Inspection on 16/07/08 for The Tower House

This inspection was carried out on 16th July 2008.

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

Other inspections for this house

The Tower House 24/07/07

The Tower House 06/07/06

The Tower House 13/12/05

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Tower House Reading Road Shiplake Henley on Thames Oxon RG9 3JN Lead Inspector Ruth Lough Unannounced Inspection 16th July 2008 10:45 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.V367775.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 Tower House DS0000040609.V367775.R01.S.doc Version 5.2 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) kiddsinead@yahoo.co.uk Bridget Kidd Bridget Kidd Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2007 Brief Description of the Service: Tower House is a privately owned care home with large attractive gardens, situated approximately two miles from the town of Henley on Thames. It is on the main road from the town to Reading and on a regular bus route. Mrs Bridget Kidd is the proprietor and registered manager and provides care for up to nine people aged 65 and over who, for one reason or another, are no longer able to live in their own homes. She employs a small team of carers all of whom are responsible for providing care, domestic and catering duties in the home. Agency staff are employed regularly to provide assistance when the need arises and are familiar with the home and the service users. There are a good variety of communal areas including a conservatory and a separate dining room, all situated on the ground floor. The bedrooms are situated on two floors all with en – suite facilities and one on the first floor a double bedroom with an en-suite bathroom. There are two communal bathrooms with walk in shower and assisted bath. Access to the first floor is via staircase and stair lift. Fees £2700.00 per month. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 Star. This means that people who use the service experience poor quality outcomes. This was an unannounced key inspection process generated from the adequate findings during the last inspection visit in July 2007. This was where a number of requirements and recommendations were made to improve the outcomes for people living in the home and to meet the homes regulatory responsibilities. The inspection process included information provided by the manager in the Annual Quality Assurance Assessment, self-assessment document submitted before a one-day visit to the home. The people who use the service were given the opportunity to comment about the service through surveys and during the visit to the home. Other records that were relevant to care planning and the administration of the service were reviewed during the day. It was apparent from the evidence gathered through these processes that the welfare of the people who live in the home could be compromised by some poor practices. A number of serious issues identified previously in July 2007 had not been rectified and one new area of concern has arisen. The commission takes seriously the lack of response to rectify concerns that were previously identified and is considering taking enforcement procedures to ensure the safety and wellbeing of service users is improved. What the service does well: What has improved since the last inspection? The manager has implemented a number of changes in the administration and management of the home and although they have not direct impact on the people living in the home they have ensured that their safety and wellbeing The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 6 has improved. This was through the regular monitoring of the fire safety and hot water temperature testing and the formal supervision of staff. 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 summary of this inspection report can be made available in other formats on request. The Tower House DS0000040609.V367775.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 Tower House DS0000040609.V367775.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users needs are assessed before they are offered a place in the home. EVIDENCE: The records for two people living in the home were reviewed to see the processes for admission are carried out effectively and that it was a good experience for the individuals. We also had the opportunity to speak to the people concerned and others to gain their opinion of the whole process. One person had been admitted over two years previously the other in the last seven months. From the discussion with service users they confirmed that the manager visited them prior to admission and carried out an assessment of their needs. They also confirmed that they were given an opportunity to visit or stay for a The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 9 trial period before they decided to commit to living in the home on a permanent basis. The records seen did show that the key information had been obtained about the individuals needs although the depth of information was greater in the most recent admission to the home. Detail about the individual’s personal life history, social needs, and interests including any religious or ethnicity needs was very minimal in both records reviewed. However, staff were able to evidence a good understanding of each person verbally that is not reflected in the care records. One relative commented, “I have known The Tower house for over eleven years, visiting a friend there, I had watched it grow and develop and was certain this was the right place to care for my husband when the time came.” The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people living in the home are not supported fully by the care planning and are put at risk by some of the medication practices. EVIDENCE: The residents who we spoke to said that they felt cared for and that they that they were looked after well. Written comments in the surveys returned were, “Everyone here is kind and helpful,” and “The care and support my husband receives is excellent.” The care records for three