Inspection on 11/06/07 for Tilford Park Nursing Home

This inspection was carried out on 11th June 2007.

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

The inspector 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

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Tilford Park Nursing Home Grange Road Tilford Farnham Surrey GU10 2DG Lead Inspector Mavis Clahar Unannounced Inspection 11th June 2007 11:30 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 Tilford Park Nursing Home DS0000068703.V338400.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. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tilford Park Nursing Home Address Grange Road Tilford Farnham Surrey GU10 2DG 01252 792543 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) London Residential Healthcare Ltd Care Home 40 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (40) Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home to admit persons from the age of 60 years. Date of last inspection Not applicable. Brief Description of the Service: Tilford Park is an established nursing and care home that provides support for people who are elderly and mentally frail. The home is situated in a quiet rural area close by to the town of Farnham and has limited access by public transport. The home has been recently purchased by a new provider London Residential Healthcare Ltd who have ten other care service establishments in the south of England region. The home can offer services to up to 40 residents in both shared and single bedroom accommodation. They are able to accept both social service and private referrals for people requiring care to be admitted to the home. The fees range from £ 650.00 to £850.00 per week. Additional charges are made for Chiropody, hairdressing and newspapers. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection visit as part of a planned review of the service that was generated by the change of ownership in December 2006. The manager provided key information about the service prior to and during the one-day visit to the home. Relatives and other health care professionals were consulted through surveys. During the visit visitors, staff and a member of the local social services team were consulted about their opinion of the home. Due to the frailty of their mental health and degree of dementia of the people living there, observation of service users was partly used as to assess how their needs are met and their opinion of living in the home. Twenty surveys were sent out and eleven were returned. The surveys were completed by families, on behalf of, their relative living in the home. What the service does well: What has improved since the last inspection? What they could do better: The home could ensure that that it obtains better information about the service users personal life history, interests and hobbies in order to develop activities that are appropriate to the individual. Service users need to be reassured that they will be supported to access routine dental, sight and hearing tests and treatment. The home should make sure that the bathing and toilet facilities are fit for purpose and meet the needs of the people living there. They should also make sure that the service users safety, health and welfare is not put at risk from the lack of training given to staff and storage facilities in the home. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tilford Park Nursing Home DS0000068703.V338400.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 Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that service users are assessed appropriately before they are admitted. EVIDENCE: The records of three service users were reviewed to look at the assessment of need process that is carried out before a service user is admitted to the home. The home uses the information provided by the referring social services, clinical practitioners and the families as part of the assessment process. Service users contribute where able. The documents reviewed supported that the individuals physical and mental health needs are recorded with information about their medication, mobility and ability to carry out their own personal care. Some information about their personal history is noted when there are able to obtain this, however in the files reviewed this was minimal and does not give staff a detailed insight into their life experiences or interests. The home has already identified this as an area that they could improve and has begun to implement changes in order to rectify this. The home does offer respite care but currently does not have any service users using this service. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users are provided with the care and support that they need and specialist healthcare is sought when required. They are treated with dignity and respect by the staff working in the home. EVIDENCE: The care plans of three service users were reviewed as to assess how the home plan and deliver support and care. Two service users had been resident in the home for over two years and were selected to review as they were identified through concerns expressed by District Nurses and the Ambulance service. The other person had been admitted to the home in the last two months. The care plan documents are currently stored in the medication room that is only accessible to the senior nurse on duty in the home. Any changes in the planned care, such as hospital appointments and clinical interventions are noted in the daily handover sheet that is held at the nurse’s station. Daily outcomes are also recorded here. The senior nurse did state that all change of Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 10 shift handovers now included the care worker’s as this did not previously occur. The care plans are detailed documents that are developed from the information obtained in the pre- admission assessment and subsequent knowledge of the individual as staff observe and care for them. They include using assessments for clinical risks and nursing dependency and the nutritional status of the individual and utilise body maps should any concerns be raised. There are monitoring tools for service users weight, falls, blood pressure and blood sugar levels if required. The care plans also give instruction for oral, continence, pressure area care and communication that is relevant to the individual. Risk assessments are carried out for mobility, bed rails and moving and handling. All these records are reviewed regularly and could give comprehensive information for providing the