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Inspection on 11/11/08 for Tiled House

Also see our care home review for Tiled House for more information

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Good service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff and people in this home have been told that there are plans to close it, but they have not been given a date for this to happen. Despite this uncertainty, staff remain cheerful and optimistic when working and maintain a homely and pleasant environment for the people who live there. There are good arrangements for making sure that people are safe. These include checks made on staff and visiting workers and training for staff in adult protection. The arrangements for ensuring health and safety in the home are good. Staff are well trained and receive ongoing updates in relevant areas. Over 80% of staff are trained to NVQ level 2 or above. The manager demonstrates good leadership and the staff team members work well together. There is good communication between members of the staff team and between management and care staff. The longstanding members of staff provide consistency for the people in the home. The food is of a high standard and meets people`s needs. Staff make sure that people receive a healthy diet. People are encouraged to maintain contact with their family and friends and to participate in a good range of activities. Staff treat the people in this home with respect and maintain their privacy and dignity. There are good arrangements for encouraging people to express their views and for responding to complaints.

What has improved since the last inspection?

There are no ongoing requirements from the last report. Care plans are now more detailed and are updated more frequently. There are better records of visits by healthcare professionals. There are more risk assessments and these are more detailed. Staff have received more training and this includes training in caring for people with dementia and adult protection. The medication records are better organised. There are more staff on the dementia unit so that more activities are possible.The records of what people have eaten are more detailed. There are improved arrangements for infection control.

What the care home could do better:

In order to demonstrate that the home responds to people`s comments, the manager shouild keep a record of informal complaints and their resolution. A nominated person from senior management should visit the home on at least a monthly basis and produce reports of the visit. This is to make sure that someone outside the day to day running of the home participates in the quality assurance system.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tiled House 200 Tiled House Lane Pensnett West Midlands DY5 4LT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Lancashire     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Tiled House 200 Tiled House Lane Pensnett West Midlands DY5 4LT 01384813425 01384813427 anita.williams@dudley.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dudley Metropolitan Borough Council care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: All requirements contained within the registration report of 10 December 2002 are met within the timescales contained within the action plan agreed between Dudley Metropolitan Borough Council and the National Care Standards Commission. By the 31 September 2003 water available from bedroom/bathroom taps together with any exposed pipeworks shall not exceed 43 degrees celsius. In the interim folowing risk assessments, strategies are Implemented to safeguard service users. Day care provision must not encroach on the facilities, staffing and services provided to residential service users. One service user named in the variation applicationof 21 April 2004 may be accommodated in the category of PD as a respite placement. This will remain until such time that the identified service users placement is terminated. Date of last inspection Brief description of the care home Tiled House is a large forty-eight bedded unit owned and managed by Dudley MBC. The home is located near to Pensnett where there are a number of shops, public Care Homes for Older People Page 4 of 25 0 0 Over 65 12 36 Brief description of the care home houses, a post office and main bus routes to surrounding areas. The home is divided into six residential units on two floors. One unit is specifically identified to care for people who are in need of respite or an emergency admission and another caters for people with dementia. All bedrooms are single occupancy. The home does not offer ensuite facilities. Each of the six units is self sufficient other than the centralised services of catering and laundry facilities, which also serve the day unit. Each unit has a separate lounge/dining area with kitchen facilities. The intention of the small units is to ensure a more personalised care service to the residents. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this inspection on a weekday and we did not tell anyone that we would be arriving that day. Before the inspection, the manager provided us with information about the home, the staff and the people who live there. On the day we looked at records including details of peoples needs and their care plans, medication, staff recruitment and training, staff meetings, residents meetings, health and safety, menus, rotas and complaints. We looked at the ways in which the manager assures the quality of the care. We spoke to the manager, senior staff and other staff on duty. We spoke to people who live in the home. We walked round the building and looked in some peoples rooms. We ate a meal. We used this information to write this report. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? There are no ongoing requirements from the last report. Care plans are now more detailed and are updated more frequently. There are better records of visits by healthcare professionals. There are more risk assessments and these are more detailed. Staff have received more training and this includes training in caring for people with dementia and adult protection. The medication records are better organised. There are more staff on the dementia unit so that more activities are possible. Care Homes for Older People Page 8 of 25 The records of what people have eaten are more detailed. There are improved arrangements for infection control. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move in and they are assured that these will be met. Evidence: We sampled files and found that they contained details of the assessments made before people were offered a place at this home. These assessments involved a variety of professionals where necessary. People had been assured, before they moved in, that the home would be able to meet their needs. The assessments had been used to form the basis of the plans which inform staff how to care for each person. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in a plan so that staff ensure that they are met. People are protected by the homes practices for the storage and administration of medication. People are treated with respect and their right to privacy is upheld. Evidence: We sampled three files and found that they contained care plans which had been drawn up to address the issues identified in the initial assessment. They contained details of peoples health, personal and social care needs and preferences. Each had instructions for staff on how to meet the persons specific specialist needs, for example, their needs arising from dementia or diabetes. We found records of consultations with various health professionals showing that people had been enabled to access general health, optical and dental treatment. Medication is stored in safe locations in each unit. There are enough trained staff to administer this safely. People are enabled to administer their own medication wen they Care Homes for Older People Page 12 of 25 Evidence: have been assessed as capable and some administer some items. We found the medications records up to date and appropriately completed. People confirmed that they are treated well by staff. Staff were respectful in their interactions with people and they upheld their privacy when knocking on doors before entering rooms. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People find that their lifestyle matches their expectations and preferences and they are encouraged to maintain relationships with significant people in the community. People are enabled to exercise control over their own lives. They receive a diet which meets their needs and suits thier preferences in pleasant surroundings. Evidence: We spoke to people in each unit and they confirmed that they were able to take part in a range of activities. The inspection took place at the time of the remembrance service for the end of the first World War. There was a service in the day centre room and several people chose to attend that. Other people were watching the service on the television with staff. Some had chosen to remain in their rooms and some were preapring to make Christmas decorations. The notice boards had details of activities on each day, including exercises, visiting entertainers, crafts, bingo and religious services. People are consulted about how they want to live. Staff ask them on a daily basis what they want to do and they have a daily choice of food. The records show that people and their relatives where appropriate, are involved in the preparation of care plans. There are regular meetings of people who live in the home and the minutes were made Care Homes for Older People Page 14 of 25 Evidence: available to us. As part of the homes quality assurance system there are questionnaires which seek peoples views on the running of the home. We saw that the menus provide choice at each meal and a variety of meals which appear to be well balanced in terms of nutrition. There are snacks and drinks throughout the day and people complimented the staff on the quality of the food. One person told us They feed us very well and another described the food as wonderful. We saw nutritional assessments on files and records of weights and action which had been taken when peoples health may be improved by changing their weight. We saw records of what each person had chosen and what they had eaten. Peoples specific medical needs are recorded and their cultural needs are met by food which is familiar to them. Staff know their preferences. The food which we ate on the day was well presented and appetising. There were a variety of sandwiches and some home made soup. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well protected by the homes arrangements for dealing with complaints and allegations of abuse. Evidence: We saw policies and procedures for dealing with complaints and allegations of abuse. The details of how to make a complaint are on noticeboards in the home. People told us that they would complain to staff or the manager, should they need to do so. One person told us that he would ring up the manager from his room and had done so in the past. There are records of formal complaints which have been made and the way in which they were resolved. There has been one complaint during the past year and this was investigated, with nothing being proved. There are some records of informal complaints and staff also told us about some changes which had been made a result of comments from people who live in the home. We discussed with the manager the advisability of keeping a separate record of all informal complaints made. We saw that staff are trained in adult protection. The home has a copy of the local procedures and keeps a record of any issues raised. One issue of alleged neglect was investigated but no evidence was found to support this. People confirmed that they feel safe in the home. One person told us the staff are very kind and others made similar comments. Care Homes for Older People Page 16 of 25 Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean and pleasant surroundings which are reasonably well maintained and where they are protected from the spread of infection. Evidence: We toured the building and found that it is divided into six units, each with its own lounge and dining room, where there are kitchen facilities for preparing snacks. Bedrooms are adequately furnished and those which we saw contained items brought by the occupants so that they were personal and homely. We found all areas clean and tidy, with no unpleasant odours. Some areas looked in need of decoration and some carpets, particularly in corridors, looked worn and in need of replacement. However, the manager informed us that it is unlikely that these will be replaced due to the planned closure of the home. Staff use gloves, aprons and handgel when necessary to minimise the spread of infection. They are discreet in their use of these controls so that their approach to people is not clinical. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by sufficient staff who are well trained and competent to do their jobs. People are protected by the homes recruitment practices. Evidence: We saw the rotas and they demonstrated that there are enough staff on duty at all times. The manager explained that there are two staff at all times in the unit where people have dementia. This provides a good level of supervision. There is some use of agency staff but the manager explained that the same people are used each time so that there is consistency for the people in the home. We looked at the files of three members of the staff team and saw that they ahd been recruited through a common process which includes taking up references and making checks through the Criminal Records Bureau and the Protection Of Vulnerable Adults list. The manager confirmed that visiting workers in the home also provide evidence that they are safe to work with people. Staff are well trained. 82 per cent of staff are trained to level 2 NVQ and they also undertake training in a variety of aspects of care so that they are able to meet the needs of the people in the home. For example, six members of the team recently Care Homes for Older People Page 19 of 25 Evidence: received diabetes training and most of the staff have received training in dementia care and palliative care. There are rolling programmes to make sure that staff update their training in the basic areas. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home which is run in their best interests and where there are good systems for maintaining the quality of care. Their financial interests are safeguarded and their health, safety and welfare is promoted and protected. However, there is no evidence that the required checks by managers outside the home are taking place. Evidence: The manager has been in post for several years. She has the Registered Managers Award and demonstrated at the inspection that she is knowledgeable about good practice and committed to maintaining good standards at the home and developing further the good practice, even though the closure of the home is pending. We saw the quality assurance system which follows the National Minimum Standards. Each standard is audited at least once a year. There are also resident and other stakeholder surveys and a sample of these showed us that people are pleased with the Care Homes for Older People Page 21 of 25 Evidence: care provided. One contained the statement, my mother could not be in a better place and another relative had written, x has settled down very well at Tiled House.There are regular staff meetings and meetings of people who live in the home and when we sampled the minutes of these we found that staff and people in the home are encouraged to express their views. In addition to the in house quality assurance system a representative of the provider should visit the home on a monthly basis and report back to the manager about the findings of the visit. These have not taken place on a regular basis and there have been no such visits since October 2007. We saw a good system for making sure that money held on behalf of people is secure and recorded accurately. We checked the money held be the home on behalf of three of the people living there and found that it was correct. We checked the money held be the home on behalf of three of the people living there and found that it was correct. The manager provided us with the dates of servicing and checks on equipment in and services to the home. We checked a sample of these and found them to be correct. This means that there are good systems to make sure that all users of the building are safe. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 16 The manager should keep a record of informal complaints and the action taken so that there is evidence that the home has responded to peoples comments. The registered person should make sure that a nominated person visits the home at least once a month and compiles a written report of their findings as per Regulation 26. 2 33 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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