Inspection on 19/09/06 for Tickford Abbey

This inspection was carried out on 19th September 2006.

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

Tickford Abbey 31/01/06

Tickford Abbey 06/08/05

Tickford Abbey 06/10/04

Tickford Abbey 10/06/04

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 Tickford Abbey Priory Street Newport Pagnell Bucks MK16 9AJ Lead Inspector Mike Murphy Unannounced Inspection 19th September 2006 09:30 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 DS0000015073.V304363.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. DS0000015073.V304363.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tickford Abbey Address Priory Street Newport Pagnell Bucks MK16 9AJ 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) 01908 611121 Greensleeves Homes Trust Ms Heather Joy Lee Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places DS0000015073.V304363.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 32 older people. Date of last inspection 31st January 2006 Brief Description of the Service: Tickford Abbey is a care home providing residential and personal care for 32 older people. It is owned and managed by The Greensleeves Trust and is situated in a rural area close to the town centre of Newport Pagnell. The home is a large detached property with a modern extension. Part of the house is listed and was once an abbey set on the riverside of the River Ouse. There are extensive grounds which are well maintained. Accommodation is individual and comfortably appointed. There are 25 single rooms. Seventeen have en suite facilities. There are two double bedrooms with en suite facilities, which are currently being used singly. There are three spacious lounge areas and a separate dining room. Fees are between £450 and £490 per week. DS0000015073.V304363.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over the course of one day in September 2006. The inspection methodology included discussion with the registered manager, deputy manager, staff, residents, one visiting relative, and one visiting district nurse. It also included examination of care plans and other documents, a tour of the home and grounds, consideration of information supplied by the registered manager in a pre-inspection questionnaire and of comment card completed by residents, relatives and health and social care professionals in advance of the inspection. Overall, the inspection finds that this home provides a good service to residents, relatives and other stakeholders. The environment is generally good. The home is located in very pleasant landscaped grounds and the interior provides a range of accommodation for residents. It is an older building however, and will always require an ongoing programme of refurbishment in order to maintain a comfortable and safe environment. The home’s procedures for the assessment of prospective residents are sound and the quality of it’s arrangements for planning and providing care are good. It appears to liaise well with health services in the local community, and, from the feedback received over the course of this inspection, has the confidence of local health and social care professionals. People seem comfortable here. Staff describe it as a good place to work. Residents seem well supported. It may wish to consider whether its current approach to activities and the social care aspects of its programme are fully meeting the needs of residents. The home provides for a diverse range of needs and this aspect of its work might merit further exploration with residents and other stakeholders. Policies and procedures for the protection of residents are good and staff have access to regular training on a range of subjects including POVA (Protection of Vulnerable Adults). The home is performing well in relation to NVQ training and at the time of this inspection around 65 of staff had acquired NVQ2 or above. The registered manager and deputy manager are both experienced in the care of older people and, together with their staff, are providing a good and valued service to residents and their families. What the service does well: The home is located in very pleasant and tranquil grounds with mature trees, flower beds and extensive lawns, some of which lead down to the River Ouse. Tickford Abbey is homely and comfortable, providing adaptations and equipment necessary to support the residents in a safe and inviting environment. Standards of cleanliness are very good. DS0000015073.V304363.R01.S.doc Version 5.2 Page 6 The Manager is approachable; operating an open door policy to ensure issues of concern can be raised appropriately. All residents have an individual plan of care, which supports staff to implement appropriate care in a manner preferred by the resident. Personal care is implemented in a manner that ensures the privacy and dignity of residents is maintained. Resident, relatives and visiting professionals express a high level of satisfaction with the home and confidence in the managers and staff. 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. DS0000015073.V304363.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 DS0000015073.V304363.