Inspection on 06/09/05 for The Tudors

This inspection was carried out on 6th September 2005.

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

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

Other inspections for this house

The Tudors 18/12/07

The Tudors 04/01/07

The Tudors 15/02/06

The Tudors 17/03/05

The Tudors 07/09/04

The Tudors 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Tudors Street Road Glastonbury Somerset BA6 9EQ Lead Inspector Justine Button Unannounced 6 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Tudors Address Street Road Glastonbury Somerset BA6 9EQ 01458 831524 01458 831608 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) Mrs Noreen Maria Khan Mrs Wendy Lavina Weddell Personal Care Home Only 22 Category(ies) of Old Age (22) registration, with number of places The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2005 Brief Description of the Service: The Tudors provides residential accommodation for up to 22 adults under the OP category of registration. The home is owned by Mrs N. M. Khan-Mullane. The registered manager is Mrs Wendy Weddell. The home is sited in Street Road, not far from the centre of Glastonbury. There is a large supermarket just opposite. The home is at the base of a hill. There are patio areas and steps leading to an attractive hill garden. Access to the garden is limited to mobile service users who can manage the stairs. Access to the patio areas is easier. Service users’ accommodation is on two floors. The first floor is accessed by stair lifts. Some bedrooms of the first floor have nice views of the hill beside it, others of the garden or the front of the house. Communal areas and the kitchen are sited on the ground floor. The home faces a busy road. There is car parking space at the front of the property. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this unannounced inspection over the course of one day. The inspector was able to speak with a large number of the residents as well as staff on duty. The manager, Mrs Weddell, was available on the day of inspection. The inspector would like to thank the residents and staff for their time and hospitality shown to the inspector during their visit. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. Records examined were care plans, staff recruitment files and some health and safety records. Other records will be examined at subsequent inspection visits. A tour of the building was carried out on this visit. What the service does well: What has improved since the last inspection? There were a number of requirements and recommendations made in the last inspection particularly with regard to the environment. Due to the ongoing hard work of the management a number of issues have been addressed. During the inspection a list of work that has been completed was provided and discussed with the home manager. Works completed include fitting of window restrictors on all upstairs windows, a new boiler has been fitted. There is now a lockable space in all of the bedrooms, the ceiling has been repaired in one of the bedrooms, door guards have been fitted to all fire doors. This list is not complete but covers the main area’s that have been addressed. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 6 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 Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.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 Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.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, 3, 4, 5. Standard six relating to intermediate care is not applicable for this service. People who intend to move into the home have adequate information in order for them to make an informed decision about moving to The Tudors. A member of the senior staff team conducts assessments prior to admission. The opportunity to visit the service prior to admission is available and people moving into the service are aware that the home can meet their individual needs. EVIDENCE: The home displays it’s statement of purpose and service user guide in the hallway. These documents contain all necessary information about the services the home is able to provide including a copy of the last inspection report. This document states, “The aim of the home is to provide high quality care” The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 9 One person who recently moved to the home stated that her family had been able to visit prior to her moving in. Staff had answered any questions that had been raised. The information given had lessened her concerns about moving into the care environment. The manager stated that she visits all people prior to moving into the home to ensure that the service meets their needs. This service provides personal care only so is not suitable for those people who have complex or multiple nursing needs. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 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 standard(s) 7, 8, 10. The majority of people who live at the service have their health and personal care needs met. People who live at the service are treated with dignity and respect. EVIDENCE: All people who live at the service have a care and support plan. Five of the care plans were viewed on the day of inspection. The plans need to be developed in order to give clear guidance to the staff on the specific needs of the people living at the service. Ambiguous statements such as “encourage fluids” need to be avoided. The plan should state how much fluid should be encouraged. One of the people living at the service has a urinary catheter and another has been having a reduction in drugs. There were no specific guidelines for staff on how to manage these aspects of the persons care. Discussions with staff however showed that they had a clear knowledge of individual’s needs and requirements. The use of assessment tools e.g. for moving and handling or nutrition was spasmodic. Staff need to develop these for all people living at the service. All the plans had been reviewed on a regular basis. There was no evidence however which demonstrated that service users and/or their representatives had been involved in this process. The care of one individual was discussed with the manager on the day of The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 11 inspection. It was agreed that this individual would be referred to the GP