Inspection on 11/09/07 for Tendring Rest Home

This inspection was carried out on 11th September 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

Tendring Rest Home 05/09/08

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Tendring Rest Home Ringwood Road Netley Marsh Totton Hampshire SO40 7DY Lead Inspector Craig Willis Key Unannounced Inspection 11th September 2007 09:15 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 Tendring Rest Home DS0000069341.V344772.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. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tendring Rest Home Address Ringwood Road Netley Marsh Totton Hampshire SO40 7DY 023 8086 4571 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) Tendring Care Homes Ltd Mrs C P Lacey Care Home 23 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Old age, not falling within any other of places category (0) Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category Dementia (DE) not to be admitted under the age of 60 years. N/A Date of last inspection Brief Description of the Service: Tendring Rest Home is registered to provide care and accommodation twentythree older people, who may also have dementia. The home has nineteen single and two shared rooms, all with en-suite facilities. There are two lounge rooms and a dining room that people living in the home can use. The home is approximately a mile from Totton town centre and is situated on a local bus route. The manager reported that the weekly fees for a place at the home range from £396 to £550. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to the Commission for Social Care Inspection (CSCI). This information included incident reports, an annual quality assurance assessment and comment cards from two relatives. A site visit to the home was made on 11 September 2007. During the site visit the inspector spoke with several residents and observed the interactions between residents and staff. The inspector also spoke with the manager and two members of staff on duty. Communal areas of the home were viewed and documents relating to the running of the home were inspected during the visit. Two immediate requirements were made during the visit, which were followed up with a letter to the provider. These concerned medication records and checks on staff working in the home. What the service does well: What has improved since the last inspection? Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 6 Not applicable. This is the first inspection of this service since the current provider has owned it. 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. Tendring Rest Home DS0000069341.V344772.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 Tendring Rest Home DS0000069341.V344772.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): Standards 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a system for assessing people’s needs before they move in, however, these assessments are not always fully completed. This does not help to assure people that all their needs can be met. EVIDENCE: The manager reported in the annual quality assurance assessment for CSCI that the home carries out a very comprehensive assessment when a new resident wishes to move in. The files of five people who live in the home were inspected during the visit. One assessment had not been fully completed, with many of the sections left blank including, personal care needs, physical well being, personal hygiene and dressing, history of falls, personal safety and social interests. Two of the assessments had been fully completed with the exception of personal history, social interests and hobbies. The sections that had been completed contained clear information about what the person’s Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 9 needs were and how they were currently being met. The manager said it was sometimes difficult getting all of the information requested on the assessment form. Copies of hospital discharge notes were available in some of the files inspected. Two relatives completed a CSCI survey. One said that the home always meets the needs of their relative and one said that the home usually meets their needs. The home does not provide intermediate care and therefore standard six is not applicable. Tendring Rest Home DS0000069341.V344772.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): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive good support to attend health services and staff provide personal care in the way people prefer. The lack of information in risk assessments and gaps in medication records does not demonstrate safe practice. EVIDENCE: The care plans of five people who live in the home were inspected during the visit. These documents set out how people’s needs should be met and were reviewed monthly. Each care plan had a section for risk assessments. It was noted that some hazards had been identified in the care plans, without an assessment of the risk to people or action that should be taken to minimise the risk of harm. Examples include: a plan that refers to a person’s aggression towards staff, but no plan of how this should be managed; a plan that refers to a person’s confusion and attempts to walk out of the home with no assessment Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 11 of the risks and how they should be minimised; and a plan that refers to a person being prone to falls with a history of increasing falls without an assessment of how they should be supported to minimise the risk of injury. Staff spoken with demonstrated a good understanding of people’s needs and action they should take to keep people safe. All residents are registered with a local GP, who visit the home when requested by the staff. People’s records showed that they were supported to attend regular health appointments, both in the home and the community. People who live in the home and a relative spoken with confirmed that people were able to see their doctor when they need to. Medication is securely stored in a locked trolley. The administration records were mostly completed, although there was a gap, where staff had not signed to indicate how many of a blood thinning tablet a person had been supported to take on the day before the visit. The dose of this tablet varies with a different dose being taken on alternate days, so it is important that a record is kept of the number of tablets taken. There was also a gap for the same medication in the previous month’s medication administration record. The manager reported that although medication is checked when it is received from the pharmacist, no record is made of the amount of medication coming into the home. It was therefore not possible to say whether the person had received this medication. All staff administering medication have received training. Records were available of medication that had been returned to the pharmacist to be destroyed. An immediate requirement was made on the day of the visit that accurate records of medication administered to people who live in the home must be kept. The manager reported that one person currently administers their own medication, which they keep in a locked cabinet in their room. No assessment was available to demonstrate that it was safe for the person to administer their own medication and there were no details in their care plan about the support that was required. The manager said she would take action to resolve the problems highlighted. People spoken with said that staff treated them well and provide support in a manner that maintains their dignity. Care plans seen included details of how people have said they want their personal care provided. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good support for people to take part in social activities and visitors are made to feel welcome. A choice of good food is provided and meal times are a relaxed, social occasion. EVIDENCE: The home organises a range of activities including singers, arts and crafts, reminiscence and bingo. There is a selection of books and games available for people to use. A mobile library visits the home every month. People with dementia are supported to take part in activities to meet their needs, with additional support provided where needed. People are supported to practise their religion. People spoken with during the visit said they enjoyed the activities. The manager reported in the annual quality assurance assessment for CSCI that she plans to extend the number of activities that are offered. People spoken with said their friends and relatives were able to visit at any time and were made to feel welcome. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 13 During the visit a mealtime was observed. Staff were observed providing appropriate support to people who needed help to eat and there was a relaxed and friendly atmosphere in the dining room. People spoken with said that the food was good and there was a choice of meals. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems to investigate complaints and protect residents from abuse. This gives residents and their representatives confidence that their concerns will be taken seriously and acted upon. EVIDENCE: The home’s complaints procedure is supplied to residents and their relatives with the service users’ guide. People spoken with said that they were aware of the home’s complaints procedure and were confident that any complaints would be taken seriously and responded to appropriately. Both of the relatives who completed a CSCI survey said the home has responded appropriately to any concerns they have raised. One complaint has been received about the home by CSCI in the last year. This concerned heating during the night, choice about breakfast and freshness of food products. The complaint was passed to the home to be investigated under their complaint procedures. The records of this investigation were viewed during the visit and showed that the complaint had been thoroughly investigated. As a result of the investigation the complaint was not upheld. Staff have received training in adult protection issues and those spoken with demonstrated a good understanding of issues of abuse and action they should Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 15 take if they witness or suspect abuse. There are safeguarding adult procedures in place. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 16 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): Standards 19 and 24. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, safe, well maintained and provides a comfortable and homely environment for people. EVIDENCE: A tour of all the communal areas of the home was made during the visit. The home was clean throughout and people spoken with said this was always the case. New carpets have been fitted throughout the ground floor and first floor hallway. New dining furniture has been provided and the ground floor communal areas have been decorated throughout. The manager reported that bedrooms are being decorated when vacant. The manager reported that as part of the refurbishment of the home a new bathroom will be created on the first floor. There is currently a bathroom on each floor, one of which is adapted to enable people with mobility difficulties to use it. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 17 The home has a separate laundry room, which is fitted with specialist washing machines capable of safely washing soiled clothing. There are suitable handwashing facilities throughout the home. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 18 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): Standards 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are sufficient well trained staff to meet people’s needs, however, the failure to check staff before they are employed places people who live in the home at risk. EVIDENCE: Residents and staff spoken with during the visit said they felt there are sufficient staff on each shift to meet people’s needs. The home has a rota, which showed that there are at least two carers at all times with additional cover from the manager or deputy manager in the mornings. In addition to care staff there are kitchen and cleaning staff. The manager reported that four of the twelve care staff have completed the National Vocational Qualification (NVQ) in care at level two or above and seven are currently working towards the qualification. The manager reported in the annual quality assurance assessment for CSCI that all the people who have worked in the home in the last twelve months have had satisfactory pre-employment checks. The recruitment records of three members of staff were inspected during the visit. Two of these staff did not have a Criminal Records Bureau (CRB) disclosure and one did not have any Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 19 written references. The manager said she thought a CRB disclosure one of the staff had completed through another employer was acceptable and she had not undertaken checks on the most recently employed person as they were a chef who was at the home on trial. An immediate requirement was made during the visit that staff must not work in the home unless suitable employment checks have been completed, including a CRB disclosure. Staff undertake an induction when they start work and other courses, including fire safety, moving and handling, first aid, food hygiene, medication, dementia care, stoma care and catheter care. Staff spoken with said they received good training, which helps them to meet people’s needs. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 20 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): Standards 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems to promote the health, safety and welfare of people who live in the home and staff. The quality assurance systems are not effective and have not identified the areas of concern in this report. This has resulted in some practice that does not protect people who live in the home. EVIDENCE: The manager reported that she is currently completing the NVQ level 4 in care and the registered manager’s award. She has been managing the home for five years and worked there for fifteen years. Staff and residents spoken with said she was good at her job. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 21 The manager reported that the provider has been visiting the service each month to consult with people and assess quality. A copy of the reports of these visits is sent to the manager. Despite these assessments, the areas of concern in this report about the medication systems, staff recruitment, needs assessment and risk assessment systems have not been identified and addressed. The manager reported that the provider plans to introduce a quality assurance system soon, which will assess the quality of the service that is being provided. Questionnaires are currently sent to residents, their relatives and staff. The results of these surveys will feed into the quality assurance system that is being introduced. The manager reported that the home does not hold any money for residents or operate any bank accounts on their behalf. The manager reported in the annual quality assurance assessment for CSCI that that the home’s electric, lift, hoists, heating and fire systems have all been regularly serviced and maintained. The lift, hoists and fire fighting equipment were sampled during the visit and found to confirm the manager’s report. Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14(1) Requirement The registered person must ensure people do not move into the home before their needs have been fully assessed. The registered person must ensure action is taken to minimise the risk of harm from identified hazards to people who live in the home. The registered person must ensure accurate records are kept of: • medication received into the home and; • medication administered to people who live at the home. An immediate requirement was issued on the day of the visit. The registered person must ensure staff do not work in the home unless a full Criminal Records Bureau disclosure or POVA first check has been obtained. An immediate requirement was issued on the day of the visit. Timescale for action 31/10/07 2 OP7 13(4) 31/10/07 3 OP9 13(2) 11/09/07 4 OP29 19(1) 11/09/07 Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 24 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 Tendring Rest Home DS0000069341.V344772.R01.S.doc Version 5.2 Page 25 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. 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