organiser was also due to go on an activities course with some other staff. The manager stated that the hours of the activity organiser was going to be extended to a full time position in three months. The home did not have service users’ meetings. The manager stated that she held an open surgery on a monthly basis for service users and families to discuss issues on an individual basis. Records showed that service users’ families and friends visited them at the home. Service users finances inspected were well managed and recorded by the home. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 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) 16,17,18 There were systems in place to ensure that service users were protected and complaints were listened to and dealt with satisfactorily. Improvements were needed in the training of staff, in order that they fully understood certain areas of practice. EVIDENCE: The service users and a family member spoken to, were able to speak to staff or the manager if they had any concerns about the home. This was also stated in the service users’ comment cards. The complaints book inspected showed that the complaints recorded had been investigated by the home in a satisfactory manner. The staff spoken to had been given a copy of the whistle blowing procedures and a copy was also displayed at the front entrance of the home. However they had not received training on the protection of vulnerable adults policy (POVA). The staff spoken to had also not received training on how to deal with aggression. It was also stated that the home had service users who were aggressive but there were no written guidelines available in the service users’ file to show how this aggression was being managed. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 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) 19,20,21,22,23,24,25,26 The environment was well maintained, homely and comfortable and met service users needs. EVIDENCE: The home was purpose built and met the needs of the service users. Service users were observed accessing all parts of the communal areas safely. Furnishings of communal rooms were of a good quality. There were adequate number of assisted toilets, and bathing facilities provided for service users. The hoist kept in the corridor needed to be stored in a suitable and safer place. Service users’ rooms seen were individualised to meet their needs. The service users stated that they were able to bring in their own personal items to make their rooms more homely. The rooms had adequate lighting and ventilation with no unpleasant odours. The home had increased their single rooms and reduced their double rooms from 8 to 5 rooms. The number of bedrooms had also been increased from 32 to 33 rooms. Service users had lockable draws but none of them had locks on their doors. One service user
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 16 stated that they had a valuable item stolen from their room and this was very upsetting. It was suggested by the inspectors that the bathrooms doors should be locked from the inside by staff when providing personal care. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 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, 28, 29,30 There were sufficient number of staff with relevant training to ensure that the needs of the service users were met. EVIDENCE: Information from the pre-inspection questionnaire showed that the home was meeting the staffing ratio to service users. The home had 8 first level registered nurses, 17 care staff, and 19 ancillary staff. Two care staff had NVQ level 2 or above. The manager stated that six staff had registered last week to undertake NVQ level 2. Three staff were undertaking NVQ level 3. The manager needs to ensure that 50 of the care staff meet the NVQ training by 2005. The staff files randomly inspected showed that one file did not contain two references. However all other aspects of the recruitment procedures were satisfactory maintained. The information in the files needed to be better filed. A training list for staff for the whole year was seen. However the staff training and development manual had not been completed for all staff. The staff spoken to had not attended training on dementia care, POVA, dying and death, and aggression. All staff spoken to were very happy working at the home and observations showed that positive relationships had been formed between staff and service users. It was also stated that the home was more settled and staff worked
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 18 well together. The home had a hand over on each shift, however no extra time had been built in for. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 19 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) 31,32,33,35,36,38 The home was well managed to ensure the needs of service users were met. EVIDENCE: The management approach was described as being open and very positive. The manager was very experienced and had worked hard to maintain the home to a high standard. The staff spoken to stated that the manager was supportive and she had good leadership skills. Some of the staff spoken to had not received supervision or an appraisal. The manager stated that she had been unable to undertake this task with all the staff because she did not have a deputy manager. At present she had to manage her responsibilities and those of the deputy manager. However ten staff had received training on appraisals and they were due to undertake this task with staff in the near future. The position of deputy manager had been advertised but the home had not received any suitable applicants. The manager had appointed two nurses to deputise in her absence. Evidence from reading staff files and observation on the day of the inspection showed that a deputy manager was needed to
Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 20 manage the clinical side of the care. The inspectors found that the head chef was very helpful in providing information about the home. The manager had started work on completing information on quality assurance, and had completed 85 of the information. It was also stated that service users questionnaires were on a regular basis randomly sent out to service users’ families. Service users’ families and the funding authority managed their finances. The money checked on the day of inspection was correct and records were well maintained. The organisation was looking at opening a bank account in the name of the home to provide better security in keeping service users money safe. At present the money was kept locked in a filling cabinet. The inspector was informed that individual bank statements in service users names were going to be sent to the next of kin. Fire alarm testing, emergency lighting, and fire drills were being carried out on a regular basis. The names of people involved in the fire drill needed to be recorded to show which staff had been involved in the drill. The service users spoken to were not aware of the fire procedures. The hot water in bathroom 41 was very hot and the tap was leaking. The inspectors were informed that this was going to be dealt by the maintenance man today. Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 21 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 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 3 3 2 3 3 Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP36 Regulation 18(2) Requirement Timescale for action .31/7/05 2. OP27 18(1) (c) 1 12(4)a, 13(4)c 3. OP24 The registered provider must implement a system for supervision, appraisal, and clinical reflection for care staff and nurses. the target date of 30/10/04 was not met. The registered provider must 31/8/05 provide staff training on dementia, POVA, agression and dying and death. The registered person must 31/7/05 provide locks for all service users who wish to lock their bedroom doors within a risk assessment process. 4. 5. 6. 7. 8. 9. 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 Good Practice Recommendations
I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 23 Taymer Nursing Home 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Standard OP27 OP38 OP29 op15 op12 op12 op22 The registered person should provide evidence that the service user or their representative have been fully involved in the assessment and care planning process. The registered person should ensure that the names of staff involved in fire drills are recorded and involve service users in fire procedures. The registered person should ensure two references are obtained for all staff The registered person should provide information in service users care plans for reasons why some service users sit in their chairs to have their meals. The registered person should provide a weekly activities list and ensure this is displayed where service users can view it. The registered person should introduce service users meetings. The registered person should provide suitable storage space to accomodate the hoist Taymer Nursing Home I51 S42234 TAYMER V213946 260405 - Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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