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed prior to admission to ensure that the home is able to meet those needs. Prospective residents visit the home to meet staff, view its facilities and have any questions or concerns answered. The visit aims to ensure that the resident is comfortable in accepting the offer of a trial admission and that the home is likely to be able to meet their needs. EVIDENCE: The registered manager said that referrals to the home usually come through personal contact. This may be through an enquiry by a family member or through contact with a health or social care professional. Initial contact usually consists of a visit, lunch perhaps, and a chat with the manager or deputy manager. The home can provide information on a specialist financial planning service on funding the cost of care if required. Where the enquiry progresses to an application, an assessment of need is carried out. This may be conducted in the person’s own home, another care home, in hospital, a day centre or in the home itself. An assessment form is DS0000015073.V304363.R01.S.doc Version 5.2 Page 9 completed and further information may be obtained from the prospective resident’s GP, social worker or district nurse. Times scales are flexible at this point. The process includes a risk assessment. The process enables the home to determine if it can meet the prospective resident’s needs. The information acquired during the process of assessment, that obtained from health and social care professionals, the skills level of staff acquired through training and experience, and the experience which managers have acquired while running the home all inform this decision. Where it is felt that it can meet the person’s needs, then a trial admission is arranged. A care plan is drawn up. Again there is a degree of flexibility in terms of time but the manager said that there is usually a good level of agreement between the home and the resident. If all goes well then a more permanent placement is agreed. DS0000015073.V304363.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care plans are based on a thorough assessment of needs, are detailed, well written and support the provision of care appropriate to individual needs. Liaison with other healthcare agencies is good. However, daily reports should record all aspects of care provided in order to provide evidence that residents needs, psychological and social as well as physical, are being met. Arrangements for the control, storage and administration of medicines are satisfactory and ensure that residents receive medicines as prescribed and that the potential for errors is minimised. EVIDENCE: A care plan is in place for each resident. Three care plans were examined. Each care plan had a photograph of the resident. The ‘personal profile’ and ‘health and medication’ sections had relevant and useful information. Other sections cover personal care, diet and weight, sight and hearing, continence, mental state, special health needs, social interests and hobbies and religious observance. There are risk assessments for the grounds, rooms, moving & handling, falls, and pressure sores as indicated. DS0000015073.V304363.R01.S.doc Version 5.2 Page 11 There was a very good section on ‘daily routine’ which summarised the resident’s preferences with regard to activity in the morning, afternoon, evening and night. Two of the three care plans had ‘dependency’ forms which summarised the assessed dependency rating of the resident. Care plans are reviewed monthly. The care plans examined were of a good standard and it was noted had been drawn up by the deputy manager. In discussion it was recommended that the senior care workers be trained (through perhaps discussion, example, supervised practice, audit etc.) to develop care plans to the same standard. One area of weakness in the care plans examined (and it is assumed for other care plans) was the daily record. These were brief and limited to physical care given and contained no reference to psychosocial aspects of care – for example such matters as mood, interaction with others, and participation in activities. The daily record did not appear to reflect the range of activities which staff and residents engage in over the course of a day. All residents are registered with a general practitioner. The home has arrangements in place for an optician to visit. A dentist, on referral, will either visit the resident in the home or the resident may attend the surgery. A chiropodist visits regularly. Physiotherapy and dietician are available on referral. Specialist nurses (e.g. continence or tissue viability) are accessed through the district nurses and health centre. A consultant or a nurse (community psychiatric nurse (CPN)) in mental health services for older people are contactable through Milton Keynes hospital. A visiting district nurse said that it was a good home, the care was good and the staff carried out special care as directed. Personal care is given in the privacy of the resident’s bedroom or bathroom. Medicines are prescribed by the resident’s GP and are dispensed by a local pharmacy. They are recorded on receipt to the home. Medicines returned to the pharmacy are recorded in a book and signed for by the pharmacist. Deliveries are usually made once a month. Most