Inspection on 02/06/05 for The Tower House

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 13/12/05

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 RG9 3JN Lead Inspector Jane Handscombe Unannounced 02 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Tower House Address Reading Road, Shiplake, Henley on Thames, RG9 3JN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01189 401 197 Bridget Kidd Care Home 4 Category(ies) of Old age, not falling within any other category registration, with number (4) of places The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15 March 2005 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 is 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 that are 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 v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, lasting 4 hours, which took place during the afternoon of 2nd June 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 upon the care they receive at the home, speaking to staff members and the manager and viewing records held whilst also observing the day to day operations of the home. Family members visiting the home were also invited to give feedback. The home presented as one with a homely ‘family’ atmosphere, which 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 included: ‘I couldn’t be happier anywhere’ ‘I think they are absolutely wonderful’ ‘I am very happy here’ What the service does well: The home has a very friendly, caring inclusive atmosphere in which the residents feel confident that they are very well cared for, and their right to privacy and dignity is upheld at all times. The home ensures policies and procedures are followed, and stringent recruitement procedures and pre-employment checks have been undertaken on all staff to safeguard the health, safety and welfare of the esidents in their care. Special occasions and birthdays are acknowledged and celebrated in the home. All residents and their familes and friends are invited to join in their celebrations. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 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 Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 The home gives clear written information about the home and the services offered to all prospective residents and their families. EVIDENCE: Information contained in the residents’ guide allows prospective residents to gain a ‘feel’ and ‘picture’ of the home. Information within the guide includes the ethos of the home, the facilities and services that are provided, details about the staff and training they have undertaken, information on the individual and communal room sizes and their facilities and information regarding social activities and leisure time. The manager visits each prospective resident to discuss their expectations of the care they wish to receive and to assess their needs to ascertain if the home is suitable to meet those needs. Once it has been agreed by both parties that the home can meet a service user’s needs, an admission date is agreed and there is a month’s trial period to ensure that both the service user and the management are confident that the individual needs are being met. Each service user has a written contract, copies of which were seen to be held on each resident’s file. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 and 10 The residents’ health, personal and social care needs are assessed and reviewed regularly providing an individual plan of care to ensure their needs are identified and met. EVIDENCE: An individual plan of care is drawn up with the resident’s involvement and is reviewed on a monthly basis. Two of the residents’ care plans failed to contain a photograph and a requirement has been made within this report to address this matter. The inspector viewed the daily comments books which showed inconsistencies in the style of reporting. Some entries were very detailed whilst others had very little detail. It is a good practice recommendation that entries are of a fuller description thus enabling any staff member to read about and know what care has been given. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 In line with the residents’ expectations and choice, the home provides group social events which are arranged with the residents and to which family and friends are invited to attend. Residents are assisted to attend any local activities/gatherings if they desire. EVIDENCE: Whilst there are no formal activities in place, the residents informed the inspector that the home is very much in line with their expectations, is run as a family home and in line with what their wishes are. The proprietor, in collaboration with the residents, arranges social events with the residents and one such event took place recently. One resident showed the inspector photographs of an event held in the gardens to celebrate a recent birthday, which was attended by all the residents and family members and friends. Residents spoke fondly of these social events and of forthcoming fellow residents’ birthdays, which will be celebrated. A chaplain visits the home every six weeks offering communion to those who wish. It was mentioned to the inspector that the visits were welcomed and ‘it is a shame that there are not more frequent visits’. This was mentioned to the manager, who informed the inspector that she would approach him with the comments and ascertain if more frequent visits could be made possible. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 11 Arrangements for accessing and attending religious services within the local vicinity can be accommodated with the support of the residents and their relatives. Each resident has a television and radio in their room and there is the facility for each service user to have a private telephone line if required. Residents informed the inspector that they are able to receive visitors in their rooms or the shared communal rooms and that they are welcomed at any time. Visitors who were in attendance during the day verified this. A hairdresser visits the home regularly for those who require the service and daily newspapers are placed in the conservatory for residents to enjoy. The residents are offered three meals a day with snacks and drinks available throughout the day. All the residents generally like the food offered, although comments received during the day led the inspector to speak with the manager and recommend that the residents be asked (either directly or in the form of a questionnaire which could be anonymised) if there is anything they would like to be added to the menu in order to address all the residents’ likes and dislikes, thereby being inclusive and removing the monotony that was voiced. Food plays a very big part in the residents’ lives and it is felt that discussions with the residents around the subject of meals offered should be of high priority. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 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 standard(s) 16 and 17 There is a complaints procedure and policy in place, which all residents are aware of and would use if the need arose. EVIDENCE: The complaints procedure is clearly found in the residents’ guide and all residents were aware of who to approach if they were to have any concerns and felt that, if the need arose, they would be listened to and their concerns would be taken seriously and dealt with appropriately. The manager reported that all residents are included on the electoral roll and were enabled to take part in the recent general election via the postal system of voting, as many had recently done so, or by attending the local polling station as did one resident. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, and 26 The home provides comfortable surroundings, which are equipped to meet the residents’ needs. EVIDENCE: The home encourages residents to bring small items of furniture and memorabilia to personalise their rooms. On the day of the inspection, the home was generally well maintained and clean, with a homely atmosphere. It was noted that a visit by an environmental health officer had been undertaken in March who required that a risk assessment of the home and the premises be undertaken. The inspector has made a requirement in this report that the registered manager must undertake the risk assessment in order to protect the health, safety and welfare of the residents. Once the environmental health department is satisfied that this has been completed, written verification must be forwarded to the Commission. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 14 Residents have the use of a newly built conservatory and a communal sitting room and during the warmer months are able to spend time in the well kept gardens as they so wish. There are three bedrooms on the first floor, all of which are of equipped with ensuite facilities. A further bedroom is situated on the ground floor with ensuite bath, toilet and wash basin. All the residents’ rooms were viewed and seen to be spacious and equipped to offer comfort, privacy and meet the residents’ needs. Residents are encouraged to bring small items of furniture and memorabilia to decorate their rooms to their liking where required. A toilet and washbasin is situated in close proximity to the communal rooms on the ground floor and a bathroom on the first floor is equipped with a hydraulically operated seat to help residents into and out of the bath where required. Grab rails were seen to be fitted where necessary. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Due to the small size of the home and the needs of the residents within the home, the proprietor provides the majority of care and is supported by four part-time carers. All staff have undergone the necessary pre-employment checks and the necessary training in order to ensure competency in their roles. EVIDENCE: Mrs Kidd, the proprietor and registered manager of the home, is the only Full-time carer and employs four part-time carers to assist in meeting the residents’ needs. Mrs Kidd is a state registered nurse and had many years’ experience in caring for older people. When necessary, such as holiday periods, Mrs Kidd uses the services of a specialist agency to provide an experienced nurse in her absence. It was noted that in order to provide the continuity of care, Mrs Kidd employs a nurse who is known to the residents and familiar with their needs. Residents are supported and protected by the home’s recruitment policies and procedures. All the necessary pre-employment checks and relevant training of staff are followed up and kept in a personnel file, as are those of the nurse provided by the agency. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 16 All staff who provide care at Tower House undergo relevant training and supervision in order that they can undertake their care duties competently. Staff employed by Tower House and those supplied by the agency have undergone mandatory training, which is reviewed and updated annually. Recent staff training has included medication training and manual handling training which was carried out in October 2004, with another planned later this year. Mrs Kidd has updated her first aid and fire training and continues to update her skills and knowledge to ensure the residents receive a quality service. Residents spoken to on the day of the inspection spoke highly of the care they receive at the home. ‘They are very competent and the care we get is very good’. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 Tower House is a well managed home, run in the best interests of the residents with safeguards in place to protect their health and well being. EVIDENCE: The manager of the home has undergone registration with CSCI deeming her a fit person to manage the home. Mrs Kidd has many years’ experience as a state registered nurse supporting and caring for older people and continues to update her skills and knowledge in order to meet the residents’ needs. Residents spoken to during the inspection have every confidence in Mrs Kidd and the care she provides at the home and feel comfortable in approaching her with any concerns or complaints that they may have. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 18 There is no formal consultation in place whereby service users contribute to the way in which the home operates. Residents are welcomed to approach the manager, although there could be occasions when some residents would prefer to make their voices heard anonymously. It would be a good practice recommendation to establish and maintain a system in which residents and family members can provide feedback on the service they receive, thereby allowing their voices to be heard and to ensure that the home creates an inclusive atmosphere for all those in their care. Residents’ personal finances are looked after by either the residents themselves or a named relative and the home does not have any involvement in the financial aspect of those in their care The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 2 3 x x x x 3 The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 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. 2. Standard 7 19 Regulation 17(1) sch 3 23(2)(5) Requirement The registered manager must ensure that each residents file contains a recent photograph The registered manager must fulfil requirements made by the environmental health officer in March 2005 with regard to risk assessment of the building and premises, and the response from the environmental health department must be forwarded to the CSCI Timescale for action 02/06/05 22.07.05 3. 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. Refer to Standard 7 32 Good Practice Recommendations Entries made in the daily comments book should be fuller in description to allow any care staff to gain a full picture on the care that has been given. It is good practice to establish and maintain a system whereby residents can provide feedback on the service they receive. The Tower House v230834 h57-h08 s40609 the tower house v230834 020605 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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. 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