Inspection on 27/09/06 for The Towans

This inspection was carried out on 27th September 2006.

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

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

CARE HOMES FOR OLDER PEOPLE The Towans The Towans Berrow Road Burnham on Sea Somerset TA8 2EZ Lead Inspector Alison Philpott Unannounced Inspection 27th September 2006 09:30 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 The Towans DS0000067036.V310818.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. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Towans Address The Towans Berrow Road Burnham on Sea Somerset TA8 2EZ 01278 782642 01278 782762 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) Towans Care Limited Mrs Claire Frances Brownless Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23/02/06 Brief Description of the Service: The Towans is a large two-storey property, set in spacious and well-maintained gardens. The Home is in a residential area, set back from Berrow Road at the end of a drive, with sea views to the rear of the property. The centre of Burnham-on-Sea (with local amenities) is approximately half a mile away. Extensions have been added to the original house. There is a passenger lift, as well as the main staircase, giving access to different parts of the Home. The Home is registered with the Commission for Social Care Inspection to provide accommodation to up to twenty-eight people over the age of 65 years, who require assistance with personal care and whose needs are primarily due to physical health problems. The home cannot provide nursing care other than that which district nurses can provide. The home is not registered to care for people whose needs are primarily in relation to their mental health state. Additionally, a day care service is offered at the Home (such services are not registered or regulated by CSCI). The current fee range is £369 to £470 per week. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous inspection took place on 23 February 2006. This unannounced key inspection took place over 8 hours on 27 September 2006. The provider and the managers were available throughout the inspection. There were twenty five residents living in the home. During the inspection, seven residents and five members of staff were spoken with. Comment cards were received from three relatives and three residents. The Inspector viewed the home. There was a comfortable and homely atmosphere. Staff were friendly and were observed being kind and caring toward residents. Records viewed included care plans; risk assessments; accidents; medication; staff recruitment & training. The Inspector would like to thank the residents and staff for their involvement and participation in the inspection process. As a result of this inspection the home has two requirements and three recommendations. What the service does well: Residents living in the home are generally very happy with the care and support that they receive. Residents are offered a choice of menu. The home caters well for residents with special dietary requirements. Staff are friendly and caring. Staff respect resident’s privacy and were observed offering support and choices to residents. The Inspector observed warm and friendly interaction between staff and residents. A number of residents commented on the kindness of the staff. The home provides a very homely and well maintained environment with comfortable furnishings. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Towans DS0000067036.V310818.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 The Towans DS0000067036.V310818.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6. The quality in this outcome area is good. The home undertakes a comprehensive pre-admission assessment to ensure it can meet the needs of prospective residents. EVIDENCE: The home has introduced new assessment paperwork since the last inspection. The inspector viewed a pre-admission assessment for a new resident. This was comprehensive and detailed. The manager visits prospective residents in their own home or in hospital to undertake a needs assessment and ensure that they can meet the individual’s needs appropriately. Some of the new residents spoken with confirmed that they had previously visited the home for day care or respite and therefore they knew what to expect. The provider advised that the home was currently updating its brochure and developing a website. The home has not introduced intermediate care since the last inspection. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10. The overall quality in this outcome area is good. Care plans are comprehensive and detailed. Medication is stored securely. Some lack of recording and updating on the medication administration record sheets may potentially put some of the residents at risk. Staff respect resident’s privacy and dignity. EVIDENCE: The Inspector viewed three care plans. These contained clear and detailed information for staff to follow in order to meet resident’s healthcare & social needs. Individual care plans are reviewed monthly and updated where necessary. Where a risk to a resident was identified, the home had completed a risk assessment. The care plans viewed contained risk assessments relating to manual handling; medication and falls. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 10 Residents have access to a range of professionals including GP, District Nurse, Dentist, Social Worker, CPN, Optician and Chiropodist. Medication is stored securely. The home uses a monitored dosage system. There were some gaps in the Medication Administration Record (MAR) Sheets. However, the home advised that they discuss any shortfalls with staff to ensure continuous improvement. The administration of medication must be recorded at all times. Hand transcribed MAR Sheets contained two signatures and were dated. It was evident from the MAR sheets that there had been changes to dosage instructions for the medication of several service users. The printed instruction on the MAR stated one dosage instruction but staff were recording that they were administering a different dosage. When the GP changes dosage instructions for a service user’s medication, the home must ensure that a new MAR sheet is generated so that staff have clear instructions to follow. Creams viewed were dated on opening. The application of prescription creams was not recorded on the MAR sheet. The home must keep a record of the application of prescription creams. The controlled drugs were double locked. The Inspector checked the balance of one medicine and this was correct. The book contained two signatures. Staff spoken with demonstrated a good awareness of how to respect resident’s privacy and dignity. Residents confirmed that they are treated with respect. Some residents have chosen to have a private telephone line in their bedroom. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 11 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. The quality in this outcome area is good. The home has its own activities co-ordinator. Visitors to the home are made to feel welcome. Residents are generally very happy with the food at the home and the choices available to them. EVIDENCE: The inspector spoke with the home’s activities co-ordinator. The home keeps a record of activities for each resident. The provider advised that the home is currently reviewing its activities programme to ensure that all residents continue to be offered opportunites. Activities include games, bingo, quizzes, gardening, cooking, and painting. During the inspection, residents were observed singing, reading, listening to music, and chatting. The home had also organised a donkey visit on the day of the inspection. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 12 The activities co-ordinator advised that they also spend time chatting with residents in their own room and visit residents if they are admitted to hospital. The Inspector observed warm and friendly interaction between staff and residents. A number of residents commented on the kindness of the staff. All residents spoken to confirmed that their visitors are made to feel welcome at the home. The Inspector observed staff offering resident choices throughout the day. Residents confirmed that they can spend their time as they want to and that they are given choices. Resident’s rooms are very homely and personalised with their own possessions. Residents can access their personal records on request in accordance with the Data Protection Act 1998. The home has a four week menu. The tables in the dining room were laid attractively for lunch. All residents spoken with confirmed that the food is generally good and there is always a choice of dishes. One resident who has special dietary requirements confirmed that she was offered alternative dishes. The home is currently developing and implementing a new menu that will offer more choice to residents. The chef had consulted with residents to find out their preferences. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 13 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. The quality in this outcome area is good. The home has a complaints procedure that is available to residents and staff. Residents are protected from the risk of harm. EVIDENCE: The home has a complaints procedure. This is displayed in the entrance hall and on the home’s notice board. The home had not received any complaints since the last inspection. Residents confirmed that they knew who to speak to if they had any concerns. Four staff files were viewed. These all contained evidence of POVA first checks and completed Criminal Record Bureau checks. The members of staff did not commence work until the home had received the POVA first check. The home has policies relating to whistleblowing and abuse. Staff spoken with demonstrated a good awareness of the steps to take if they witnessed or discovered abuse. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 14 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): 19,26. The quality in this outcome area is good. The home provides a homely environment with comfortable furnishings. The home provides a safe environment. The home was clean. The home has systems in place to control the spread of infection. EVIDENCE: The Inspector viewed the home. The environment is well maintained and homely with comfortable furnishings. The home has pleasant lounges and dining area. The garden was attractive and well maintained. The home has a planned programme for maintenance and renewal. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 15 Two bedrooms have sloped access with a rail. The provider has taken advice from building regulations. The home should ensure that the mobility of the residents occupying these rooms is kept under review to minimise any risk of harm. Since the last inspection, thermostatic mixing valves have been fitted to the sinks in the home to regulate the hot water temperature and protect residents from the risk of scalding. The home was clean and smelt fresh throughout. The inspector observed that the laundry was clean and tidy. The door to the laundry is kept open. The home should ensure that the door to the laundry is closed and locked when the area is unmanned, to reduce the risk of harm to vulnerable residents. Aprons and gloves were available for staff. Liquid soap, hygienic hand rub and hand towels were provided. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 16 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, 30. The quality in this outcome area is adequate. Residents are generally satisfied that the care they receive meets their needs, but there are some times when no one is available to help them immediately. Staff recruitment procedures are not consistently robust to protect residents. The home has a staff training and development programme. EVIDENCE: The inspector viewed the rotas. The home employs four care staff in the morning; three care staff in the afternoon and evening; and two waking night staff. There appeared to be sufficient staff on duty during the inspection to ensure that resident’s needs were met appropriately. A number of residents spoken with confirmed that staff are usually available. However, some residents and relatives confirmed that there are times when residents ring their call bell and then have to wait for staff to meet their care needs. In order to address this issue, the home has recently recruited several new members of staff. Further to this, the home should ensure that there are sufficient staff on duty at all times to meet the resident’s needs appropriately. The Inspector viewed four staff recruitment files. The home has recently introduced a health questionnaire for new staff. The