Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Tenterden House Lye Lane Bricket Wood St Albans Hertfordshire AL2 3TN The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julia Bradshaw
Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Tenterden House Lye Lane Bricket Wood St Albans Hertfordshire AL2 3TN 01923679989 01923680517 strandee@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (BNH) Ltd Name of registered manager (if applicable) Heather Dawn Constance Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: This home may accommodate 5 people (aged 50 years or more) who require convalescent nursing care. Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 27 0 15 0 Over 65 41 0 3 care home 41 Brief description of the care home 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. The information relating to the service is available in the Service User Guide and Statement of Purpose, which are displayed within the recption area of the home The range of fees for Tenterden House are between £832.00 and £1,150.00. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out on the 19th January 2009 and took place over one day. The last key inspection was carried out on the 13th July 2007 and aan Annual Service Review was carried out on the 8th January 2008. The process included speaking to people who use the service, visitors and staff, examining care plans, staff files, staff training, health and safety records, administration and management of medicines, maintenance records and all relevant records and documents and also included a full tour of the premises. The home has completed an Annual Quality Assurance Assessment (AQQA). This is a self assessment document that looks at how the service is meeting the needs of the people living within Tenterden House and also provides us with some numerical information. Information from the assessment has been reflected within the report. Care Homes for Older People
Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 27 The service has introduced a new and improved care planning system into the home.( Quest). The service has also had new call bell system installed since the last inspection was carried out, improving response times for people living at Tenterden House. The manager and deputy manager have worked hard to improve the frequency of one to one supervisions. The manager now ensures that the service user or representative now signs their care plan. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides detailed and written information which allows people to make informed choices about entering the home. Full and comprehensive assessments ensure that the home can meet and maintain the needs of the individual service users. Evidence: The home has a Statement of Purpose and Service Users Guide that contains the required information and these are available for prospective service users, visitors and outside professionals. Contracts of occupancy are held on peoples 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. Several examples of a pre-admission assessments were seen on individual files and confirmed that these assessments are being completed in a detailed and comprehensive way.
Care Homes for Older People Page 11 of 27 Evidence: Several service users spoken to said that visitors were able to visit freely and could be entertained in any of the lounges or the garden. The inspector was also able to observe this practice throughout the day. Two relatives were very complimentary about how the staff were extremely welcoming and friendly in their manner one relative stated that I always see the staff smiling, never miserable. The new Quest care planning system includes a thorough assessment process ensuring the home can meet the service users needs. Prospective service users are welcome to visit the home prior to admission and a review takes place after 6 weeks to ensure the service users needs are being met. The assessment plans seen contained detailed information in order to develop a plan of care on admission. The care plans incorporated all aspects of care and support required ,physical, mental health, (including behavior management) nutrition, and when necessary dealing with falls, and pressure sores. The inspector was able to observe several care practices with individual service users which helped evidenced that staff treat people with the respect and dignity they deserve. The care workers spoke to the individual service users in a kind and caring manner and ensured that they were assisting the person at the pace of the individual. Nothing appeared too much trouble. The very simplest of requests were respected and honored. Care Homes for Older People Page 12 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their health and personal care needs would be met appropriately because the service has detailed, well documented procedures in place that reflect peoples changing needs and policies that keep them safe. Evidence: Five care plans were examined and these demonstrated that the service provides detailed and comprehensive information, including details upon admission, assessment of needs, risk assessments, nutritional assessments, activity plans, daily progress reports, care plan monthly reviews, weight charts and detailed nursing procedures, including fluid charts and detailed pressure care information. The service introduced its new Quest care planning system in 2008 and this is now fully operational and forms part of a more effective system for both assessment and care planning. The service has two senior staff who have received the appropriate training to be the named tissue viability link nurses. This, in turn helps prevent and treats pressure sores more effectively. The service reported that there was currently only one person