to discuss an aspect of his care that was causing concern. The plans demonstrated that the district nurse visits the service regularly to treat medical conditions that are outside of the skills of the staff group. GP’s from the local practise visit the service as and when required. People who live at the service also have access to chiropody, dental services and opticians. One person at the home is frail and is cared for in bed. The care and support this person received during the inspection was appropriate and included a regular change of position and fluid intake. Staff were observed talking to people in a respectful manner and knocking on bedroom doors. People who live at the service stated that staff treated them in a dignified manner and that all treatments and personal care is conducted in privacy. Locks have now been fitted to all the bedroom doors which people can use if they wish to increase their privacy. In order to access one of the bedrooms staff and visitors have to walk through an adjoining bedroom. Whilst both people living in these rooms currently have expressed consent for this and do not have any issues with this arrangement this may not be suitable in the future. The management need to consider how this is to be addressed when the time arises. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 12 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, 15. People who live at the service maintain contact with family and friends. People are supported to maintain interests and to live an active a life as they choose to lead. The food provided is of a good quality. The choices and control people have could be developed in some areas. EVIDENCE: A number of people were spoken to during the inspection. When asked how they spent their time a range of answers were given. A number of the more independent people stated that they walked into the local town and did some shopping. One lady accessed a local hairdressing salon via use of a taxi. A number stated that they enjoyed watching TV, doing puzzles and crosswords and one lady enjoyed doing her knitting. One person was actively involved in looking after the pots of flowers in the patio area. The activities that people enjoyed appeared to be those that could be completed independently. The provision of organised activities and events should be developed particularly for those who are less able. A hairdresser visits the service regularly. All the people spoken to stated that they could receive visitors as and when they wished and that people visiting the home were made welcome by the staff. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 13 Lunch was viewed on the day of inspection. Two choices were available on the menu that is displayed in the dining area. The choices consisted of sausage casserole or cheese pie. Mashed potatoes, peas, cabbage or tinned tomatoes were also served. Rice pudding was then served. The meal looked and smelt appetising. All the people spoken to stated that the food was of a good standard. Although the menu was on display in the dining room all the people observed had the sausage casserole. Some of the people spoken to stated that they found the menu difficult to read and access. Due to this a number of people were unsure of the choices available to them. Staff need to review this system to ensure that people are able to make active choices about the meals they would like. The building has recently undergone refurbishment and decoration in a number of areas. People spoken to stated that they had not been involved in choosing colour schemes or furnishings. The majority of people living at the service would have been able to contribute to this discussion. The management should consider this aspect of promoting choice. Positive feedback was received from people in connection with the freedom of movement and ability to exercise self-determination in their daily lives. This may be increased however if people were involved in the development and review of their plan of care. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 14 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, 18. There is a clear complaints procedure and people who live at the service are confident that their complaints would be listened to. People are not protected from abuse to the fullest extent; see standard 29 on staff recruitment. EVIDENCE: There had been no complaints. A complaints and compliment folder has been placed by the front door although this had not yet been used by anyone. The complaints procedure was inside and there were questionnaires for service users and visitors to complete seeking feedback about the home. Service users spoken with continue to provide a most positive feedback about the home and their ability to raise issues with the staff and the manager. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 15 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, 23, 24, 25, 26. A number of environmental improvements remain although the home is clean and safe. All people have their own rooms in which they have personal possessions. One area with regard to infection control needs to be addressed. EVIDENCE: As previously stated the management has invested a lot of time and effort into improving the standard of the environment. Discussions and a tour of the building took place during the inspection. A number of the bedrooms and communal spaces have been refurbished and redecorated. The manager stated that three of the bathrooms are to be refurbished. The bath is to be removed and a shower is to be fitted in one of the bathrooms and the other two are to have new fixtures and fittings. One dining/sitting area is due to be redecorated and new carpet laid in the near future. A number of bedrooms also are due for redecoration. The service was clean and tidy on the day of inspection. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 16 The people who live at the service invited the inspector into a number of the bedrooms. Those seen were clean and tidy and had been personalised by the people living in them. The upper floor is accessible by two stair lifts. One of these is to be replaced in the near future. A number of the bedrooms and one dining area also have steps so are not easily accessible to those who are not ambulant. The garden is sloped. A ramp has now been provided from the house to the patio area. People spoken to during the inspection stated that this had been welcomed and had enabled them to sit out during the summer months. Rails have been added to the stepped parts of the garden, which has improved access. The manager stated that there are plans to excavated part of the garden near the patio to extend the area available for those with mobility problems. The laundry was inspected. On the day of inspection the tumble dryer was not working. Whilst this may not be an issue in the summer months given the amount of laundry produced from a service of this size this will require replacement in the very near future. Some of the bedding and towels were a little threadbare and consideration should be given to replacing some of these items. The laundry area is in need of refurbishment however priority is being given to communal areas currently. One of the bedrooms, which was only accessible via the laundry, is now being used as staff accommodation. The management need to consider a reduction in the number of registered beds to reflect this. On the day of inspection some toiletries including bar soap and shampoo were seen in the bathrooms. People should be provided with individual toiletries in order to reduce the risk of cross infection. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 17 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, 30. Staff are available in adequate numbers. It could not be confirmed if staff had received all necessary training. Staff recruitment is not in line with current regulations. EVIDENCE: Testimony from the people living at the home and staff confirmed that there are adequate numbers of staff on duty at all times. People living at the service stated that they did not have to wait long if they required assistance or support. Following a recommendation made in the last inspection report a training matrix is in the process of being developed. As this document has not been fully developed it could not be confirmed if all staff have received all necessary mandatory training. Staff spoken to however stated that they had received training in moving & handling, medications, health & safety and fire prevention. The staff recruitment files were viewed for the last three staff employed. These showed that the staff have two references had been received prior to commencement of employment. The files showed however that Criminal Record Bureau and POVA checks had not been completed prior to the staff commencing employment. The management may like to consider the use of POVA first. This matter needs to be addressed prior to any new staff commencing employment in order to protect people living at the service to the The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 18 fullest extent. The staff recruitment files need to contain all the information as stated in schedule two of the Care Home Regulations. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 19 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, 37, 38. This home generally has good occupancy rates. Service users speak well of the care and service they receive. Records are well managed but consideration needs to be given to how some documents are stored. The service is well managed. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 20 EVIDENCE: The manager has been in post since March 2004. She is an experienced carer and had performed the role of deputy manager in the home in the past. She has relevant NVQ III and is an NVQ assessor. The manager is working towards NVQ 4 and the RMA. The management of the home is open and inclusive as evidenced during conversations with staff and the people who live at the service. There was a relaxed and positive atmosphere in the home. A lockable filing cupboard in the dining room is used for care records. This cabinet was unlocked for the majority of the inspection. The management need to consider how this would impact on people confidentiality if any unauthorised person accessed these records. A number of improvements to the home have been made which have reduced the health and safety risks. These include the fitting of thermostatic controlled devices to all bathrooms and the repositioning of the boiler out of a bedroom. Work has been completed to reduce the risk of injury or damage in the event of a fire including the fitting of fire doors and new locks to the fire escapes. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 21 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 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 3 x x 3 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x 2 3 The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 22 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 OP7 Regulation 15(1) Requirement A full plan of care must be completed with each service user that fully describes how needs will be met and action to be taken to minimise risks. Ambigiuos statements should be avioided. All elements of the care plan must be reviewed at monthly intervals with the involvement of the service user. Previous unmet requirement by 31/12/04 It is required that all staff recruitment files contains all the information as per schedule 2 of the Care Home Regulations. This should include a CRB and POVA check prior to commencing direct work with peole living at the service. Timescale for action 30/12/05 2. OP29 19 and schedule 2 With immediate effect for any new staff employed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Tudors Refer to Standard Good Practice Recommendations D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 23 1. 2. OP12 OP14 3. 4. 5. 6. OP26 OP19 OP30 It is recommended that the range and provision of activites be reviewed. It is recommended that the management team consider the promotion of choices available to people living at the home to include input into the plan of care, active choice of meals, and discussion about the decoration and refurbishment of the building. It is recommended that the replacement of the tumble dryer should be considered. It is recommended that the on going refurbishment of the property continues. It is recommended that the development of the training matrix continues. The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 24 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Tudors D53_D02 S15996 The Tudors V229094 060905 Stage 4.doc.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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