routine tablets are dispensed in colour-coded blister packs. The pharmacy audit the homes arrangements every six months. Medicines are stored either in cupboards in the treatment room or in a small lockable trolley which is used for administration at various ties in the day. No resident was self-administering their medicines at the time of this inspection. However, if a resident wished to do so, and was assessed as capable, there is a lockable cupboard in each room. The home is required to conform to the policies and procedures of the Greensleeves Homes Trust. Only senior carers, NVQ level 3, the deputy manager and the manager administer medicines. Staff training is provided by the pharmacist and a training agency ‘Primary Care’. Competence is assessed before a member of staff is allowed to administer medicines on their own. A list of signatures and initials is posted on the door of a medicines store cupboard. DS0000015073.V304363.R01.S.doc Version 5.2 Page 12 The arrangements for storage of medicines were examined and found to be in order. Medicines administration records (‘MAR’ charts) were in good order. The home does not have a ‘homely remedies’ policy; all medicines have to be prescribed by a GP. References for staff include a MIMS (monthly index of medical specialities), Greensleeves Homes Trust policy, and the CSCI guidelines on the administration of medicines. The home would be advised to obtain a copy of the Royal Pharmaceutical Society of Great Britain guidelines for ‘The Administration and Control of Medicines in Care Homes and Children Services’ (this document can be downloaded from The Royal Pharmaceutical Society’s own website or through the ‘guidelines finder section’ of the NHS ‘National Library for Health’ website). DS0000015073.V304363.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home maintains a range of activities for residents. Residents may have visitors at any time. This supports the emotional well-being of residents and helps maintain contact with family and friends. Residents may bring personal possessions in to the home which personalises their room, increases a sense of comfort and well-being, and maintains associations with family, friends and life events. The choice and quality of food is good and helps maintain the health of residents while contributing positively to their quality of life. EVIDENCE: Resident’s social interests and hobbies are recorded in their care plan. Planned activities are advertised in a notice board. Events include music and singing, bingo, keep fit, hairdressing and manicure (which border on being social events for many residents), afternoon tea in a nearby hotel, art, occasionally a trip to the theatre, and showing films (where, the manager said, the larger living room is set out like a cinema). Evidence of art work produced by residents is on display. The home does not have an activities co-ordinator and the merits of such posts were discussed with the manager during the course of the inspection. One resident has attended a computer course; other residents have attended sewing classes, art, and choir. Residents have also attended an DS0000015073.V304363.R01.S.doc Version 5.2 Page 14 event performed by U3A (University of the Third Age) in Milton Keynes. It may wish to consider whether its current approach to activities and the social care aspects of its programme are fully meeting the needs of residents. It was not possible to get a firm measure of this during the inspection. The home provides for a diverse range of needs and this area might merit further exploration. Some residents continue to lead a relatively independent life while others are quite frail and require a higher level of support and direction. Residents seemed generally happy with life in the home. Two particularly appreciated being close to their families. One resident said that it was “A wonderful home”, another as “A lovely home, my room is lovely, I’ve got everything I need”. In contrast though, one resident said that “Some residents do not want to do anything but sleep or watch TV but if there was more going on it would possibly get them out of a rut and make life more interesting”. A visitor expressed satisfaction with the care and said it was good to have such a good home nearby. All residents seen had personalised their rooms with furniture, photographs, audiovisual equipment, paintings and objects (in one case a working model of a steam locomotive which the resident had built). People seem comfortable here. Residents seem well supported. Residents have a good level of autonomy. During the course of the inspection visitors came and went, some residents went out with their visitors, and one resident took a trip to Milton Keynes in her car for the afternoon. There are plenty of places around the home and grounds for residents to see their visitors in private. The Art therapist was the only volunteer at the time of this inspection. There is a residents committee which meets approximately monthly. This is chaired by a resident. Topics recently discussed have included food, entertainment, outings, levels of satisfaction with the service (in the context of feedback from residents) and menus. Meals are cooked by a chef and kitchen