Care Homes for Older People Page 13 of 27 Evidence: with a grade three pressure sore that was present upon admission but was now responding well to treatment. The arrangements in the home for health and personal care are such that several people spoken to confirmed that they felt they were treated with respect and that all staff promote their privacy and dignity. The records for the management and administration of medicines were found to be accurate and detailed and no errors were found on the medication recording sheets indicating that there is a robust system in place that safeguards peoples well being. The appropriate procedure was being adhered to in relation to the administration of controlled medication and these were reconciled on the day of this inspection and found to accurate. A GP visits the service on a weekly basis and the deputy manager stated that this was an effective and positive relationship between the two services. The service continues to rotate staff around the home on a regular basis to encourage flexibility and to ensure there is a continued fresh and objective approach offered within the service, as a whole. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff provide an extensive choice and diverse range of activities which ensures that peoples individual interests and needs are being exceptionally well met. The standard of menus and meals provided ensures that peoples nutritional needs are being maintained and met exceptionally well. Evidence: On the day of this inspection people were enjoying a game of bingo in the activity room and in the afternoon a music quiz was going to offered to anyone who wanted to take part. The service should be congratulated on the variety and choice of activities and a clear commitment by BUPA in providing this service with 82 hours of activities per week. These hours are also offered over a seven day period, instead of the usual five days. The staff appear to go out of their way to ensure these activities are inclusive and opportunities to experience new activities are always welcomed. The activity worker spoken to on the day of this inspection appeared both committed and enthusiastic in her approach and was observed throughout the whole day as kind, caring and professional. Several visitors and relatives also commented on how pleased they were with the choices offered to their relatives. The activity co-ordinator also visits everyone on a daily basis. The home is surrounded by extensive grounds that
Care Homes for Older People Page 15 of 27 Evidence: can be easily accessed and enjoyed in the warmer months. The manager was in the process of organising a local dog show for both the home and the local community to enjoy. This is another example of how this particular service goes further in investing their time and commitment in order to provide a diverse range of opportunities for people to experience. The inspector had the pleasure of joining several people for their lunchtime meal which was a treat to enjoy such a well prepared and flavoursome meal. Again the Chef and kitchen should be congratulated on their achievements in providing a varied and extremely well balanced menu that people stated was exceptional. The Chef visit us every day and asks us what we would like and if we would like anything different from the main choices, that we may prefer. The kitchen presented as extremely clean and well orgainsed with a detailed maintenance programme in place. The chef provided the inspector with a training and supervision schedule for each member of the kitchen staff. The kitchen appeared to be exceptionally well managed and was clearly producing food that is thoroughly enjoyed by people living within this service. The chef and kitchen staff carries out their own Quality Assurance programme ensuring any issues are dealt with effectively. However feedback from both the people living at Tenterden House as well as several visitors spoken to on the day confirmed that the food and menus were always highly praised by all. Care Homes for Older People Page 16 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident their concerns will be listened to and that procedures followed by staff in the home will help protect them from abuse. Evidence: The home has written policies on making a complaint, safeguarding adults and on whistle blowing. Staff spoken to on the day of this inspection were well informed of how to report any concerns they had regarding a safeguarding issues and had all received safeguarding training since the last inspection took place. Whistle blowing is covered as part of every new member of staffs induction. Policies are updated annually as part of BUPAs reviewing procedures. The reception area of the home also displays the complaints procedure and this is also covered in the Statement of Purpose and Service User guide. A total of twelve service users were spoken to with regard to making a complaint and they all confirmed that they were made aware of the procedure when they were admitted into the home and felt that they could raise any issues with the manager, who they found approachable and always prepared to listen. Twenty service user questionnaires completed and returned to the Commission also confirmed that people were aware of the complaints procedure and knew how to complain. The service has experienced some thefts of service users personal belongings over recent months. These thefts have all been reported to the Commission through the
Care Homes for Older People Page 17 of 27 Evidence: appropriate system on regulation 37 notices and also followed up through the safeguarding adults procedure and referred to Adult Care Services by the manager of the home. The manager had identified the person responsible and under BUPAs disciplinary procedures they were suspended whilst the investigation took place. Unfortunately the member of staff resigned before the disciplinary hearing could take place and has now left the service. The documentation relating to these thefts was checked as part of this inspection and there was sufficient evidence to confirm that the manager had been both thorough and professional in her management of this issue. The manager also confirmed that the individuals who were victims of these thefts would be fully re-reimbursed by BUPA. Care Homes for Older People Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service benefit from living in a home which is comfortable, well maintained and safe. Procedures followed by staff ensure that safe practices are maintained and safe and meets peoples needs. Evidence: Upon arrival the inspector was greeted by a well presented reception area , a friendly receptionist and a very welcoming yellow Labrador that gave the home a welcoming and homely atmosphere. The inspector was given a full tour of the environment as part of this inspection and all areas of the home appeared well presented and well maintained except for one area on the first floor where the wall had been damaged where wheelchairs have continually hit it and caused the plaster to be cracked and the paintwork had peeled off. This was pointed out to the deputy manager at the time and it was agreed that this would be reported to the maintenance person for immediate attention. The inspector also had the opportunity to be invited into peoples bedrooms and discovered that these had been personalised by the individual and their families and presented as warm, comfortable and homely. People are encouraged to bring items of their own items of furniture and personal belongings into the home, upon admission. Tenterden House is set in beautiful surroundings and people have the opportunity to enjoy the extensive landscaped grounds in the warmer months. I love going out into th garden in the summer when my family visit. There were several bird
