CARE HOMES FOR OLDER PEOPLE
Tile House Tile House 34 Victoria Avenue Shanklin Isle of Wight PO37 6LS Lead Inspector
Mark Sims Unannounced Inspection 12th December 2005 09:45 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 Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tile House Address Tile House 34 Victoria Avenue Shanklin Isle of Wight PO37 6LS 01983 862762 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) Island Healthcare Ltd Carol Ann Barker Care Home 21 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (15) of places Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th August 2005 Brief Description of the Service: The home is located in Victoria Avenue, Shanklin and is only a short distance from the amenities and facilities of the main town. The local bus company operates a regular scheduled service which runs past the premises. The nearest stop is situated within a few metres of the premises. The building itself is a period town house, offering accommodation to 21 people, across three floors, access to both the lower ground floor and the first floor are achieved via a series of stair-lifts. The home is presently registered in respect of 21 people under the following categories of registration: dementia (elderly) DE(E) – 6, Older Persons OP 15. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for Tile House Residential Home. The inspection focused on those core standards not addressed at the 24th August 2005 inspection and various sources of evidence were considered in the formulation of judgements: records, observations and discussions with service users, staff and management. What the service does well: What has improved since the last inspection?
At the last inspection two recommendations were made that would improve the service for the residents further: The first was related to the need to ensure information contained within the running records or assessment tools, etc. is properly and promptly transferred across to the care plans, as these systems are designed or intended to instruct staff on the day-to-day care needs of the service users. A brief review of these documents indicated that action to address the oversight noted at the inspection had been taken and that the care plans were being regularly reviewed and appropriately updated. The second issue involved a couple of broken locks on the toilet doors, which the quality manager arranged to have repaired whilst the inspector was present in the home last August.
Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 6 On this inspection it was noted that these locks and all other locks, etc. were fully functional and operational. Also since the last inspection visit the company has overseen the complete recarpeting of the hallway and main stairwell, replaced the flooring in the dining room, refurbished the front lounge (including furniture) and added a tasteful en-suite facility and built-in wardrobe to a first floor bedroom. What they could do better:
It seems harsh to suggest to a proactive and caring service like the one found at Tile House that they could do anything better, however, as with all walks of life invariably there are things that can always be improved or changed. On this inspection two issues came to light that the manager would need to address with the company directors: • The first being the need to redecorate the exterior aspects of the property, which have become damaged by the weather and will require attention within the next 6 to 12 months. The second is the need to replace the laundry room floor, which has become worn and tattered with years of heavy use and is no longer impermeable to water, etc. and so not fit for purpose. • 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. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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 Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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): Standard 4. The service users and/or their relatives are welcome to visit the home prior to admission and to ensure the services and facilities will meet their needs. EVIDENCE: In conversation with service users it became apparent that many of them had either known the home prior to admission, as they had been attending the home as day care clients or that their relatives had been involved in locating a suitable home, as they had been unable (due to circumstances) to visit homes themselves. Two service users in particular spoke of the support their relatives had provided in locating a suitable home for them, a gentleman stating that his wife had been instrumental in finding a home that would both meet his needs and their combined needs (for visiting purposes, etc.). Another service user had relied on her daughter to find a suitable home for her, as she had moved from the mainland and was unable to visit the home before moving to the Island, she stated she felt her daughter’s choice had been a good one and that she had settled well into her new environment.
Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 9 In conversation with the manager it was ascertained that it is normally the practice of the home/staff to invite potential service users and/or their relatives to visit the home and to meet other residents and staff, familiarise themselves with the environment and collect copies of any brochures, etc. A logging form is used by the company to record the particulars of any person enquiring about accommodation at the home, with arrangements made to send information about the service, etc. to people making enquires. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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): Standard 10. The rights of the service users to be treated with respect and dignity are promoted within the home and the practice of the staff. EVIDENCE: The inspector spent time touring the premises, visiting service users within their rooms or sitting with them in communal areas of the home. Throughout these various activities the inspector was able to observe the staff at work and was pleased to note the polite and professional manner with which the staff interacted with the service users. It was evident from these observations that the staff are very familiar with how the service users and their relatives like to be addressed, with people either addressed by their given name or a name of their own choosing, these preferences documented within the service user’s plan. In conversation with residents it was ascertained that they feel the staff are dedicated and committed to the home and described them as nice, kind and caring people who are always around to help or assist as required. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 11 Service users also confirmed that staff never enter their bedrooms without knocking or being invited in and that care is taken to respect their wishes, especially around rising and retiring times, which was important to one person resident at the home. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12. The home offers an extensive programme of entertainments and activities. EVIDENCE: In discussion with the manager it was ascertained that the service users had won this year’s inter-home quiz competition, which involved teams of residents competing against each other on a round robin basis. The home and the service users are understandably pleased with this achievement, which formed one of the many activities or entertainments arranged in-house this year. The extensive programme of both internal and external entertainments is welcomed by the service users, many of whom were involved in a spontaneous game of eye-spy shortly before lunch and who were looking forward to a crossword competition after lunch. In conversation with service users it was established that this kind of spontaneity is commonplace and regularly supplements the scheduled activities, which according to the service users is varied and stimulating. Over the Christmas period the home has arranged a party for the service users (18th), many people expecting their relatives to visit on that day and for
Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 13 musical entertainment to be provided by a visiting entertainer who is popular with the majority of the people residing at the home. On touring the premises it was noted that in addition to the activities mentioned the home has a full programme of entertainments planned, details of the forthcoming events displayed within the main hallway of the home. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18. The company ensure staff are appropriately equipped and skilled to protect the service users from abuse. EVIDENCE: The company has produced for staff an adult protection procedure that is fully compliant with the recommendations of the National Minimum Standards and reflects the guidance provided via the ‘All Island Adult Protection Procedure’, which was created in accordance with ‘No Secrets’, a Department of Health document. The company has also brought into play a ‘Whistle Blowing Policy’, created in accordance with the ‘Public Disclosure Act’, which along with the adult protection guidance is made available to staff through the staff handbook. Training for staff around adult protection was delivered on 15th September 2005, with additional information disseminated via the induction programme and National Vocational Qualifications (NVQs), both of which contain units aimed at raising awareness of abuse issues, etc. In addition to the training completed the company has already drafted a full training programme for staff for 2006 which contains dates for update sessions around adult protection, amongst other courses. The updates are scheduled for 13th January, 9th February, 9th March, 25th April, 9th June, etc., these courses open to all staff employed by Island Health Care Ltd. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 15 In discussions with the staff it was evident that they are pleased with the levels of training provided and the opportunities to develop new skills or increase existing knowledge. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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 the following standard(s): Standard 19. All areas of the home used by the service users are in a good state of repair and very well decorated and presented, although some areas of the property less frequently visited or accessible to the service users need attention. EVIDENCE: A brief tour of the premises was undertaken as part of this inspection visit, where it was noticed that large areas of the home have been refurbished or redecorated and that additional facilities had been created in an upstairs bedroom. The most noticeable change since the last inspection is the newly redecorated and furnished main lounge, which has been transformed from the dark, antiquated room maintained by the previous proprietors into a bright vibrant and pleasant room, which is now the social centre of the home. The service users occupying the lounge during the inspection praised the work undertaken by the decorators and the foresight of the management in creating such a lovely, comfortable environment.
Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 17 They also complimented the home on its choice of furniture, which was described as comfortable and on the fixtures used to finish off the room, which were felt to be warm and welcoming by people. In addition to the work completed on the lounge the proprietary company had also overseen the re-flooring of the dining room, replacing the previous flooring with a more practical but tasteful covering in a wood effect. New carpet had also been laid within the main entrance hallway, which followed on up through the main stairwell to the first floor landing, creating a sense of continuity and space, although the area is naturally roomy. The decorators had also been employed within the entrance hall and had redecorated the entire area including the high vaulted ceiling. The tour of the premises, as always, allowed or enabled the inspector to visit residents within their own accommodation, one recently admitted service user occupying a room which had been reconfigured and redecorated prior to her admission, creating an en-suite facility and built-in wardrobe, both of which appeared well constructed and finished. Whilst the focus of the proprietary company has rightfully been on improving the internal environment for the service users, it is important that they do not lose sight of the fact that they also need to maintain those areas of the home either not used by the residents or not visible to the residents. During the tour of the premises it was noticed that the laundry room floor is in need of replacing, as it is damaged and tattered through years of repeated usage and spillage. Also some aspects of the external premises require attention due to weather damage, although it is appreciated that this kind of work cannot necessarily be addressed during winter months. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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 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): Standards 28 & 30. Staff training is sufficient to ensure appropriately skilled employees who are competent in their jobs care for service users. EVIDENCE: To date 3 of the home’s 11 staff posesses a National Vocational Qualification (NVQ) at level 2 or above with the remaining 8 staff in the process of completing their NVQ qualification. Currently this means that 27 of the staff team hold an NVQ qualification, which should rise to 100 in 2006 when the remaining staff complete their courses. In addition to the NVQ courses made available to the staff the company, as previously reported, also offer staff the opportunity to attend core-training events: • • • • • Moving and Handling. Health and Safety. Fire Safety. Infection Control. Food Safety. Staff are also afforded the opportunity to attend courses that are not considered core to the business but are essential for the care and protection of the service users:
Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 19 • • • • First Aid. Medication Courses. Adult Protection. Insulin administration. In addition to all of the training courses and events arranged by the company, the training manager has also produced a robust and comprehensive 6 unit induction/foundation training programme for new employees. This course is based on the recommendation of ‘Skills for Care’, the Social Care Skills Council, and is intended to equip new staff with the necessary skills and competences required when entering the care profession. On top of the work undertaken in preparing this programme the training manager has also produced 52 learning handouts, aimed at helping the new staff with the induction/foundation programme. The training manager has also gone to the lengths of producing training or induction programmes for the separate staff units within the team, i.e. care staff or catering staff, etc. Also as mentioned earlier within the report the company, via the training manager, has produced a training schedule for 2006, which includes both core and essential training events, which are open to all staff employed by Island Health care Ltd. In discussions with the staff it was evident that they are pleased with the levels of training provided and the opportunities to develop new skills or increase existing knowledge. It was equally evident from talking to the service users that they appreciate the caring qualities of the staff, which could be attributed to their training and skills development, although the service users had little insight into the training completed by staff. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 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 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): Standards 31, 35 & 38. The home is well run by a manager who is appropriately skilled and qualified. The home’s approach to supporting service users to manage their finances is allowing people to go into debt. The interests of the service users are safeguarded by the home’s quality auditing process. EVIDENCE: The manager is both a skilled and competent leader who possesses both a managerial qualification, ‘The Registered Managers Award’, and relevant care qualification ‘National Vocational Qualification level 4 in Care’. The manager has worked at Tile House for over 18 months now and has in her time overseen or been party to many of the changes completed at the home
Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 21 and is considered by the company to be a central part of their managerial structure. As with all managers employed by the company, the manager of Tile House regularly attends management meetings with other home’s managers, senior staff and the directors and is involved in shaping not only how the service runs within Tile House but the general direction of the company. As part of a larger company, the manager feels well supported in her role and is able to call upon the support and expertise of other home’s managers, senior staff (quality manager, training manager, etc.) or the directors of the company who are actively involved with all aspects of the business. Tile House, as with other homes within the Island Health Care Ltd group, has shared in the joint attainment of the Investors in People Award, which as established prior to the inspection was not easily achieved and involved a lot of hard work from all staff. In addition to the Investors in People process the company also operates its own in house quality auditing system, which is overseen by the quality manager and combines QA audits with the Regulation 26 visiting process, regular reports being provided to the Commission. In addition to the audits and Regulation 26 visits the quality manager, in conjunction with the home’s manager, also conducts service user satisfaction surveys, environmental audits, reviews of the records and record keeping practices and is involved in the updating and monitoring of policy and procedure for the company. In conversation with service users, it appeared that a large percentage of the company’s quality assurance process is unfamiliar to them, although people are familiar with the questionnaires about the service, staff and facilities. The service users were also familiar with the quality manager and confirmed that she often visits the home and speaks to them with regards to their feelings of how the service is performing. The company historically prefer not to become involved in the direct management of service users’ finances, offering instead to support people through the provision of a tick system, the home purchasing all items required by a service user and billing or invoicing them at the end of the month. On reviewing the system previously at the one of the home’s sister establishments it was noted that some families or representatives are slow to pay bills or settle accounts leading to several people being in the red. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 22 As technically the accounts belong to the service users they were set up for, it was suggested that the company introduce an upper limit, which would stop people developing debt, due to families or representatives not settling the accounts accordingly. In response to this advice the company has introduced an upper limit of £100, beyond which the company will no longer subsidise service users and thus eliminating the accruing of debt. One of the company directors is trained as a health and safety advisor having completed a ‘NEBOSH’ (H&S qualification) some years back, and therefore takes responsibility for ensuring all aspects of health and safety legislation is complied with and that guidance is available for staff and service users as required. During the course of the visit and throughout the inspector’s time in the home no issues or concerns purporting to health and safety were identified with all reasonable steps taken to ensure both the service users’ and employees’ safety undertaken. In discussion with the manager it was established that the director is due shortly to complete a review of the home’s environmental risk assessments, the assessments having last been updated in 2005 (29.01.05), it was also clear that the ‘Portable Appliance Test’ (PAT tests) would also soon need addressing, as these were last conducted on 25.02.05, although the director does have a couple of months to complete this annual check. On reading through the ‘Control Of Substances Hazardous to Health’ (COSHH) data sheets and instruction for staff, it was obvious that these had been recently updated (23.10.05) and provided staff with clear guidance on the preparation, usage, storage and disposal of chemicals used within the home. The director is also understood to liaise closely with the training manager with regards to training and development for staff and was acknowledged by staff to be a good instructor, making training relevant to the field within which they work. Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 23 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 X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 24 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 OP19 Regulation Requirement Timescale for action 05/03/06 Regulation The manager must formulate, 23 with the proprietary company a plan for addressing the redecoration of the external areas of the home and the replacement of the laundry room flooring. A copy of the scheduled dates must be provided to the Commission. 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 Tile House DS0000055596.V250181.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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