CARE HOMES FOR OLDER PEOPLE
Tenterden House Lye Lane Bricket Wood St Albans Hertfordshire AL2 3TN Lead Inspector
Mr Tom Cooper Unannounced Inspection 12:20 17 January 2006
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 Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 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. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tenterden House Address Lye Lane Bricket Wood St Albans Hertfordshire AL2 3TN 01923 679989 01923 680 517 strandee@bupa.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) BUPA Care Homes Limited Mrs Andrea Stranders Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (13), Terminally ill over of places 65 years of age (3) Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home may accommodate 5 people (aged 50 years or more) who require convalescent nursing care. 8th September 2005 Date of last inspection Brief Description of the Service: Tenterden House is a period country house that has been extended and modernised whilst retaining the features and atmosphere of the original building. Service users are accommodated in single bedrooms, although one is designated as a double room. Thirteen bedrooms have en-suite facilities. Assisted bathing and assisted toilets are also provided. Communal space includes two lounges, a dining room and an activities room that is used for most of the activities events in the home. Well maintained level gardens surround the building, with lawns, flowerbeds, a patio area, a pergola and views over mature parkland. Interior decor is consistent with the country house style of the building, with pictures, ornaments and fresh flower arrangements contributing to the attractive environment. Adequate car parking is available. The home is located on the outskirts of Bricket Wood in a rural setting between St Albans and Watford. There is convenient access to both the M1 and M25 motorways. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Tenterden House is a care home with nursing, owned and operated by BUPA Care homes Limited, a private provider. This was the second inspection for the year 2005/6 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The last inspection was carried out on 8thth September 2005. This unannounced inspection took place over one afternoon/early evening on a weekday. Discussions were held with service users, visiting relatives and members of staff on duty including the manager, nursing staff and care assistants. Documentation examined included samples of service users’ care plans, staff recruitment records, complaints and fire safety records. Staff were observed working with service users and a brief tour of the premises was made, including visiting a dozen residents’ bedrooms and the laundry. The inspection indicated that the home was being run smoothly, with contented and well cared for service users and good staff teamwork, lead by the new manager who had been in post for approximately four months. What the service does well:
Many of the service users were unable to communicate verbally due to their medical conditions, however all those who expressed views said that they liked the home, mostly praising the food provided and describing the staff as particularly helpful, caring and respectful. They also felt staff were able to care for them in the way they preferred. Staff described teamwork as good and confirmed that the reporting system from shift to shift ensured that they were kept up to date with the changing needs of service users. Staff were knowledgeable about individual needs, lead by the manager who clearly already knows the residents well. Care plans are in place for each service user. These provide a fair overview of individual needs and the actions planned to meet them. Examples seen had been updated regularly. Service users have good opportunities to engage in a wide range of stimulating activities, coordinated by specifically designated staff, including one to one attention and conversation as well as games and occasional outings. Those attending the afternoon activity session said they found the various activities stimulating and enjoyable.
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 6 The premises are clean, fresh and well maintained throughout and suitable for elderly residents with restricted mobility. The various lounges and other communal spaces are comfortable and safe. Bedrooms are suitably furnished to suit individual needs and tastes. Special equipment is provided as necessary. Heating, ventilation and lighting are adequate and safe. The home was warm in all areas on the day of the inspection. Staff confirmed that mandatory training had been kept up to date, for example in moving and handling, fire safety and so on. New recruits are thoroughly vetted prior to employment and receive a comprehensive induction to ensure they are competent to carry out their duties. The manager is a qualified nurse and provides consistent leadership to the team, and the senior team will be strengthened when the new deputy manager starts work. Staff said they felt well supported by senior colleagues and felt communications were good. However formal supervision remained patchy due to the recent turnover of senior staff (see recommendations). What has improved since the last inspection? What they could do better:
The only concern raised by service users was regarding the occasionally long response times to nurse alarm calls. The manager should reinforce the importance of quick response times to staff. Although reportedly improving, the frequency of one to one supervision sessions for care staff should be increased to meet the standard of six times per year.
