CARE HOMES FOR OLDER PEOPLE
The Turner Home Dingle Lane Liverpool Merseyside L8 9RN Lead Inspector
Les Hill Key Unannounced Inspection 26th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Turner Home DS0000025383.V295287.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 Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Turner Home Address Dingle Lane Liverpool Merseyside L8 9RN 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) 0151 727 4177 The Turner Home Mrs Alison Charlesworth Care Home 59 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Old age, not falling within any of places other category (49) The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 49 (N) (OP) Nursing Care or 49 (PC) (OP) Personal Care for older people (OP)aged from 55 years in an overall total of 49 Male residents only. 10 (N) or 10 (PC) mental disorder elderly (MD/E) aged from 55 years in an overall number of 10 6th December 2005 Date of last inspection Brief Description of the Service: The Turner Care Home is a large Victorian listed building, built in 1880 to provide personal and nursing care for men. In 1995 a major extension was built, that provides 59 single bedrooms with en-suite facilities. At the same time the home was dually registered with both the Liverpool Health Authority and Liverpool Social Services. The current registration is for 59 residents (49 Nursing and 10 Mental Disorder). There are several lounge areas, a large spacious dining room, a chapel and rooms for recreational activities. Designated smoking areas are provided. The building is set in large private grounds that are well maintained. The home has its own chapel, a weekly service is held for residents. A number of car-parking spaces are available for visitors to the home. The Turner Home is conveniently situated close to local shops and amenities and is close to main bus routes into the city centre. Fees for accommodation at the home range from £292 - £549 depending upon assessed need. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of the Turner Home was undertaken on Thursday 26th October 2006 over a period of 5.5 hours. It involved the examination of some records, meeting with the manager and deputy manager, the cook and the activities organiser. The inspector also met some of the residents. The inspection was undertaken as part of the Commission’s responsibility to visit and report on all registered care homes. What the service does well: What has improved since the last inspection? What they could do better:
Only one requirement has been made to ensure that fire precautions in the home are fully operational. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 6 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 Turner Home DS0000025383.V295287.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 Turner Home DS0000025383.V295287.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): 1, 2, 3, 4, 5 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to the home. Residents have the information they need to make a choice about the suitability of the home and comprehensive assessments ensure staff are able to provide the levels of support necessary. EVIDENCE: The home has a statement of purpose that doubles as a service user guide and is presented well. It contains all of the information required in Schedule 1 and Standard 1.2 of the National Minimum Standards, Care Homes for Older People. The document is given to all new residents and to professionals who have a connection with the home. A written contract/statement of terms and conditions of residence is completed for all residents and a copy is kept on their main file in the home. Four residents care files were sampled. Each contained a pre-admission assessment that had been undertaken by a senior member of staff from the
The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 9 home. The documents are completed to ensure the home is able to meet the needs of potential residents and to give them and their relatives the opportunity to enquire about care and support in the home. A number of residents have moved into the Turner Home from other care and nursing homes in the area. Potential residents and their families are given to opportunity to visit the home and to spend some time there before making a decision to move in. The home is not contracted to provide intermediate care. The Turner Home DS0000025383.V295287.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 good. This judgement has been made using available evidence including a visit to the home. Support for residents is outlined in detailed plans of care and staff carry out their responsibilities with due regard for the privacy and dignity of residents. Medicines are managed safely. EVIDENCE: Each of the four care files seen contained a comprehensive plan of care that had been constructed from the assessment and developed in conjunction with the resident and/or their family. They include a social history, previous occupations, hobbies and interests and a note of likes and dislikes, particularly around foods. The plans of care identify areas of need and the ways in which staff support should be provided. Where a particular risk to the resident is identified a separate risk assessment is undertaken that again gives guidance and support to staff. Notes are maintained on the files to confirm that plans of care have been reviewed. Care plans include the health care needs of residents. The home has good links with a local GP practice and funds a weekly clinic at which residents can be