service users were reviewed to see what the quality of care planning had been put in place and that the support they are provided with, meets their needs. The information about the daily routines for each person was good and gave staff a good picture of the structure of each person’s day. Areas to improve this, would be to include greater recorded personal choices, and for some The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 11 activities like assistance with personal care better information of how the support is to be carried out. Staff who we spoke to on the day provided very detailed information of how they achieve to support each person that is not necessarily reflected in the care records. The residents provided information that the staff were flexible and were able to accommodate any changes in the planned care. One relative wrote, “The Tower House staff know all my mothers likes and dislikes and tailor her care accordingly” The information in regard to assessing the risks to each individual that are part of the care planning process did show that the main topics such as moving and handling, using the stair lift or bathing had been carried out and reviewed regularly. The medical history and health needs of the person are recorded in the initial needs assessment process but not necessarily updated in great detail as and when, changes occur. For one person this was particularly relevant, as a significant change in health had not been documented. Information about consultations, treatments, and any outcomes from these are not recorded in great detail but noted in various places including a central home diary and the daily outcome records. They were advised to review the processes for this to ensure that the have a good record of the persons health history, make sure that confidentiality is maintained and that they have a good system to support that each person can have regular access to any health professionals that they may need. Individuals weight is assessed periodically and the manager provided information that they had sought advice for concerns with one person’s weight loss and lack of appetite three months ago. The GP has provided support for this but the home has not put monitoring tools in place to assess that the prescribed treatment is meeting the person’s needs. They were given advice to seek further professional help as to be able to identify if there is anything else that they could implement to improve the nutrition for this one resident. The manager supplied information that residents are enabled to continue with accessing health care from their chosen GP, the majority of the people living in the home are from the local area and this has given greater continuity of care. Comments were given about the medical support the service users receive, the majority of which were positive. Others were, “The district nurses visit every day. Medical help takes a while to arrange”, “The district nurse and doctor come whenever necessary”, and “The GP is not always as attentive as he could be.” The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 12 The records and management for the administration of medication were reviewed to see if improvements have taken place since the last inspection visit and the requirements made to ensure that service users are protect from possible harm have been met. The care records for the three service users showed that minimal information is taken about their medication needs during the assessment process. Any changes to these are currently only recorded in the MAR (Medication Administration Records) and in the daily outcome records completed by staff. From the records reviewed there is not a process of recording these changes that would assist with future care planning and the reviews of care needs. The records seen for administration for the regular medications and any controlled drugs had been completed appropriately. With the exception being the previous evening where the manager had not recorded her signature as witness to the administration of controlled medications for two services user’s, which she did in our presence the next day. Any over the counter medications such as painkillers are now recorded, as this was an omission found during the last inspection process. From the records seen and the training certificates in place it was evident that staff had been provided with training for medication. One staff member confirmed that she was to attend training for this topic in the near future. Changes to the induction programme for staff now mean that the requirement made in regard to medication training for new staff will be met. The processes for assessing the risks to individuals who manage their own medication was a concern that was highlighted during the last inspection visit and a requirement was made to improve this. From the information in the home during this visit there were three service users currently self- medicating and the records for this and the policy and procedure for the whole of the management of medication in the home were reviewed. All three records show that the manager did action a risk assessment relevant to this topic but on closer examination the content was inadequate and did not show that the risks to the individual or others in the home had been reviewed appropriately. At least one service user who self medicates keeps their tablets out on full view of people passing the open door of her room. The room is not secured and can be left unattended at times during the day. Therefore this requirement still stands as not met as service users and others are not protected by the medication practices in the home. The policy and procedures for medication do not reflect fully the new guidance for care homes in regard to medications, ‘ The Handling of Medicines in Social Care.’ The manager was advised to obtain a copy and update the current documents and processes they have in place accordingly. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 13 The overall storage of medications held in the home were looked at as part of the inspection process as changes in the legislation for this have occurred in the last few months. The home has two medication cabinets both of which are compliant to the regulations for security and one does meet the necessary standard for the storage of controlled drugs. However, one medication cupboard is placed in the communal bathroom on the first floor and therefore will compromise maintaining the correct temperature recommended for storing medication. The manager was given a short timescale to remove the medication here and place in a safe environment. Which she confirmed would be carried out as soon as possible. The care plans did not show that personal choices of how the individual wishes to be cared for at the end of their life had been obtained. This was discussed with the manager who agreed that they had not yet made provision in the care planning to obtain information from the person concerned about this sensitive topic. This was of particular relevance to people who live in the home who have no close relatives who could ensure that their personal wishes are carried out should their health decline. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. That service users are given the opportunity to exercise choice over their lives and be able to maintain their interests. Meals and menu planning appear to suit the people living there and support is given when required EVIDENCE: The commission received several comments prior to and during the inspection in regard to the provision of activities and enabling residents to have some social contact with others. Some of the comments were: “I am taken to an external club alternate weeks, there is Holy Communion regularly. There are Christmas and Garden Party’s in the summer where we can invite relatives and friends.” “Activities such as visits from the local rector for communion - communal lunch- wheel chair access to garden - birthday parties and several concerts, especially at Christmas.” The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 15 “My mother is semi - paralysed and cannot stay out of bed for long. The staff enables her to attend birthday parties and other activities she would enjoy.” A member of staff commented about what they thought the home could do better, “Perhaps arrange a few more group activities for those residents who enjoy social contact with others. Of course I realise there are few residents who wish to keep to themselves.” Through discussion with the people living in there and reviewing the information in the home it was evident that people were supported to continue with some of their preferred interests. The majority of these were, through personal choice, activities that they undertook in the comfort of their own rooms such as reading and sewing. There were a small number of activities that could be enjoyed by all people living in the home such as meal times and most recently the Garden Party where family and friends could join in. Some residents, where able, continue to go out to the local town independently. From correspondence received by the manager, the recent garden party was much appreciated by relatives as much as the residents living in the home. The records for individuals as to identify interests and hobbies that could be assessed before coming to live in the home were very brief and there was no evidence that there was a planned programme of support by staff to enable people to continue with their preferred activities. Again through discussion with the manager and the staff it was evident that they have a very good knowledge and understanding of the people they support that is not fully noted in the care planning. The meals and menus appear to be set by the manager with no particular information recorded about personal likes and dislikes or changes to what is planned. The majority of the people living in the home did state, on the whole, they enjoyed the food provided and that if they required a change in the planned meal, it was available. Other comments made in the survey were, “ Food is good. Home cooked,” and “I do not like some of the vegetables as they are not cooked enough and there could possibly be more variety.” All care staff in the home are responsible for the preparation of the meals and the manager has ensured that they all have achieved obtained food hygiene training in order to do so. Since the last inspection the kitchen facilities have been improved with new storage areas and worktops that assist them to keep a good standard of hygiene. Most of the residents meet for the midday meal in the dining room with the majority of breakfasts and supper’s meals being taken in the comfort of their own rooms. A variety of drinks are on offer including sherry and wine with The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 16 their main meal of the day and some service users are able to have tea and coffee making facilities in their own rooms. Snacks are available between meals should they require it, but the majority of the people who spoke to the inspector said that this was rarely needed as the meals were usually very satisfactory. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that their concerns will be listened to but the processes for ensuring they are protected from possible harm are weak. EVIDENCE: Comments from participants in the survey and from residents during the day did confirm that they felt listened to should they have any concerns or complaints. They also expressed great confidence in the manager in regard to responding swiftly to rectify any small ‘Niggles’ or worries. From the records available and the information provided by the manager there have been not been any complaints made to the home during the last twelve months. Minor concerns have been acted upon and any comments about the service have been logged in the individual’s daily records. The manager was not able to provide sufficient evidence that there is a process of monitoring any trends of concerns for quality assurance. The current complaints procedure is provided in the Service User Guide that is given to all service users living in the home. The details for contact with the commission had not been amended to show the changes made six months ago. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 18 The commission has not been in receipt of any concerns, complaints, or allegations during the period since the last inspection process. During the last inspection in July 2007, it was identified that the manager had not ensured that staff have a good understanding of the local policy on safeguarding the people in their care from possible abuse. From discussion with the manager and staff available during this day visit to the service it was apparent that although training had been obtained for all staff there was still a gap in knowledge of how to handle a concern should it arise or how to obtain the contact details of the local authority who take the lead if an incident should occur. This was concerning as the manager did not express confidence in managing a situation even after training had been obtained during the last year for this. The homes policy and procedure for safeguarding adults was available to view by the inspector and although it provides some information it does not give detail of the current local policies. We were informed during the visit that a relative of one of the residents was staying for a few days in the home. From information provided it was identified that the person concerned was a minor (under 18 years old) and was using one of the bedrooms on the same floor as some of the residents. The manager was not able to provide evidence that any risks to this had been assessed, who was taken parental responsibility or that the homes public liability insurance was appropriate. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. These judgements have been made using available evidence including a visit to this service. That the home is maintained well and meets the needs of the people who live there. The practices for managing the control of infection could put service users at risk. EVIDENCE: The premises is not purpose built and is a family residence that has been converted over the last nine years to provide the current facilities within a homely friendly atmosphere. The most recent changes in the last two years have been an extension to the home that has improved the bedroom facilities in the home. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 20 From a review of the facilities is was apparent that the home is well maintained and cared for and service users can enjoy good sized bedrooms with en suites. There are two communal bathrooms that have been recently updated and can offer a pleasant comfortable bathing experience with the necessary equipment to assist those less able. There is plenty of communal space available in addition to a large conservatory to the rear of the home where they can enjoy views of the garden at all times of the year. The upper floor is accessible via a stair lift. Each individual is able to bring some of their own furniture and personal possessions and the bedrooms reflect the individual’s personality and interests. However, a review of the documentation made available by the manager it was apparent that an inventory of personal possessions bought into the home is not carried out. This is a key record that is required to ensure that the personal property of the service user is protected. Throughout the home there is a good standard of cleanliness and care and attention is taken to maintain a welcoming homely family environment that the service users who we spoke to felt was a key factor to them choosing to live there. The new laundry room is appropriate to the size of the home and has a sufficient capacity of washing and drying facilities for the number of service users living there. As previously identified during the last inspection process the current washing machine although relatively new is not able to disinfect soiled linen should there be a significant need. The laundry room not only housed the washing machine, dryer, and the homes boiler it is used as a storage facility. The manager was advised to review this arrangement in light of the possible fire risks and control of infection being compromised. They will need to reassess the practices of storing clean linen in the communal bathrooms and placing disposable gloves in close proximity to the toilet as most infections are carried by droplet infection. They should also ensure that personal toiletries are not left in these bathrooms. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment practices are weak and do not protect service users effectively. Staff do not evidence that they have sufficient knowledge about key health and safety practices that should be in place to protect the people living in the home. EVIDENCE: From information provided by the manager there has been no changes in the staff team since the last inspection process. The home is managed by the provider/owner who is supported by a deputy manager and a small team of full and part- time staff. All staff with the exception of one is employed by the home and there has been no new employment of staff at all over the last year. One care worker is on a long term placement in the home is employed through a local agency. The records for one permanent member of staff and the information obtained about the agency staff member were reviewed to see if safe recruitment and employment practices are carried out. The records show that there had been no amendments to the processes previously seen and that the application and recruitment process remains insufficient and does not follow the necessary requirements for employment The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 22 practices. The application form does not request the full work history, explanation of gaps in employment or require for criminal record declaration. We also passed good practice recommendations to the manager to record the interview process and the decision making to employ the person concerned. For one staff member’s recruitment information there was little evidence of the reasoning