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 7 All documents placed in service users’ files should be dated to indicate their relevance and all risk assessment documents should be reviewed at least annually and this should be recorded. 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. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Adequate information is available to prospective service users and their relatives/advisors to enable them to make an informed choice about whether the home is somewhere they would like to live. Contracts are issued to all residents on admission. All admissions are made following a thorough assessment of the individual’s needs. Prospective service users may visit the home prior to admission to assess the service and judge whether it will be suitable. EVIDENCE: The home has a statement of purpose and service user’s guide that contain the required information and these are available to service users. Contracts of occupancy are held on resident’s personal files. The manager or one of the trained nurses assesses the needs of prospective service users prior to admission and the assessment is used to inform the initial care plan. An example of a pre-admission assessment was seen on the personal file of a recently admitted service user. Residents spoken with and two visiting relatives said that visitors were able to visit freely and could be entertained in
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 10 any of the lounges or the garden. Staff were said to be most friendly and welcoming. The home does not provide intermediary care. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Service users’ needs are set out in individual care plans covering medical, health details and personal care needs, with risk assessments in place for nutrition, falls, pressure sores, moving and handling etc. and instructions to staff on how to proceed. However risk assessments should be updated regularly. Staff continuously monitor service users’ health care needs and take action as appropriate. The home has sound policies and procedures for the safe management of medication that ensure service users are protected and receive medicines as prescribed by their GPs. The arrangements in the home for health and personal care are such that service users feel they are treated with respect and that staff promote their privacy and dignity. However call bell response times should be improved. EVIDENCE: Service users looked well cared for, were neatly dressed and had tidy hair and fingernails. Those spoken with said that staff were kind and caring and in general treated them with great respect for their dignity and privacy. The only concern raised by them was in respect of the occasional long waits for
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 12 attention from staff in response to pressing the nurse call buttons. This issue was also raised with the CSCI independently of the inspection by a resident’s relative. The manager accepted that there was room for improvement in this area and had requested an upgrade of the call system to one with a record of response times to facilitate monitoring of practice. See recommendations. Care plans seen were in generally good order, with clear descriptions of individual needs in all major care areas such as medical, personal care requirements, eating and drinking etc and corresponding instructions on how to meet them. Basic details of spiritual and cultural needs were included on all examples viewed, although the manager explained that more specific forms were now being introduced for recording such details more fully. The home has a comprehensive medication policy and operates sound procedures to ensure that staff handle medication correctly. Following a recent complaint a full medication audit had been carried out by the company and several recommendations implemented. The Operations Manager had also checked and reported on the medication practice of the home at successive monthly monitoring visits since October 2005. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users are able to lead stimulating lifestyles with staff support as necessary. Numerous suitable activities are provided that take into account the interests and abilities of service users. Service users can maintain social and family contacts and staff are welcoming towards visitors. Service users receive a wholesome and nutritious diet that corresponds to individual assessed and recorded needs, with a reasonable level of choice. EVIDENCE: Service users and visitors spoken with expressed general satisfaction with the lifestyle available in the home, including the range and scope of recreational and occupational activities provided. The activity room provides an excellent forum for organised activities and there were three dedicated staff on duty on the afternoon of the inspection. Much one to one attention is given to service users in recognition of individual needs for conversation and intellectual stimulation. Service users generally praised the food provided and two rated it “wonderful”, although two others felt the menus were rather bland and the presentation of dishes was poor. However the menus indicate a well balanced and nutritious diet.
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 14 Visitors spoken with said that staff encourage regular contacts with service users and were always welcoming. Staff attitudes towards residents observed during the inspection were commendable, with great empathy shown to those with verbal communication problems. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 16, 18 Adequate procedures are in place to ensure that complaints are dealt with appropriately. Service users feel that any issues they raise will be listened to, taken seriously by staff and management and acted upon. Policies and procedures in place and staff training is provided to ensure that service users are protected from abuse. EVIDENCE: Details of the complaint procedure are contained in a BUPA leaflet as well as the statement of purpose and service user’s guide, all of which are available on the premises to residents and relatives. All the service users asked said that they knew how to make a complaint should it be necessary and expressed confidence in the likely response from the manager and the organisation. Two complaints had been recorded since the last inspection and there was ample supporting documentation to indicate that the manager had responded appropriately. In both cases well considered action plans had been devised and implemented designed to improve care practice and relationships in the home. The home has an adult protection policy and a whistleblowing policy. A copy of the Hertfordshire inter agency adult protection procedure is kept in the home. The manager has arranged for adult protection training (starting in February 2006) for the qualified nurses, who will then do some in-house training for the rest of the team. The subject is covered during the staff induction programme and also as part of the NVQ2 course undertaken by a number of staff.