provider advised that The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 17 contracts are currently being issued to new staff. All of the files contained proof of identity, POVA first checks, CRB checks and interview checklists. Two of the files viewed contained two written references, as required. The other two files each contained one written reference and one verbal telephone reference. The home must ensure that verbal references are followed up with a written reference. New staff must have two written references before commencing employment. The employment history on the application forms was not fully completed. It was not clear when the applicants had commenced and left previous employment or whether they had any gaps between their employment. The home must ensure that they explore the employment history and any gaps when recruiting new staff. The staff induction programme is comprehensive. The inspector spoke with a new member of staff who confirmed that they had undertaken an induction and spent time shadowing an experienced member of staff. A new comprehensive staff training programme has been introduced which will aid the home in developing its staffs’ knowledge and understanding. This covers emergency basic aid, food hygiene, health and safety, infection control, fire safety, risk assessment, manual handling, dementia, diet & nutrition, dealing with aggression, care and administration of medicines, and abuse. The home has also booked appointed persons courses for staff to update their first aid knowledge. These are due to take place before the end of 2006. The home should develop a staff training matrix so that it is clearly evident when staff have completed training. 55 of the care staff working at the home hold an NVQ at level 2 or above. Three staff are currently working towards an NVQ. The provider advised that the home is currently developing a staff appraisal and development system. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 18 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, 33, 35, 38. The quality in this outcome area is good. The home is developing its quality assurance systems. Service users’ monies are safeguarded. The home is committed to promoting health and safety. EVIDENCE: The registered manager left the home earlier in the year. The provider has appointed two managers to undertake a job share. One manager, Marie Drewett has experience in a senior role within the home. She is currently undertaking the Registered Managers Award. Kaz Drewett has completed an NVQ 3 in care and will soon be starting the Registered Managers Award. The The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 19 two managers will be required to submit applications to the Commission of Social Care Inspection to become registered managers. The inspector viewed the survey that the home has developed. The provider advised that the survey would be distributed to service users. This asks service users to rate the home on catering and food; personal care and staff support; daily living; premises; management and senior staff. It also provides space for comments on what service users like and what can be improved. The home also has a suggestion box in the hall. The home holds small amounts of cash for some residents. The monies are stored securely. Financial transaction records are maintained for each of these residents. The records for two residents were viewed. The record is double signed, where possible, by a member of staff and the resident. The home’s health and safety records were viewed. The home tests its fire alarm system weekly. The system was serviced on 04.07.06. Emergency lights are tested monthly. Fire extinguishers were serviced in July 2006. The company who serviced the extinguishers carried out a practical demonstration with some of the home’s staff. Where a resident chooses to have their bedroom door wedged open, the home has fitted doorguard release mechanisms to reduce the risk of harm in the event of a fire. Portable appliance testing was carried out in August 2006. The gas safety certificate was issued on 09.09.06. The boiler was serviced on 23.09.06. The nurse call bell system was serviced on 25.08.06. The home’s hoists were serviced on 03.07.06. The passenger lift was serviced on 04.09.06. The home carries out regular checks on hot water temperatures and maintains a record. The Environmental Health Officer visited the home to carry out a food hygiene inspection on 16.06.06. The home was awarded the Somerset Hygiene Award in August 2006. Accidents are recorded in the home’s accident book. The accident book complies with the Data Protection Act 1998. The door to the laundry should be kept closed to protect vulnerable residents from risk of harm (see Standard 19). Cleaning chemicals were stored securely in locked cupboards. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 21 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. 1. Standard OP9 Regulation 13(2) • Requirement Timescale for action 11/10/06 • • 2. OP29 19(4)(c) • • The administration of medication must be recorded on the MAR sheets at all times. When the GP changes dosage instructions for a service user’s medication, the home must ensure that a new MAR sheet is generated so that staff have clear instructions to follow. The home must keep a record of the application of prescription creams. The home must ensure 11/10/06 that verbal references are followed up with a written reference. New staff must have two written references before commencing employment. The home must ensure that they explore the employment history and any gaps when recruiting new staff. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 22 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 OP19 OP27 OP30 Good Practice Recommendations The home should ensure that the door to the laundry is closed and locked when the area is unmanned, to reduce the risk of harm to vulnerable residents The home should ensure that there are sufficient staff on duty at all times to meet residents’ needs. The home should develop a staff training matrix so that it is clearly evident when staff have completed training. The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI The Towans DS0000067036.V310818.R01.S.doc Version 5.2 Page 24 - 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. 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