The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 11 examined by the doctor and medication regimes can be reviewed. Appointments outside of the weekly clinic are arranged as necessary. Residents are able to maintain their own GP if they are admitted from the local area. Dental, ophthalmic, podiatry, dietary, and continence advice and support are arranged as necessary. Policies and procedures are in place to support the management of medicines. None of the current residents are able to self medicate. A sample of the records and storage of medicines in the home confirmed that they are being managed appropriately. The home’s policies and procedures and its practices support the need for residents to be supported as individuals with respect for the maintenance of their privacy and dignity at all times. Discussions with the manager, the deputy manager and the activities organiser centred around the need for staff to respect the needs, wishes and preferences of individual residents, and to work with them in creating opportunities for fulfilment. Staff were observed to speak respectfully with residents and to knock on bedroom doors before entering. Procedures require that staff will deal sensitively with residents and their relatives at the time of death and will have respect for the dignity of the occasion. Information about the wishes of residents and their families at the time of death is gathered when it is felt to be appropriate. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the home. Residents are helped to exercise choice and control over their life through regular consultation and involvement in reviews. The home is actively involved in ensuring that the community understands the needs of residents. Menus are arranged to meet the expectations and any special dietary needs of residents. EVIDENCE: The home gives a great deal of time to the organisation and support of appropriate activity. A full time activities organiser is in post and another member of staff is allocated to support the programme of activities each afternoon. Care staff on duty will also get involved in the activities. The activities organiser is the regional representative on the national Association of Planned Activities (NAPA) and is hoping to establish an NVQ accredited course for activities organisers in the region. Group activity such as Bingo, films and entertainment is organised but a great deal of time is spent in encouraging individual interests and the maintenance of skills. From the social history, the list of employments and the list of interests the activity organiser can engage with residents and provide encouragement to continue their interest in the home. Seven residents have
The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 13 achieved an NVQ in Horticulture and a photography club is being introduced. The home has two mini-buses and regular trips are made out from the home. A number of residents have benefited from a small group holidays in Scotland, Yorkshire and London. Links have been made with Liverpool Community College and with local schools and the home has assisted sixth form art projects. Negotiations are to be held with local groups around the use of playing fields that belong to the home. The activities organiser reviews each activity with residents who have participated to ensure it was appropriate and that they had been able to enjoy it. The activities organiser also carries out regular quality reviews about the ways in which the home is run with small groups of residents and the information gained is used to develop care practices. Resident’s birthdays are acknowledged on the day with a small birthday cake. At the end of each month a celebration party is arranged for all the residents who had a birthday within the month and they receive a small present. Visitors are welcomed at the home at any time. And a payphone is available for residents. Liverpool Environmental Health Officers were pleased with the standards that are maintained in the homes kitchens. At the time of this inspection the kitchen was clean and well ordered. The cooks have a list of the likes and dislikes of residents and of those who have special dietary needs. Mealtimes are set and there are two sittings. A choice of foods is available at breakfast time. The main meal of the day is at lunchtime and residents can choose an alternative to the main meal on offer. A choice of meals is also available at teatime. The home’s menus show that a range of foods appropriate to the needs of the residents at the Turner Home is being provided. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Policies and procedures ensure that residents can be supported safely. EVIDENCE: The home has a complaints procedure in place that conforms to good practice and is outlined in the service user guide. There have been no formal complaints made to the home or to CSCI in the past twelve months. All residents are included on the Electoral Register and have the opportunity to vote in local and national elections. Up to date information is available on the protection of vulnerable adults and staff are provided with appropriate training on the different types of abuse, how it can be recognised and how it should be reported. A “Whistle Blowing” policy is in place to encourage staff to report any concerns. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents are supported in a safe and well-maintained environment that is appropriately equipped to meet their needs. EVIDENCE: The Turner Home is located in a unique building in the Dingle area of Liverpool, close to the city centre and with local amenities and local public transport routes to the city centre and surrounding areas. A local philanthropist funded the construction of the main house in 1880 as a refuge for homeless men and it has continued with this function to the present day. A new purpose built extension was added in 1995. The home now provides single room accommodation (most with en-suite facilities) for 59 men over the age of 55 years. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 16 A handyman, a decorator and gardeners are employed on a permanent basis and the home and its external grounds are maintained to a good standard. The homes manager completes regular audits of the standards of cleanliness and the overall maintenance of the building and manages a budget for the continuous improvement of the home. The property is protected by external and internal corridor CCTV but cameras do not intrude on the personal privacy of residents. Keypads on external doors protect the security of some residents who might wander out into the local community. Environmental standards on the day of this inspection were good. Any odours are contained and polices and procedures, supported by staff management and training ensure that good health and hygiene practice is upheld. The home has four sitting areas and a dining room. Separate smoking areas are available. Residents can choose to spend time in their own rooms or in one of the communal spaces around the home. Sufficient and appropriate WC and bathing facilities are in place. Residents are accommodated in single bedrooms that can be locked if the resident chooses to do so. All of the bedrooms were of an appropriate size, were fitted with essential storage facilities and had been personalised to a greater extent by the resident or their family. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 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 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 good. This judgement has been made using available evidence including a visit to the home. Resident’s needs are met, and they are protected, by the homes recruitment and selection procedures and by a trained and experienced staff team. EVIDENCE: The home employs a manager, 12 first level nurses (including the deputy manager), 26 care staff and 18 ancillary staff. Trained nurses are on duty in the home at all times. All of the nurses have responsibility for the administration of medicines. Staff rota arrangements are in place that ensure the home is adequately covered to provide the levels of care necessary for the group of residents living in the Turner Home. Four staff files were sampled during the inspection. Those for staff appointed in the last ten years contained an application form, two references and confirmation of identity. All of the files contained confirmation of CRB clearances. Personal Identification (PIN) numbers for nurses were logged and the home ensures that they are maintained. All of the files contained a contract of employment. Fourteen of the homes twenty six care staff have an award at NVQ level 2 or above in care and plans are in place for further NVQ training.
The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 18 New staff are expected to follow a programme of induction training and to work alongside existing staff until they are familiar with the home’s routines. Ongoing training is provided in moving and handling, fire awareness, food hygiene and first aid. Specialist training has been provided in the protection of vulnerable adults, Epilepsy, diabetes and non-violent crisis intervention. Additional courses are arranged as necessary. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Resident’s benefit from strong management and supervised staff support. Their financial interests are protected and they are encouraged to contribute to the development of the service through regular consultation. EVIDENCE: The home’s manager is a qualified nurse and has been in post for approximately ten years. The deputy manager is also a qualified nurse. The manager and her deputy are fully aware of what is happening in the home and have a good knowledge of the needs of individual residents. It is also clear that strong leadership is provided and staff are clear about what is expected of them. Throughout the inspection it was evident that the needs of residents are central to the operation of the home.
The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 20 Residents are routinely asked for their opinion about the day-to-day running of the home. The home’s manager carries out monthly audits of the cleanliness of all areas of the home, the cleanliness and appropriateness of resident’s rooms, the cleanliness and operation of the kitchen and all other aspects of running a home. Written records are maintained and are available for inspection. The home’s business plan and audited accounts were not seen but the Commission is unaware of any matters that would affect the ongoing operation of the Turner Home. The Administrator was not available during the inspection but she manages the personal finances on behalf of the majority of residents in the home. Some records of income and expenditure were seen and were kept well. Each of the residents has a separate bank account on which deposits and withdrawals are made. Records of all transactions are in place and the resident is asked to sign and confirm each event wherever possible. Staff receive one-to-one supervision on a 3-monthly basis. Care staff are supervised by qualified nurses who in turn are supervised by the manager and her deputy. Annual appraisals are carried out and the manager follows through any important development issues. The home has a full set of policies and procedures that have been produced professionally and cover every essential element of running a care home with nursing. Additionally record keeping is maintained to a good standard. Health and safety is given appropriate priority. Standards are in place and the manager routinely checks to confirm that they are being maintained. The gas safety certificate was renewed in June 2006 and the electric wiring system is due to be checked in the days following this inspection. PAT testing of portable electrical appliances was carried out in May 2006 and testing for Legionella was undertaken in May 2006. Records show that the fire alarm and emergency lighting is checked weekly and that all equipment used in the home is tested at appropriate intervals. However, during the course of the inspection the fire alarm system was activated. It was noted that automatic closures on three fire doors did not operate as they should. The matter was reported to the handyman for immediate action. The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 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 3 3 3 3 3 3 3 2 The Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13(4) Requirement The registered manager must ensure that the automatic closures on fire doors are operating appropriately. Timescale for action 26/10/06 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 Turner Home DS0000025383.V295287.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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
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