physical care and support to the individual. However, these could be enhanced by greater information of their personal history, religious and cultural needs, and recording past and present interests. Not all the records reviewed provided evidence that a photograph of the service user had been taken, but the manger did state that they did keep electronic copies. The current storage of care plans in the secure medical room does not allow staff to refer to the care plans at all times. Service users are supported to obtain routine and specialist healthcare treatment including District Nurse and Psychiatrist and information for this is recorded in the GP’s notes kept in the home and in parts of the care plan. It was noted though that the recording of service users accessing dental, ophthalmic and hearing treatments from external providers is minimal. Relatives expressed in the survey that they were concerned about whether these were being accessed regularly. Service users medication requirements are recorded in their care plans when they are admitted to the home and they are amended when changes occur. The records for the administration of medications show that staff record appropriately any action they carry out and omissions or amendments that take place. The medications are stored in two secure trolleys on each floor of the home. There are new policies and procedures for the administration and safe storage of medications and they are in the process of being provided to the staff in the new induction and staff handbook. Some of the prescription charts did have photographs attached of the individual to ensure that staff are administrating the medications to the correct service user, but not all. A discussion with the registered nurse on the evening shift who was providing medications highlighted that there were some difficulties with communication (English not first language) and the inspector was unable to establish if a singular member of staff was responsible for the checks made for medications in and out of the home or compliance with storage and disposal. On observation she appeared to be carrying out administration of medications appropriately. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 11 During the inspection visit service users were observed to be, dressed in clean clothing and appropriate footwear, their hair cared for and the men were clean-shaven. The staff were seen to communicate well and be respectful to the service users. Relatives confirmed that they had observed this and also commented, “They treat the residents and families with respect and kindness,” and “ I have never seen them rush anyone or speak unkindly to them.” A visiting member of the social services team commented that the service users always appear to be well cared for and the staff friendly. Information is taken when service users arrive in the home or when able about the choices of how they wish to be cared for after their death. However, there was no evidence that this was reviewed periodically to ensure that the information is correct. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to continue with a lifestyle where they are enabled to continue with activities and some interests. The menu and mealtimes appear to meet the service users needs and enjoyment. EVIDENCE: The care plans reviewed showed little information about the individual’s choices and wishes of how they wanted to live in the planned care, partly due to the poor mental health or dementia and communication difficulties of the individual and the information obtained when they are admitted to the home. Their choices were reflected in how the care was provided as records and discussion with staff and relatives confirmed that each day was taken in accordance to the responsiveness and wishes of the individual. Therefore if they wanted to remain in their rooms, wear their night attire or not take part in activities, staff accommodated this but did still encourage them to join in. The activities organiser and the manager confirmed that they had identified that there were deficits in their knowledge in this area of the individuals they care for and had commenced looking at developing this with the help of the relatives and friends. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 13 They also acknowledge that the recording of the outcomes of the service users involvement in leisure and social activities could be improved to ensure that they had a holistic picture of their needs that would support better planning to meet these. The activities organiser is employed to support service users between 10am and 4pm, Monday to Friday. Relatives spoken to and who responded to the survey stated that the activities provided had improved since December 2006 under the new ownership. Comments also made were; “ It would be nice to have some outings either by vehicle, or locally on foot /wheelchair. Fresh air and change of scenery are beneficial. Stimulating indoor activities other than sing-a–longs would be welcome.” “ They had a cream tea this week with homemade scones. A guitarist was laid on. We have had residents and relative’s drinks and buffet evenings. Sometime they have Millers Ark Farm visit with animals.” “ We like it that the home organises social events for the residents to which we are invited. They are always welcoming and accommodating when we visit.” One relative added, “ I am particularly pleased that they have an activities coordinator there now and they employ musicians and other therapists to engage the residents.” Activities planned in the next few months include a visiting theatre, small zoo, summer party, barbeque and a strawberries and cream tea. The home records some information about the service users ethnicity, first language and previous and current religious observances. They do offer an interdenominational church service once a month and can access support from other religious leaders from the community if required. The manager and relatives stated that the current residents of the home were predominately Christian. One relative stated, “ I have confidence that they would try to meet different ethnic/ faith needs if required, but this doesn’t appear to be too relevant for residents at present.” The service users are provided with a four weekly rotational meal plan that is partially generated from information provided to the cook from staff, relatives in regard to the service users likes and dislikes and the health needs of the individual. The cook also stated that the menu was flexible and changed with the seasonal