assistant. Staff on duty in the afternoon reheat the hot supper dish which has been prepared earlier in the day by the chef and chilled. The temperature of the food is checked and recorded before serving. Menus rotate on a four week, four seasons cycle with occasional special or themed menus. Breakfast is served around 8.30 am. Morning coffee and biscuits at 10.30 am. Lunch is at 12.15. Afternoon tea and cakes is served at 3.30 pm. Supper is served at 6.00 pm. Evening drinks are served at 8.00 pm and may include a snack if desired. Breakfast usually consists of cereals, toast, tea or coffee, grapefruit or prunes although a cooked breakfast is offered on Sundays. Lunch is the main meal of the day and is a two course meal. Lunch choices in the two weeks menus submitted with the papers for this inspection included: roast chicken and stuffing or cottage pie, pork fillet in tomato and mushroom sauce or mini grill (bacon, egg, sausage, hash brown and beans), fried battered cod or omelette. Roast is served on Sundays. Desserts included apple crumble and custard, crème caramel, jam and coconut sponge with custard or sherry trifle. Supper DS0000015073.V304363.R01.S.doc Version 5.2 Page 15 menus include soup and fresh fruit, yoghurt and cheese and biscuits every day. In addition the supper menu included: bacon and tomatoes, assorted sandwiches and garnish, scrambled egg on toast, and pate on toast. Drinks are provided as required. Staff provide assistance to residents where needed. No residents required pureed food at the time of this inspection. The advice of a dietician is sought by referral. DS0000015073.V304363.R01.S.doc Version 5.2 Page 16 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 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 service. The home has a system for reporting and investigating complaints and has a robust framework of policy and staff training with regard to the protection of vulnerable adults. Together, these aim to protect residents from abuse and to ensure that complaints are properly investigated. EVIDENCE: The home is required to conform to the Greensleeves Homes Trust policies on complaints and the protection of vulnerable adults (POVA). The complaints procedure is outlined in a leaflet which is on display in the home. The procedure allows for written or oral complaints, sets out timescales for action at various stages, and informs the complainant or their representative of their right to complain to the CSCI at any stage. The home has not had any complaints since the last inspection. The manager believes that this, in part at least, is due to the fact that the home holds regular meetings with residents. All residents are registered to vote. The manager said that most prefer a postal vote although a small number chose to vote at the local polling station. Arrangements for the protection of vulnerable adults appear satisfactory. The subject is included in the induction programme and all staff attend training run by Milton Keynes Council. A copy of the Milton Keynes POVA policy and procedure is available in the home. Staff seen during the course of the inspection were aware of the subject and most had attended training. Training is ongoing and it is expected that further sessions are likely to be held. Staff training is also organised on the subject of ‘Challenging Behaviour’. This is DS0000015073.V304363.R01.S.doc Version 5.2 Page 17 provided by a Northampton care consortium. Some staff attended training in 2004 and 2005 and further training sessions are scheduled for October and November 2006. The home does not routinely manage monies on behalf of residents. Arrangements are in place for holding small amounts for a few residents. These are managed by the manager, deputy manager and administrator. Records are kept. Balances were checked and found to be in order. DS0000015073.V304363.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good quality and well maintained environment which provides residents with a comfortable and safe place to live and which enhances well-being. EVIDENCE: The home is set in very pleasant and tranquil landscaped grounds backing on to the River Ouse about three quarters of a mile from the centre of Newport Pagnell. There is space for parking to the front and rear. Part of the home is a listed building. The home is an older building, built in 1891, with an extension added in the 1970’s. The accommodation is over three floors. A passenger lift connects all floors. This is supplemented by a small stair lift in one place. Most resident areas are accessible by wheelchair. Over the past year the floors have been raised in some areas to provide a more level surface for residents. Grab rails are provided. DS0000015073.V304363.R01.S.doc Version 5.2 Page 19 The accommodation on the ground floor includes the entrance hall, a waiting and seating area, manager’s office, staff room, treatment room, three living rooms, dining room, kitchen, kitchen office, laundry, bedrooms (in the extension), bathrooms and WCs. The first and second floors include bedrooms, bathrooms and WCs and the administrator’s office. It is a pleasant, spacious, comfortable and rather rambling building which provides a range of environments for