Care Homes for Older People Page 19 of 27 Evidence: feeders outside the ground floor windows and people spoken to said they enjoyed watching the birds come down to feed. Simple touches that make Tenterden a nice place in which to live. All health and safety checks were up to date on the day of this inspection and the full time maintenance person appears to be rigorous in ensuring the service is well maintained and safe. All fire checks were inspected on the day and also found to be up to date. The fire systems receive an annual certificate of safety and this was also seen and up to date. A fire drill had taken place on the 26th June 2008. The manager and senior staff also carry out health and safety checks as part of their Quality Assurance auditing. All areas of the service had appropriate hand washing facilities and aprons and gloves were readily available. Care Homes for Older People Page 20 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported by staff who are very well trained and competent to meet their needs. The procedures for recruiting staff are thorough and ensures that residents are protected from abuse. Evidence: There were many positive comments about the staff at Teneterden House throughout the course of this inspection The staff are always smiling I cannot fault them We always have something to do if we want to. Everyone is so very kind to my wife I am here ever day and I never see a grumpy face. These comments are testament to the positive and inclusive atmosphere that the staff at Tenterden House have help to create. All staff were observed as both professional and caring with the people living within this home. Service user questionnaires returned to the Commission prior to this inspection taking place also commented on how kind and caring all the staff were, from the housekeeping staff through to the manager. Personal care practices and nursing practices appeared to be well managed and ensured that peoples dignity and privacy were maintained at all times. Staff confirmed that they felt valued by both the manager and by their employers. BUPA has a staff incentive scheme called Personal Best which identifies and rewards examples of good practice and initiatives that benefit and enhance the service offered at Tenterden House and throughout the BUPA services. Several examples were described to the inspector ranging from shopping
Care Homes for Older People Page 21 of 27 Evidence: vouchers to in one case an all expenses holiday. This clearly makes the staff feel valued and respected. An extensive staff training programme is offered and all staff had received their mandatory training since the last inspection took place. Examples of recent training include, dementia , care of the dying, nutrition, safeguarding, Mental Capacity Act , Epilepsy and Infection Control training. The manager and deputy have worked extremely hard to improve the regularity of individual supervisions to all staff since the last inspection took place. Staff now receive supervision at least six times per year and often this is carried out monthly. There are also regular staff meeting held for both day and nightime staff. Four staff files were tracked during this visit and all files contained the appropriate recruitment checks, including two staff re fences and CRB checks had been completed, prior to commencing employment. All records were held securely in the managers office ensuring confidentiality is maintained at all times. Care Homes for Older People Page 22 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Tenterden House can feel very confident that they are living within a service that is exceptionally well managed. Health and safety systems are in place that ensures people are protected. Evidence: The manager is registered with the Commission and has now completed her NVQ level 4 in management. Throughout this inspection the manager and deputy manager demonstrated that they both have a very clear understanding of both Quality Assurance and how to run a busy and complex service. The staff support and training offered is excellent and several staff spoken to stated that they felt both valued and supported by the manager. Several people using the service and two relatives spoken to on the day of this inspection said they found the management of the home to be of a very high standard and both felt confident that the manager and staff were caring for their relative in the best possible way. Quality Assurance systems are in place and ensure all areas of this service are monitored regularly to ensure that any aspects
Care Homes for Older People Page 23 of 27 Evidence: that require attention or improvement are acted on promptly and effectively. Regulation 26 visits are carried out on a monthly basis and are provided regularly. The manager and staff have created a service that is welcoming, homely and professional and standards of care for the people living at Tenterden House are excellent. The activities and meals provided demonstrate the commitment and hard work that every member of the team provides to ensure people can enjoy their stay within this home. The manager and deputy have worked hard to ensure that staff supervisions are now provided on a regular basis. Infection control practices throughout the service are maintained to a high standard and measures for the prevention of infection are in place. Staff spoken to confirmed that there were always aprons and gloves available and that they had received infection control training since the last inspection took place. The inspector would like to thank the residents, family members and staff who helped make this inspection a very enjoyable and rewarding one. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