produce available. The kitchen staff also observe what food is returned to the kitchen after each meal. There are alternatives on offer if a service user is unable or refuses their meal. The head cook is both an experienced carer and worked in catering for a number of years and has Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 14 recognised that further training in nutrition would improved the standard and quality of the food provided to service users. A number of service users require softened diets and full and partial support with their meals and drinks. Mealtimes are usually staggered as to ensure that staff provide the time and support with the service users to eat their meals. The home employs catering staff to provide the three main meals each day, ensuring that care and nursing staff remain supporting the residents of the home. Evening and night staff are able to provide snacks and drinks outside to these hours as they can access bread, cereals and foodstuffs stored in the fridges. On observation service users were seen to be encouraged to remain independent whilst eating and drinking, but staff stepped in discreetly to provide assistance where necessary. The home has a dining area but this is unable to accommodate all of the service users at one time so those less able to sit at a dining table take their meals in other parts in the lounge areas or their rooms. Comments from relatives about the food and meals provided were, “When I am there at meal times, they look very nice,” and “Some are excellent.” “Lunches are very good but some evening meals are a bit ‘snacky’ with tinned pasta, tomatoes and chips. There is always fresh fruit available and the puddings are great such as rice pudding, tapioca, different cakes and with custard. The head cook is a great cook.” Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are not protected by the training and knowledge provided to staff about safeguarding them from possible abuse. EVIDENCE: The home provides service users and their relatives with the complaints policy and procedure in the Statement of Purpose and Service User Guide and is also on display in the home. Of the respondents to the surveys sent out by the CSCI, five stated that they knew how to make a complaint, three did not. Comments included that they felt they could always approach the staff if they had concerns and that staff were usually swift to act upon them. One did comment that they were still waiting for a formal response regarding missing clothing made after last Christmas and another did say they were unaware of who to complain to if they were dissatisfied with the homes response. The manager provided information that the home had been in receipt of four complaints in the last 12 months, that they were responded to within the given timescales of 3-5 days and none of which were upheld. On review of the information available in the home about concerns, complaints and compliments it could be seen that they could improve how they monitor and manage this information and that they could use this for quality assurance purposes with greater effect. They do not have a system of recording minor concerns or comments passed to staff from service users or their relatives. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 16 The Commission has not been receipt of any complaints or information about the service since its registration in December 2006. The home has policies, procedures and information about safeguarding adults from possible abuse that are provided to staff in the induction process and training videos. Copies of key policies were available such as ‘whistle blowing’, No Secrets and Financial Protection. The manager stated that they were aware they were behind in schedule for staff to update their knowledge and were in the process of implementing training. The Commission was made aware of one safeguarding adults referral made in the last six months in regard to an apparent lack of proper equipment and knowledge about pressure area care that concerned medical practitioners visiting the home. This was thoroughly reviewed and the home co-operated and implemented changes to ensure that both the home and staff were better equipped to prevent and reduce the incidents of pressure sore damage to those service users most at risk. This was done through assessments for bed rails, use of dressings, cushions and safety checks on electrical pressure relieving aids. On discussion with some of the support staff it was evident that they had not received any recent training about safeguarding adults. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some parts of the environment of the home do not meet the needs of the service users living there. The safety of service users is put at risk by poor fixtures and fittings in the bathrooms and shower rooms and insufficient systems are in place for reducing the spread of infection. EVIDENCE: The home is not purpose built but an adapted large residential home that has been added to in stages to accommodate up to 40 residents requiring a safe and secure environment. The accommodation is on two levels and has bedrooms and bathrooms on both floors with four communal areas on the ground floor. The ground floor is built in an incomplete figure of eight layout that allows service users to move around the building safely and offers a secure central external space that can be observed by staff from different vantage points. Some areas of the home have been secured as to be accessible only to those who need to be in those areas, such as the kitchen, Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 18 laundry room and communal bathrooms as to protect service users health and safety. Service users are accommodated in shared and single bedrooms. It was difficult to obtain clear information about the number of bedrooms that were in use, which had en-suite facilities and what bathroom facilities were fit be used in the home. The manager did state that the information in the Statement of Purpose and Service User Guide was incorrect for these figures. There is a secure garden area to the rear that is mainly laid to lawn with a very small patio/ pathway next to the building. There are a few small shrubs and a disused aviary and very little to see or be tactile for service users. The pathway is uneven and there is very little permanent seating. The manager indicated that part of the garden adjoining the home would be lost in the future when the planned changes were made to the communal spaces and improvement to some of the bedrooms. The home