residents. The general standard of décor is good and over the past year a number of rooms have been redecorated, new carpets laid and in at least one case, a bedroom has had a new walk-in shower installed. There are 25 single bedrooms, 17 of which have en-suite facilities. There are 3 double rooms, each of which has en-suite facilities. Rooms vary in size, some in the original building, are large and have been furnished as bed sitting rooms by the present occupants. There are no rooms under 10.0 square metres. There are sufficient bathrooms, showers and WCs for the present number of occupants. Bath hoists are available if required. The manager said that there is an ongoing programme of refurbishment. Apart from the internal décor this also includes replacement of some windows in the older part of the home. Because of the age of the building some technical systems may also need attention: there is a limit to the load which can be placed on the present electrical system and it was mentioned that temperature regulation can be a problem in some areas when the central heating system is on. Almost all areas of the home were clean, tidy and free from odours. The laundry room is small but said to be sufficient for current demand. Ironing is done at night in another room next to the kitchen. It is acknowledged that this is a somewhat inconvenient arrangement but there is nowhere else at present to relocate the laundry facility. The manager said that the washing machine operates to the standard required for current use. Foul laundry is washed in alginate bags and at the required temperature. There are plenty of facilities for washing hands around the home, many of which have a notice providing guidance on correct hand washing technique. The kitchen is large and was generally clean, in good order and tidy. There is plenty of storage space. Fridges were generally in good order. Freezers were in good order. Records of fridge and freezer temperatures are maintained (although these were not accessible, having been locked away by late afternoon on the day of inspection). Some jars of sauces stored in the fridge had not been labelled with the ‘date opened’ and ‘use by’ by dates. A chain screen which aims to prevent insects from getting in to the kitchen when the exterior door was opened was in place. The trays of both insectocutors were overdue for emptying and cleaning. All surfaces were tidy and clean. DS0000015073.V304363.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. 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 service. Staffing levels are satisfactory and the home, in conjunction with other training providers, provides training across a broad range of subjects. This helps to ensure that there are sufficient numbers of appropriately trained and supported staff to meet residents’ needs. EVIDENCE: According to information supplied by the manager the home employed 19 care staff (excluding the manager) at the time of this inspection. This allows for four, and often five, care staff in the morning and afternoon, and two care staff at night. In addition the home employs a housekeeper, four domestic staff, a chef, a kitchen assistant, an administrator, dining rooms staff, a laundress, a maintenance man, and two gardeners. The manager and deputy manager maintain an out of hours on call system. The home is performing well in relation to NVQ qualifications and estimates that around 65 of staff are qualified to NVQ 2 and above with five more undertaking training at the time of the inspection. Staff recruitment is managed by the home in line with the Greensleeves Homes Trust policy. The home advertises in the local newspaper and the job centre. Enquiries occasionally arise through direct contact with the home. Applicants are required to complete an application form, provide two referees and attend for interview. Successful candidates are required to have an enhanced CRB (Criminal records Bureau) certificate although they may be appointed under DS0000015073.V304363.R01.S.doc Version 5.2 Page 21 ‘POVA first’ arrangements in advance of this. A copy of the GSCC (General Social Care Council) codes of practice is supplied to each new member of staff by the administrator. The home has one volunteer who has undergone a screening process. The files of four recently appointed staff were examined. All four files were in good order and contained the information in Schedule 2. It is noted that the recruitment process includes completion of an ethnic monitoring form – a good practice. All files contained a copy of the individual’s terms and conditions. Some staff had been appointed under POVA first arrangements. Where staff are appointed under a POVA first the home must ensure that additional supervision arrangements are in place (these are outlined in Annex C (page 40) to guidance published by the Department of Health in May 2006). In particular these require that one or more named supervisor/s be appointed until the full enhanced CRB certificate is received, in which case normal supervision arrangements apply. All new staff attend an induction of between one and two weeks. A record of the induction is retained in the personnel file. The organisation has a probationary period of three