Inspection on 05/09/05 for The Turner Home

This inspection was carried out on 5th September 2005.

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

The inspector 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 Turner Home 26/10/06

The Turner Home 06/12/05

The Turner Home 27/10/04

The Turner Home 28/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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

CARE HOMES FOR OLDER PEOPLE The Turner Home Dingle Lane Liverpool Merseyside L8 9RN Lead Inspector John McCabe Unannounced 5 September 2005 9:00. th 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 Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Turner Home Address Dingle Lane Liverpool Merseyside L8 9RN 0151 727 4177 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) The Turner Home Mrs Alison Charlesworth CRH N 59 Category(ies) of OP - 49 registration, with number MD -10 of places The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) 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 2) Male residents only. 3) 10 (N) or 10 (PC) mental disorder elderly (MD/E) aged from 55 years in an overall number of 10 Date of last inspection 27 October 2004 The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 5 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, which now ensures the provision of 59 single bedrooms with en-suite facilities. At the same time the home became dually registered with both the Health Authority and Liverpool Social Services. The current registration is for 49 Nursing and 10 Mental Disorder residents. There are several lounge areas, a large spacious dining room, a chapel and rooms for recreational activities. There are designated smoking areas provided. The building is set in a large expanse of private grounds, which are well maintained and attractive. The home has its own chapel, a weekly service are held for residents. There are numerous car-parking spaces available for visitors to the home. The home is conveniently situated close to local shops and amenities and is close to main bus routes into the city centre. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection began at 0900 hours with the Deputy manager and other senior nurses; the manager became involved with the inspection at 1000 hours. The inspector reviewed documents, and records of both residents and staff, toured the home and met and spoke with residents, care staff, staff from the laundry, kitchen and the homes handymen. The financial records of the residents were inspected, as well as their availability of their NHS entitlements, and contacts with their Social Worker, Psychiatrist and other health care professionals What the service does well: What has improved since the last inspection? What they could do better: The manager of the home must ensure that no staff is employed in the home without an up to date Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) certificate. None of the staff employed in the last year have been subject to CRB/POVA checks. This is unacceptable. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 7 Visitors who enter the home must sign the Visitor’s Book to ensure that residents are safe, and in the case of fire, it is known who is the building. The manager of the home is still not having resident or staff meetings, to ensure that the views of both groups are known on how the home is being run. Documented supervision of staff has not commenced in the home, even though this was discussed at the last inspection (October 2004). 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 Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. The pre admission protocols for residents which are undertaken by health care professionals are robust, comprehensive, and always includes a full and informed consultation with the resident and family. This ensures that the resident is accommodated in a therapeutic environment, which should enhance the mental and physical welfare of the resident. EVIDENCE: Before residents are admitted to the home on a permanent basis, the resident’s psychiatrist, community psychiatric nurse, and social workers undertake a pre admission assessment. The senior nurses from the home are involved in the process. The pre admission assessment is to ensure that the care home can meet the care needs of the resident, and that it is secure, therapeutic and safe place for the resident to live The resident can visit the home, or have an overnight stay before moving in on a permanent basis. The majority of residents have been at the home for a long time. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 10 Staff in the home undertake specialist care training to ensure that the residents assessed and changing care needs are met. Specialist training may include the following, diabetes, dementia, confusional states, and cognitive impairment. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 11 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) 7,8,9,10. The care staff encourage and promote the residents’ independence, and support residents to make informed decisions about their lives. Health care needs are well met. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home that is reviewed by the senior nurses on a monthly basis. The care plan includes risk assessments, choices and preferences of activities, nutrition and medication needs. Residents and family also contribute to the formulation of the plan. Daily health records are documented daily for each resident, and includes any critical incidences plus any visits from GPs, specialist nurses etc. The majority of residents are registered with one GP practice. Every Monday morning a GP from the practice visits the home and sees residents for health checks or referrals to other clinics in the Primary Care Trust (PCT). No resident in the home self medicates, all medications for residents are administered by the nurses in the home. The protocols for the receipt, storage, The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 12 disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). The care home is following new protocols for the disposable of residents’ drugs, a Clinical Waste company has provide the home with a “Chemical Disintegrator”, which is a bucket in which chemicals are put in and water added. Both liquid and tablet medications that are inserted in to the bucket and the chemical disintegrates and renders all drugs unobtainable and harmless. The company removes the bucket when full, and provides the home with a new one. All drugs, before being put in to the bucket are checked and recorded by two qualified nurses. All residents in the home can access their NHS entitlements, which includes dentists, chiropodist, opticians and access to consultants in the NHS. Staff in the home provide residents with information, assistance and communication support to make decisions and take responsible risks about their own lives, and daily living activities. Residents informed the inspector that the home was the best they had been in and was like a hotel, the food was great! and staffs were very helpful. Residents enjoy their independence, knowing that there is always a staff member to help them if they needed. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 13 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. Residents are encouraged to exercise about choice and flexibility how they spend their day in the home. They can also and pursue leisure and educational activities according to their choice and preferences. This allows independence and individuality for each resident. Residents receive a balanced diet offering variety, which reflects the residents’ preferences. EVIDENCE: Residents in the home are asked on admission, about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in. On admission to the home the resident with help from a family member completes “Life Story” questionnaire, which is a “Work life History” of the resident, and includes schooling, work, hobbies, food likes and dislikes etc. This care home has an experienced activities co-ordinator who varies the activities in the home and the community to suit the choices and preferences of the residents. The activities co-ordinator is now the regional member for National Association of Planned Activities (NAPA) and is hoping to form a group of other activities co-ordinators in the area. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 14 The care home has four vehicles which are used to take residents out on day trips, or transport them to clinic appoints in the PCT hospitals. Visitors are allowed in the home at any reasonable time of day and residents may entertain their visitors, in the communal lounges, or in their own bedroom. The gardens also provide an ideal setting for residents, to sit with their relatives, especially in the summer months. Residents told the inspector that they enjoyed the variety of food in the home, and were looking forward to their curry for lunch; food is available for residents 24 hours per day. The homes chef, is experienced and well organised as regards menus, menu planning, and has a good knowledge of the resident’s preferences for food. The kitchen space is large, clean, organised and well stocked with food. Most of the residents take their meals in the homes, spacious dining room. Special diets for residents with medical conditions can be provided in the home. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 15 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) 16,17,18. The home has a satisfactory complaints system with evidence that residents feel their views are being listened to and acted upon. The homes policy and training programmes for POVA, and Whistle blowing, ensure that the homes residents are protected from any abuse. EVIDENCE: There have been no internal complaints, and no complaints to the CSCI, since the last inspection. The home has robust complaints procedures, which are documented in the resident’s guide and the staff handbook. Some of the residents used their postal vote in the recent local elections. The care home has up to date information on the Protection of Vulnerable adults, this information is communicated to new employees on their induction course. On the day of the inspection there was evidence that many of the staffs in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 16 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) 19,20,21,22,23,24,25,26. The standard of decor within the home is good, with evidence of continuing improvements, through maintenance and planning. The home does present as a homely, safe and comfortable environment for the residents. EVIDENCE: The care home environment is good; all areas of the home are clean, light, well decorated and maintained, including the garden areas. Resident’s bedrooms have been personalised, and contain pictures and artefacts that reflect their own choices and preference, residents gave the inspector permission to view their bedrooms. The communal lounges are bright; one room is reserved for residents who smoke. There is also a large veranda that exits on to the gardens; this area is designated for residents who smoke. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 17 All bathrooms and toilets in the home provide privacy, and meet individual needs. The homes infection control policy is in date and valid. The care homes historic chapel is used for a multi religious service every Sunday, although residents can access the chapel at other times. The homes updated infection control policy includes the prevention and spread of Methicillin Resistant Staphylococcus Aureus (MRSA) and Hepatitis B. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 18 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 The standard of vetting and recruitment practice is unacceptable. Appropriate checks have not been carried out on all new staff. This means that the residents are potentially put at risk. EVIDENCE: There is always a first level nurse on duty who is assisted by care staff and ancillary staff. It would appear that, since the last inspection (October 2004) none of the new staff employed have been subject to the required checks at the appropriate levels. Three staff files of recently employed staff were reviewed (all carers). None of the files contained an up to date CRB/POVA certificate. The Curriculum Vitae (CV) of one employee did not match the references, which were offered on the application form. On one applicants CV, it was stated that he had worked 16 years for the same employee, yet the previous CRB/POVA certificate in his file was from a different employer within that time span. The manager of the home was made aware in October 2004, that all employees must have up to date CRB/POVA certificates, and that portable CRB/POVA certificates from other employers were not acceptable or recognised by the CSCI. All CRB/POVA certificates for new employees in the home, must be initiated by the Turner Care Home. (This failure and disregard of the The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 19 regulation has exposed the residents to potential risk, their safety and welfare could have been jeopardised.) The inspector evidenced the Personal Identification Numbers (PINS) of all the registered nurses in the home, which was documented on Nursing Midwifery Council (NMC) stationary. Mandatory and specialist trainings for all staffs are ongoing in the home; this is evidenced in the personal files of the staff. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 20 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) 31,32,33,34,35,3,6,37,38. The home has no effective quality assurance and quality monitoring systems. It is not possible to measure success, in meeting the aims and objectives, as set out in the Statement of Purpose Staff are not adequately supported through effective supervision. The management of this service must be improved to ensure residents are adequately safeguarded and staff are adequately supported. EVIDENCE: A first level nurse manages the home, on a part time basis. Currently the manager has not registered on an NVQ Level 4 care programme. All staff in the home do not have currently documented supervision six times per year, which could ensure that all staffs have the opportunity to discuss with the manager, and other senior nurses any issues, which can effect or improve the care for the residents. Documented supervision of all staff also The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 21 gives the staff and manager’s opportunities to discuss their own /or identified training needs, which in some cases have not been done. This failure to carry out documented supervision was a legal requirement of the October 2004 inspection report and must now be addressed as a matter of urgency. Both residents and staff may not be benefiting from the leadership and management approach of the home. Staff meetings are still not being held in the home. This was requirement in the last inspection report. Staffs need formal direction and correct information communicated to them so as that are aware of policy changes, new regulations etc. Staff meeting are an opportunity for discussion and to clear up misunderstanding that staff may have as regards the running of the home. Where possible residents look after their own financial affairs, the home doesn’t hold any bank accounts for individual residents. The home’s certificates of insurance and worthiness for gas, electricity, fire equipments, lift, hoists, Employer’s Liability were in date and valid The home’s visitor’s book has had few entries since the last inspection, October 2004. The manager was reminded that, the home’s visitor’s book was essential to record who had entered the premises and for what purpose. It is crucial to adequately record visitors in case of fire, so that the emergency services would know who was in the building. The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 22 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 3 8 3 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 2 2 3 3 2 2 3 The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 32 Regulation 21 Requirement The registered person must ensure that regular meetings of all staff take place in the home. The meetings should be formally arranged with an agenda, minutes taken, and actioned appropriately. This is to ensure that the views of staff on the conduct of the home are made known and recorded (Previous time scale of the 30th November 2004 not met). The registered person must ensure that any prospective staff to be employed in the home (after July 26th 2004), must have a CRB/POVA clearance certificate, before being employed in the home. (Immediate requirement in the October 2004 inspection report 2004 not met). The registered person must ensure that all staffs in the home have formal-documented supervision six times per year. Both the supervisor and the supervisee to sign and date the completed document (Previous timescsale of the 30th November 2004 not met). F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Timescale for action 30th November 2005 2. 29 19 Immediate and ongoing. 3. 36 18 30th November 2005 The Turner Home Page 24 4. 5. 38 N/A 17(2) N/A The registered person must ensure that visitors to the home sign the visitors book N/A Immediate. N/A RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard N/A Good Practice Recommendations N/A The Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS 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 Turner Home F52_F02_s25383_TurnerHome_v230559_050905_Stage 4.doc Version 1.30 Page 26 - 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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