why a person with no previous experience in care had been employed or what the strategies they were going to put in place to enable them to carry out their role. For the member of staff employed through an agency there was no evidence at all that the manager had assured that they were fit for the role they were employed for. They were only able to provide a copy of the last Criminal Records Bureau check that had been carried out by the agency and some of the training and qualifications the staff member had undertaken. The manager was reminded that it is their responsibility to ensure that any staff obtained through an agency has had the basic checks carried out including references. The manager has acted upon the requirements and recommendations in the last inspection report for induction and supervision. All staff have been recommenced on a recognised induction programme to take them through the key points of good care practice. A formal supervision programme has now been started. Information given by the manager indicated that two of the seven staff employed have an NVQ level two or above. The manager confirmed that she had just completed the last part of an NVQ Registered Manager Award and was awaiting results from this. The deputy manager stated that she was in the process of commencing this within the next few weeks. There appears to be an active training programme in place that includes the key topics of health and safety, cross infection and adult protection. The manager has also ensured that the agency staff member has been included in all training that has been provided. As yet they do not use a training needs analysis to assist in identifying and planning training for the individual staff member. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is not always run in the best interests of the people who live in the home. Fundamental processes that should be in place to protect them have not been implemented. EVIDENCE: The manager/ provider is resident in the home at all times. She is a registered nurse and has been in her present role since the home opened nine years ago. During discussion during the day of the visit to the home she provided information about the proposed changes in the management and administration practices. These in the main were to train and develop the deputy manager to carry out the greater part of the administration and record The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 24 keeping for the home and for her to concentrate in providing the personal care and support for the people living there. Some of the residents who we spoke to expressed that they felt it was reassuring that the manager lived on the premises and was contactable at all times. They also gave comments about the quick response to requests and friendliness of the staff who work in the home. The processes for any formal quality assurance monitoring have not been implemented in great detail. Consultation with the residents and their families about their opinion about the home is usually carried out informally with occasional surveys sent out, approximately annually. The manager has not used the information obtained in any formal business planning or provided information back to the participants of the outcomes of any processes carried out. The manager provided information that there had been no changes to the practices of not handling any service users monies. This remains with their families or advocates. The deficits in the monitoring for the fire safety and hot water temperatures identified as a concern during the last inspection process have been rectified and are assisted by the new record books the manager has purchased for this purpose. The manager provided information in the Annual Quality Assurance Assessment, self-assessment that the safety checks that should be carried out in the home for the environment had been carried out accordingly. A number of the policies and procedures for health and safety and the general management of the service were reviewed through the process of inspection. From those identified there were a number of policies and procedures that need further development to provide staff with greater guidance and for them to be carried out effectively. This observation was passed back to the manager and deputy manager during the inspection as it was concerning that staff may not have a good understanding of some of the key procedures such as control of infection and safeguarding adults from possible harm. The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X 2 2 The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 30/08/08 2. OP18 13 (6) 3. OP29 17 (2), Schedules 4 and 6 There should be processes for assessing the risks to individuals and others in regard to service users managing and self – administrating their own medications. This was a previous requirement that should have been met by 24/09/08 30/08/08 There should be appropriate information and structures in place to ensure that people living in the service are protected from possible harm or abuse and staff in the home should be able to demonstrate they have the required knowledge to manage a situation should a concern be raised. This was a previous requirement that should have been met by 24/09/08 30/08/08 There should be evidence that a robust process has been made to ensure that staff have been recruited appropriately and checks made to support they are fit for the role they are employed for. This was a previous DS0000040609.V367775.R01.S.doc Version 5.2 The Tower House Page 27 4. OP38 13 requirement that should have been met by 24/09/08 There should be adherence by staff to control of infection practices to protect service users from risk of infection spreading through the home. 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Tower House DS0000040609.V367775.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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.V367775.R01.S.doc Version 5.2 Page 29 - 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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