months. Care staff have access to a varied and comprehensive training programme, details of which were submitted with the papers for this inspection. This includes NVQ training at levels 2 and 3 (level 4 for the deputy manager), health & safety, manual handling (three staff are manual handling trainers), fire safety, first aid, challenging behaviour, basic food hygiene, dementia awareness (one member of staff in 2005 and two in 2006), POVA, bereavement and death, medication, abuse awareness (in 2005), deaf awareness (in 2005), sight awareness (in 2005), infection control, ‘Alzheimer’s’ (in November 2005) and diabetes. Staff describe the home as a good place to work. The managers are described as supportive. The staff met on this inspection said that it is a good home which provides good care. They appreciated the training opportunities offered by the home and the Trust. DS0000015073.V304363.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home and feedback from residents, relatives and health and social care professionals indicate that it is providing good care outcomes for residents. With some exceptions, the arrangements for health and safety are generally thorough and aim to ensure the safety of residents, staff and visitors. EVIDENCE: The registered manager is a first level registered general nurse (RGN), has acquired the registered manager’s award, has a diploma in the care of older people and is an NVQ assessor and verifier. She is very experienced in the care of older people and has been manager of Tickford Abbey for over seven years. Over the past year the manager has attended courses on health & safety, medicines, health & hygiene, POVA and a ‘back to nursing course’. There are clear lines of accountability within the home and to senior managers. Within the home the deputy manager, senior care workers (level 3), care workers DS0000015073.V304363.R01.S.doc Version 5.2 Page 23 (level 2), and support staff (administrator, housekeeper, chef, domestic, maintenance, laundry and kitchen staff) are accountable to the manager. The manager is accountable to a services manager (responsible for around six services) and in turn to other senior managers at head office. There is a five-year rolling development plan for the home. This usually includes matters which involve significant expenditure extending beyond a single financial year (such as replacing the windows in the listed parts of the home). The manager also has in mind plans to establish a small dementia care unit sometime in the future. Although not thought to be significant problems at this stage, the technical services to the older parts of the home – plumbing, heating, electricity and telephones for example – may need renewal at some stage and it is assumed that these would included in the development plan. The registered manager reported that the home carries out quarterly monitoring of aspects of its service. It frequently receives feedback from stakeholders and acts as host to other homes for events such as tea parties. It is felt that this is a recognition of the quality of its service but such events also allow managers and staff to exchange views on current developments. 18 comment cards were received in connection with this inspection. 13 from residents, 3 from relatives and 2 from health and social care professionals (including GP). All resident respondents said that they liked living in the home, felt well cared for, felt well treated by staff, and knew who to complain to if they were unhappy. All liked the food as well. These views were confirmed in conversations with some residents during the course of the inspection. Some residents indicated involvement in the running of the home through the Resident’s Committee. Additional comments from residents in comment cards have been incorporated into the narrative elsewhere in this report. Relatives were equally positive in their views: all said that they were welcome at any time, could visit the resident in private, were kept informed of important matters, were aware of the complaints procedure, and were satisfied overall with the care provided. Additional comment included: ‘My mother, who is the resident, and I are very happy with the care she gets at Tickford Abbey. The staff are always happy and I know how contented my mother feels there’ and ‘Tickford Abbey is wonderful. All the staff do a grand job and they should be praised for the wonderful patient work they do’. Health and social care professionals were also positive. They reported good communications with the home, that there was always a senior member of staff on duty to confer with, that the staff demonstrate an understanding of residents care needs, that medication is appropriately managed, and that specialist advice is incorporated into resident’s care plans. Additional comment included: ‘All staff very helpful and demonstrate good knowledge and understanding, they provide an excellent level of care to their residents’. Overall, the comment cards demonstrate a high level of satisfaction with the home. The home does not generally manage monies on behalf of residents. However, there is one exception - it does collect a pension on behalf of one resident. The DS0000015073.V304363.R01.S.doc