Inspection on 13/12/05 for The Tower House

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The Tower House 16/07/08

The Tower House 24/07/07

The Tower House 06/07/06

The Tower House 02/06/05

The Tower House 15/03/05

The Tower House 22/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Tower House Reading Road Shiplake Henley on Thames Oxon RG9 3JN Lead Inspector Jane Handscombe Announced Inspection 13th December 2005 11:00 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 Tower House DS0000040609.V258505.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. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Tower House Address Reading Road Shiplake Henley on Thames Oxon RG9 3JN 01189 401197 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) Bridget Kidd Care Home 5 Category(ies) of Old age, not falling within any other category registration, with number (5) of places The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To increase the number of residents accommodated to 5, the fifth bed to be used for respite care only 2nd June 2005 Date of last inspection Brief Description of the Service: Tower House is a privately owned care home with large attractive gardens, approximately two miles from Henley on Thames and on a bus route. Mrs Bridget Kidd is the proprietor and registered manager and provides care for up to four service users aged 65 and over who, for one reason or another, are no longer able to live in their own homes. She employs four part-time staff to assist with care work and domestic duties. Agency staff are employed to provide assistance when the need arises, all of whom are familiar with the home and the service users. Service users have access to a communal sitting room, a newly built conservatory and a separate dining room, all situated on the ground floor. There are three bedrooms on the first floor with en-suite facilities of toilet and washbasin and a communal bathroom. On the ground floor there is one bedroom with en-suite bath, toilet and washbasin. . The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place during on 13th December 2005. The pupose of the visit was to see how the home is meeting the National Minimum Standards. The visit involved speaking to residents to ascertain their views on the care they receive at the home, speaking to staff members and the manager, viewing records held and observing the day-to-day operations of the home. Family members visiting the home were also invited to give feedback and questionnaires were provided to gain feedback from relatives, friends, GPs and other social and health care professionals who visit the home. The home presented as one with a homely ‘family’ atmosphere and was clean, tidy and of very good décor. Residents were going about their daily activities in a calm, relaxed atmosphere whilst staff were observed to provide care and support to the residents in a calm, unhurried manner and respecting their individuality, privacy and dignity at all times. Comments received during the inspection include: • • ‘They are extremely good here……I am very well looked after’ ‘The food is always very nice’ Comments received from relatives’ comment cards include: • ‘Bridget Kidd runs a fine residential home and provides a high level of caring support for her residents……she maintains a very personal touch with good humour and compassion’ ‘Superb standard of care, highly recommended. No complaints, unaware of procedure but direct line to owner, Mrs Kidd’ ‘My sisters and I are delighted with the care that our mother receives at Tower House…’ • • And from a general practioner: • ‘Nothing but favourable comments from patient contacts’ The inspector would like to thank the residents, staff members and all those who contributed to the inspection. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas which were identified during the inspection that need to be addressed to ensure the health, safety and welfare of both the residents and care staff within the home. As was highlighted in the previous inspection, the management approach of the home needs to create an inclusive atmosphere in that staff, service users, family members and other stake holders are given the opportunity to affect the way in which the service is delivered, and a quality assurance monitoring system be put in place to allow for this. Whilst the manager informed the inspector that residents and/or their representatives are consulted with during the assessment and care planning process, there was no evidence to support this, therefore the manager must ensure to gain the residents’ or their representatives’ signatures to acknowledge that appropriate consultation has taken place. Training around the Control of Substances Hazardous to Health has been lacking and needs to be delivered to all staff to ensure safe working practices and the health, safety and welfare of those in their care. The registered manager must evidence that staff members are provided with appropriate supervision. Policies and procedures are required to address the issues identified within this report in order to protect the health, safety and welfare of the residents and care staff. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 7 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 Tower House DS0000040609.V258505.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 The Tower House DS0000040609.V258505.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): The inspector did not make a judgement on the outcomes in this section as all the standards were assessed during the last inspection in June 2005. EVIDENCE: The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 11 Residents’ care plans are generated from an individualised assessment of needs undertaken by a person qualified to do so. Reviewing of care plans requires improvement. Residents’ involvement in assessment and care planning is not in place. EVIDENCE: Residents within the home all have a plan of care generated from their initial assessment, although there was no evidence to show that the resident/representative had been involved in the assessment and care planning process. Care plans are at present reviewed every six months to address any further needs that may be present. It is good practice that care staff in the home review residents’ care plans at least once a month and it is a requirement that residents are involved in both the assessment and care planning procedure. A requirement and recommendation have been made to address these issues. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 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): The inspector did not make a judgement on the outcomes in this section as all the standards were assessed during the last inspection in June 2005. EVIDENCE: The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 12 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 and 18 The home does not provide residents or visitors to the home with easy access to the complaints procedure. Residents are protected from abuse EVIDENCE: Whilst the home does have a policy, and procedures are in place regarding any concerns or complaints, the home needs to ensure that residents, friends, families and people visiting the home have access to this. It is recommended that a copy be placed on view in the home in order that all have access. Whilst residents do have access to their care plans and files held within the home, the service user guide was found to be kept in each of the resident’s care plans. The service user guide contains information for residents and should to readily available to them. It is therefore recommended that these be held by the residents themselves or a copy be placed on view within the home for easy access. The registered manager has undertaken abuse training and cascades this down to staff members. Staff are aware of the Oxfordshire multi agency codes of practice for the protection of all vulnerable adults from abuse and have undergone awareness to abuse through one-to-one discussions with the manager and through video training. Speaking to staff members it was evident that they would whistle blow if the need arose, although it became apparent that this had not been included in the training they had received. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 13 It is a good practice recommendation that the manager discuss responsibilities in relation to “whistle blowing” and that this forms part of their ongoing training. Likewise the inspector noted that there was no evidence of a whistle blowing policy and a recommendation to produce such a policy has been made within this report The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 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, 20, 23 and 26 Overall, residents live in a comfortable, well maintained environment with their personal possessions around them and have safe access to all parts of the home. Residents have the use of suitable toilet and washing facilities. EVIDENCE: This is a family home (lived in by the owner/manager) and has not, therefore, been designed with reference to relevant guidance, but adaptations have been made where necessary for the benefit of service users to ensure their health, safety and well being. There is a comfortable lounge, conservatory and separate dining room on the ground floor specifically for service users. Service users can choose to eat in the dining room or in their own rooms as they require. The communal rooms are spacious and well decorated and furnished. The home provides accommodation in attractive and homely surroundings. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 15 Residents are encouraged to bring small items of furniture and memorabilia to decorate their rooms. The inspector viewed all rooms and found them to contain personal possessions and residents reported that their rooms suited their needs. Residents live in safe, comfortable surroundings with access to both indoor and outdoor facilities. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 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): 29 Generally, there are stringent procedures around the recruitment of staff. EVIDENCE: A sample of staff files was viewed which evidenced that, generally, there are stringent policies and procedures in place with regard to the recruitment of staff and relevant checks and induction training are generally adhered to, thereby protecting and supporting the residents in their care. However, there was one case in which evidence showed that only one reference had been sought as opposed to two, as is required. Furthermore, this file failed to contain a photograph. Requirements have been made to address these issues. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 17 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): 33, 34, 35, 36 and 37 Formal supervisions for staff are not provided. The home does not undertake any financial roles on behalf of the residents. Evidence of shortfalls within the home’s policies and procedures could compromise the health, safety and welfare of residents and care staff. There are no systems in place for reviewing and improving the quality of care. EVIDENCE: During the inspection process, the inspector became aware of shortfalls within the homes policies and procedures which could compromise the health, safety and welfare of residents and care staff. There was no evidence of policies and procedures around residents absconding/missing from the home, moving and handling, the death of a resident or gifts to staff, and therefore a requirement has been made within this report to address these issues to safeguard the health, safety and welfare of the residents and care staff within the home. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 18 Whilst the manager is confident that the home is run in the best interests of the residents, there are no quality assurance and quality monitoring systems in place to gain views from the residents, families, friends and stakeholders in the community on how the home is achieving goals for those using the services. The lack of such systems is not in the best interests of those using the service and fails to create an open, positive and inclusive atmosphere. Effective quality assurance and quality monitoring systems, based on seeking these views, will evidence that the home is run in an open, inclusive manner and in the best interests of the residents. A requirement has been made to address this issue. Care staff receive informal supervision. However, there are no arrangements in place to ensure that care staff receive formal supervision at least six times a year, as is required in the Regulations and Standards laid down in the Care Standards Act 2000. The registered manager must provide COSSH training (Control of Substances Hazardous to Health) to all staff members to ensure safe working practices and the health, safety and welfare of the residents and staff. It is strongly recommended that the registered manager pursues NVQ training at Level 4 in Management. The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 19 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 x x 3 x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 3 3 2 2 2 The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 14(1)c Requirement The manager must gain both the residents/representatives signatures and those of the assessors to evidence that an appropriate consultation regarding the assessment and care planning process takes place. Timescale for action 30/04/06 2 OP29 19 Schedule 2 The manager must forward in writing to CSCI confirmation that a further reference has been sought and received with regard to the identified member of staff. 28/02/06 3 OP29 19 Schedule 2 The registered manager must ensure to hold a recent photograph on all staff personnel files. 31/01/06 The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 21 4 OP32 24 The registered manager must ensure that the management approach of the home creates an inclusive atmosphere in that staff, service users and other stake holders are given the opportunity to affect the way in which the service is delivered. A quality assurance system must be put in place and maintained whereby feedback on the service can be given. This was recommended during the previous inspection although no action was taken. The registered manager must produce policies and procedures to address the issues identified in order to protect the health, safety and welfare of the residents and care staff. The registered manager must evidence that staff receive appropriate supervision. The registered manager must provide COSSH training (Control of Substances Hazardous to Health) to all staff members to ensure safe working practices and the health, safety and welfare of the residents and staff. 30/04/06 5 OP38 13(4)c 30/04/06 6 OP36 18(2) 30/04/06 7 OP38 13(4) 30/04/06 The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 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 Refer to Standard OP7 Good Practice Recommendations It is a good practice recommendation that residents’ care plans are reviewed by care staff in the home at least once a month. It is recommended that the complaints procedure be placed on view in the home to allow access to residents, families, friends and visitors to the home. It is a good practice recommendation to make the service users’ guide easily accessible as opposed to being held in residents’ care plans which are kept in locked facilities. It is recommended that the manager draws up a policy and procedure to address whistle blowing and provides same to all members of staff. It is recommended that the manager seek written evidence that satisfactory CRB and PoVA checks have been received on all agency staff supplied to the home. It is strongly recommended that the registered manager pursues NVQ training at Level 4 in Management. 2 OP16 3 OP14 4 OP18 5 OP29 6 OP32 The Tower House DS0000040609.V258505.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Tower House DS0000040609.V258505.R01.S.doc Version 5.0 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. 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