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 25, 26 The building is suitable for the needs of elderly and physically disabled service users, providing a safe, well-maintained and comfortable environment. The home has numerous fully accessible indoor and outdoor communal facilities. The home is clean, tidy and odour-free. EVIDENCE: During a brief tour of the building the inspector established that the premises were well maintained and decorated, providing an accessible, spacious, safe and comfortable environment suitable for the needs of people with restricted mobility including wheelchair users. Service users said they liked the building and especially the lovely grounds, which offer an invaluable extra space in fair weather. In response to the recommendation made in the last inspection report, the manager had arranged for locks to be fitted to bedroom doors, with keys available to residents on request, subject to a satisfactory risk
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 17 assessment. Individual bedrooms seen were nicely personalised to reflect the tastes and interests of the occupants. All areas seen were clean and tidy and free from unpleasant smells. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Staffing levels and deployment are satisfactory to meet service users’ needs. Although at present the home does not have 50 NVQ2 qualified care staff, training is ongoing to restore the required proportion. Staff demonstrate good knowledge of service users’ needs. The home has rigorous recruitment and staff selection policies and procedures that protect the interests of service users. EVIDENCE: From discussions with the manager, staff and service users and records available it was evident that day and night care staffing levels were adequate to care for the 34 service users currently in the home. Normally, two qualified nurses and between six and eleven care staff are deployed on each day shift, depending on the care demands at any particular time. Night cover is by one qualified nurse and four care assistants. There are sufficient ancillary staff to achieve high standards of catering, laundry and housekeeping. The home has thorough procedures for the recruitment, induction and training of staff members. The recruitment files for the last two employees were viewed. These contained all the information and documents required by regulation including photographs, Criminal Records Bureau disclosures and references. The manager stated that approximately 35 of staff were NVQ
Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 19 qualified at present and staff confirmed that further training was ongoing. This rigorous approach ensures that service users are cared for by competent staff. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37, 38 The manager is qualified and experienced provides strong leadership to staff to promote the caring ethos and achieve the aims of the home. Staff feel well supported are supervised and communications systems in the home are effective. However the frequency of formal individual supervision should be increased for all care staff. Records are properly maintained and kept up to date, with the exception of some risk assessments. These should be reviewed regularly and this should be recorded. Policies and procedures are in place to ensure safe working practices are followed to protect and promote the health, safety and welfare of service users and staff. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 21 EVIDENCE: The manager has been in post since late September 2005. She is a registered nurse and has commenced the NVQ4 course in management. Although not previously experienced in residential care management she has an excellent grasp of relevant management techniques and staff spoken with rated her communications skills as excellent. She is maintaining the home’s caring ethos and has already introduced some initiatives designed to improve practice in the home, such as more frequent team meetings and successful recruitment of new staff. BUPA has an effective quality monitoring system that includes canvassing the views of residents and other interested parties. The Operations Manager also makes a significant contribution to the process by virtue of his regular monthly visits and constructive reports on the conduct of the home. The manager said she felt well supported by senior colleagues and this was echoed by other staff. However, although individual staff supervision takes place the frequency needs to be increased to meet the standard of six sessions per year. The maintenance man conducts regular fire drills, with staff present recorded. The fire log showed that three drills had taken place since the last inspection in September 2005. The manager said she was taking measures to ensure that all that all attended fire safety training in accordance with their contracts of employment and the relevant health and safety legislation. All records seen were maintained satisfactorily apart from the non-updated risk assessments referred to earlier in this report (see recommendations). No health and safety problems were noted on touring the premises. Completed risk assessments were on service users’ files. Footplates were fitted to all wheelchairs in use The home has suitable insurance cover in place and a valid certificate was on the entrance hall wall. Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 2 3 Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 23 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. 1. Refer to Standard OP10 Good Practice Recommendations The manager should reinforce the importance of quick call bell response times to staff in order to respect service users’ dignity. The frequency of one to one supervision sessions for care staff should be increased to meet the standard of six times per year. All documents placed in service users’ files should be dated to indicate their relevance and all risk assessment documents should be reviewed at least annually and this should be recorded. 2. OP36 3. OP37 Tenterden House DS0000019563.V267490.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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