Version 5.2 Page 24 registered manager said that this long standing arrangement is overseen by the resident’s solicitor. It also held cash for two residents on the day of inspection. Records are maintained. Balances were checked and found to be correct. One to one supervision of care staff is now in place. Sessions take place once every three months. These are supplemented by staff meetings every two months. All care staff have an appraisal annually. The manager and deputy manager are around almost every day for informal discussions with staff. Arrangements for health & safety appear satisfactory. The Greensleeves Homes Trust has an easy to follow policy manual which is based on the national minimum standards for care homes for older people. This includes a policy governing staff practice with regard to health and safety matters. All staff receive basic training in moving and handling, fire safety, first aid, food hygiene, infection control and POVA. Further training and periodic updates are included in the annual training programme. The home has good systems in place for the regular maintenance of technical systems and equipment. These include: Gas (checked August 2005, now due for 2006), central heating (checked 30 June 2006), electrical wiring (checked 27 May 2004), PAT (Portable Appliance Testing) (August 2006), hoists (10 July 2006) and Legionella (June 2006 – remedial work to be followed up). The Legionella check included analysis of water at shower heads. The registered manager said that a fire risk assessment was carried out by an independent consultant about two months prior to this inspection and that a report was awaited. It is known, however, that this will recommend the purchase of two new ‘drag mats’ (already acquired) and an emergency fire evacuation chair. Fire training was carried out in June 2006. Fire drills are carried out at random, the most recent being on 18 September 2006 (the day before this unannounced inspection). Fire exits are checked every other day. Fire equipment is checked by independent contractors quarterly. The emergency lighting was checked on 1 June 2006. According to the manager the last visit from the fire authority took place in 2005 and there are no outstanding recommendations. Fire training was carried out in June 2006. An environmental health officer visited in June 2006. The home’s HACCP (Hazard Analysis and Critical Control Points) was recently amended. Hot water temperatures are checked weekly. Arrangements for the storage of COSHH (Control of Substances Hazardous to Health) materials appear satisfactory and copies of data sheets provided by the manufacturers are on file and available to staff. All radiators are covered. Window restrictors are on all first and second floor windows. Corridors and footpaths were clear of obstacles. A generic risk assessment is in place for the grounds. The river is fenced in order to prevent anyone getting too close to the river bank while still allowing sight of river wildlife. The home has also prepared a ‘Disaster Plan’ which offers guidance on the action to be taken in DS0000015073.V304363.R01.S.doc Version 5.2 Page 25 the event of a serious incident – such as evacuating the home and providing alternative accommodation for residents in a nearby hotel in the event of fire. DS0000015073.V304363.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A 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 Standard No Score 16 3 17 3 18 3 3 X X X X X X 2 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 X 3 X 3 3 X 3 DS0000015073.V304363.R01.S.doc Version 5.2 Page 27 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 Requirement Timescale for action 30/09/06 2 OP29 19 The registered manager is required to ensure that health & safety matters are thoroughly addressed in the kitchen. These must include good practice in labelling food products stored in the fridge and regular cleaning of insectocutors. The registered manager is 30/09/06 required to establish a process of named supervision for new staff appointed under POVA first arrangements until an enhanced CRB certificate is obtained 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 OP7 Good Practice Recommendations It is recommended that the registered manager and deputy manager establish a training programme for senior care workers on conducting assessments and writing up care plans. DS0000015073.V304363.R01.S.doc Version 5.2 Page 28 2 3 OP7 OP9 4 OP12 It is recommended that the registered manager establish a process with staff with the aim of recording a fuller account of the residents’ day in daily reports. It is recommended that the registered manager obtain a copy of The Royal Pharmaceutical Guidelines on the Storage, Control and Administration of Medicines in Care Homes. It is recommended that the registered manager conduct a review with residents and other stakeholders of the activities and social care aspects of its care programme to ensure that it is meeting the needs of all residents. DS0000015073.V304363.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000015073.V304363.R01.S.doc Version 5.2 Page 30 - 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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