Inspection on 08/09/05 for Tenterden House

This inspection was carried out on 8th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tenterden House 19/01/09

Tenterden House 13/03/07

Tenterden House 17/01/06

Tenterden House 25/02/05

Tenterden House 07/09/04

Tenterden House 24/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Tenterden House Lye Lane Bricket Wood, St Albans Hertfordshire AL2 3TN Lead Inspector Neil Fernando Unannounced 8 September 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. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tenterden House Address Lye Lane, Bricket Wood, St Albans, Hertfordshire AL2 3TN 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) 01923 679989 01923 680517 BUPA Care Homes Limited Mrs Andrea Stranders CRH N 41 Category(ies) of OP - Old Age - 41 Places registration, with number PD - Physical Disability - 13 Places of places TI (E) - Terminally Ill - 3 Places Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 5 people (aged 50 years or more) who require convalescent nursing care. Date of last inspection 25 February 2005 Brief Description of the Service: Tenderden House is a period country house, which has been extended and extensively modernised whilst keeping the features and atmoshpere of the origional building. Service users are accommodated in single occupancy bedrooms although one bedroom is designated for double occupancy. Thirteen bedrooms have en-suite facilities. Assisted bathing and assisted toilets are also provided. In addition to the two lounges and dining room, there is an activity area that is the focus of events in the home. Surrounding the building are amature level gardens with lawns, views over mature parkland, flowerbeds, a Patio area and a pergola. Service users are prrovided with a country housestyle home with attention to detail around the house such as pictures and fresh flower arrangements. The care parking availability is adequate. The home is situated 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 DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for the current inspection year. The lead inspector was on site for 4½ hours during which time he spoke with a number of service users, most of the staff on duty, examined records and undertook a tour of the premises. He also spoke with some visiting relatives who stated that, “The quality of care is excellent”. It was apparent that the staff positively encourage families and friends to both keep in contact and to visit. The way in which all staff interacted with service users was commendable. The registered manager has retired since the last inspection took place and the deputy manager is doing a sterling job in maintaining the quality of care provided. This was a positive inspection. What the service does well: What has improved since the last inspection? What they could do better: The frequency of fire drill practice should increase to three-monthly intervals. Although there is a protection of vulnerable adults procedure, not all staff have received training on the subject. A recommendation has been made. Door Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 6 locks should be fitted to bedroom doors and service users should be provided with keys unless their risk assessment suggests otherwise. Cultural and religious needs should be recorded on care plans. One-to-one supervision sessions should be re-introduced and take place at a suitable frequency. 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 DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 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 Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 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) 3, 4, and 5. Standard 6 does not apply to this home. Prospective service users are given full support in deciding if they wish to live at Tenterden House and a full assessment of their needs is undertaken. EVIDENCE: All care documentation for six service users was studied in detail to enable the inspector to ‘case track’ the care provided for those individuals. This approach indicated that comprehensive assessments of need are carried out to ensure that all identified needs can be met by the home. Information is obtained from all appropriate sources including the service users themselves and their relatives. There was also ample documentary and anecdotal evidence that prospective service users and their supporters are encouraged to visit the home prior to making any decisions to enable them to experience if this is a suitable environment for them. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 9 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, 9 and 10 Care plans are generally well maintained and ensure that the quality of care provided by all staff remains consistent. Staff were seen to be respectful towards service users and the way in which staff administered medication was satisfactory. EVIDENCE: Discussions with staff and service users indicated that health and personal needs are identified and met. Generally, care plans were well maintained although cultural and religious needs were not recorded. This information should be included so that careworkers are aware of any special needs a service user may have. The medication policy and practice is comprehensive ensuring that staff administer medication appropriately. At present, no service user administers their own medication (although this could be arranged following an assessment of any risks involved). All service users appeared to be neatly dressed and well cared for and many confirmed that they are treated with dignity and respect by the staff. The inspector’s observations during his visit supported these comments. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 10 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 and 15 Families and friends are encouraged to maintain contact with service users. Service users stated that the home matched their expectations and preferences. Meals appeared to be appetising and nutritionally sound. EVIDENCE: Service users and their visitors were positive about many aspects of daily life at Tenterden House including the standard and variety of the food presented and recreational opportunities although as previously stated cultural and religious needs were not recorded on care plans. Menus examined confirmed the variety and nutritional value of the meals being prepared. It was apparent that the staff positively encourage families and friends to both keep in contact and to visit. Staff attitudes towards mentally frail service users was commendable throughout this inspection. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 11 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 and 18 There was evidence that the complaint procedure is well understood and that there is confidence that it would work effectively. However, a potential staff training need on the protection of vulnerable adults was identified. EVIDENCE: Details of the complaint procedure are contained in the BUPA leaflet as well as in the statement of purpose and service users’ guide. Staff were conversant with the procedure and none of the service users spoken to during this inspection expressed any concerns about their care. Visiting relatives stated that, “staff respond very well to any query or concern”. There have been no complaints recorded since the last inspection took place. However, although there is a protection of vulnerable adults procedure, not all staff have received training on the subject. A recommendation has been made. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 12 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, 23, 25 and 26 The premises are comfortable, well maintained and appropriately decorated. EVIDENCE: During a brief tour of the building, the inspector established that the premises were well decorated and well maintained. Service users live in comfortable surroundings and the environment was safe for all occupants. Service users were positive about their surroundings and their own bedrooms. However, in order to promote privacy and to some extent autonomy, appropriate door locks should be fitted and service users should be provided with keys unless their risk assessment suggests otherwise, (and this should be reflected in their care plan). The home was maintained to a high level of cleanliness and there were no malodours noticed. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 13 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, 29 and 30. Staffing arrangements in terms of numbers and skills remain satisfactory. EVIDENCE: At the time that this inspection took place, there was a team of thirteen care staff including two qualified nurses. This level of staffing level is consistent and remains appropriate to ensure that the needs of the service users can be met. At night, there is a minimum of eight care staff including two qualified nurses. Service users spoke in very positive terms about the care they receive from staff and particular reference was made to the effective key worker system in operation. There are robust and thorough recruitment processes to ensure that service users are in safe hands and effective staff training remains a priority. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 14 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, 36, 37 and 38. The deputy manager is managing the home in a manner that assures positive outcomes for service users and staff alike. EVIDENCE: The registered manager retired in July 2005 and the deputy manager has taken up her mantle. Although staff confirmed that management are always available for support and advice, one-to-one supervision sessions were not taking place at a suitable frequency. Safety processes were being followed except the frequency of fire drill practice. These should take place at threemonthly intervals. This requirement has been made at the past two inspections and a further failure to comply could result in the Commission considering taking legal enforcement action. Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 15 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 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x 3 x 3 3 STAFFING Standard No Score 27 3 28 x 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 x 2 3 x x x x 2 3 3 Tenterden House DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 16 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 OP38 Regulation 23 (4) (e) Requirement The frequency of fire drill practice should increase to three-monthly intervals. This requirement has been made at the past two inspections and a further failure to comply could result in the Commission considering taking legal enforcement action. Timescale for action By 8/12/05 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. 2. 3. Refer to Standard OP12 OP18 OP24 Good Practice Recommendations It is recommended that cultural and religious needs are reflected in each care plan. All care staff should receive training in the Hertfordshire Protection of Vulnerable Adults process Appropriate door locks should be fitted and service users should be provided with keys unless their risk assessment suggests otherwise, (and this should be reflected in their care plan). This recommendation remains outstanding from the inspection report dated 7.09.2004 Regular staff supervsision should be re-instated as soon as possible. DI52-I02 s19563 Tenterden House v246043 08 09 05 Stage 4.doc Version 1.40 Page 17 4. OP36 Tenterden House Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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