employs a fulltime maintenance person who is responsible for general small repairs, redecorating and the grounds. In addition to this he leads on fire and health and safety in the home. It was evident on walking around the home that in parts there has been a lack of investment in a rolling programme of renewal and redecoration to the fabric and fixtures. The were a few bedrooms and bathrooms unfit for habitation or use due to water damage from leaking pipes, damaged plaster and poor floor coverings. There was evidence of repainting and decoration of some bedrooms being carried out on the day of inspection. In many of the bedrooms the quality of condition of the carpets showed wear and tear and that they were poorly fitted when put down. This has left some bedrooms with floor coverings that could cause trips and falls to service users, staff and visitors and where carpet ‘Grippers’ have been placed in the doorways prevent the doors from being shut completed for fire safety. The manager was informed at the time of the inspection that the deficits regarding the unsafe carpet fixtures in the doorway of some bedrooms had been seen and he confirmed that these would be rectified immediately. Some service users bedrooms appear to be decorated well and they and their families have personalised them with photos, pictures and some furniture. Others have minimal personal possessions on display. There were three bedrooms seen that are currently shared by service users. In one shared bedroom the divisional curtain to provide a screen was inadequate as it was far too short and did not offer enough privacy. The home has one shower room for that is unfit for use as the flooring is now unsafe and awaiting repair and another with damaged tiling that could compromise cross infection. The other bathrooms seen had assisted baths, one Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 19 of which on the ground floor showed rust damage to the frame work of the chair that could again have an affect on controlling cross infection and causing possible skin damage to service users. All the bath hoists had been recently serviced. All bath and shower rooms seen are used as storage for equipment such as hoists, commodes, linen trolleys and skips. None would be accessible to service users and staff to use with removing the stored items first. Clean linen was found to be routinely stored in bathrooms and in the two sluice rooms. The hand washing facilities in the first floor sluice was not accessible to staff due to stored equipment. The manager did state that the home had recently received funding for repairs and improvements to the bathroom facilities in the home. There is a small passenger lift to the first floor that can only be used by one service user and a member of staff at a time. Space is restricted further when the service user is using a wheel chair. Exit and entry to the lift has to be observed carefully as the floor levels are not compatible and could cause someone to trip. The manager confirmed that the new proprietors have already identified this as a major concern and is included in the schedule to be replaced in the refurbishment programme that is planned to improve the home. Several of the bedrooms were seen to have the electric standing and sling hoists stored there or placed for recharging their batteries. There are a number of service users who require assistance using a hoist, however in one shared accommodation where both service users require this there was not evidence of separate slings for this purpose. The premises in most areas kept clean, hygienic and free from offensive odours. Staff are also provided with liquid soap and paper towels at all handwashing facilities, although these cannot be left in some of the service users rooms due to the nature of their mental health. Staff are provided with a personal anti-bacterial hand gel to carry around with them to use as and when required. The laundry area is situated on the ground floor and has suitable washing and drying machines for the volume of dirty linen and clothing that is produced by the home. An individual member of staff is employed to carry out the laundry service. Comments from visitors about the general cleanliness of the home were, “Not as good as it should be,” “ As fresh and clean as can be expected, although do think there is a shortage of staff at weekends” and “ The odd day might have a smelly patch but considering what is dealt with it is very good usually” Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 20 Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs a sufficient number of staff to provide support and care to service users living in the home. Some of the staff have not received the necessary training for the roles they are employed for or to be able to protect the health and safety of service users. EVIDENCE: Relatives gave complimentary remarks about the staff working in the home such as, “I go every other day to see my father and know all the staff and find them helpful and willing to sort any problems out,” and “ They have regular staff as much as possible and employ people who care. They also treat the residents and families with respect and kindness.” Other comments were, “ Staff do listen, but not always convinced they understand what I am asking,” and “ At the weekend there doesn’t always seem to be enough staff around.” Staff were observed during the inspection visit to be communicating well and considerate to service users needs. The home gave information that they employ twenty-six nursing and care staff and ten other staff for the laundry, domestic, catering and maintenance needs of the home. The manager confirmed that although they have had seventeen staff leave employment in the home over the last twelve months they have been able to accommodate this by employing new staff and have not needed Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 22 use the services of an employment agency. The home usually has a minimum of four staff at night and seven during the day and evening including at weekends. These figures include one registered nurse at night and two during the day and not including the Registered Manager being on duty. The numbers of care staff with an NVQ Level 2 or above that were provided by the manager is two with one registered as working towards this. The manager has recognised that they have not provided sufficient training for staff and is working with the new providers training co-ordinator to implement a training programme to ensure that staff have the necessary knowledge to carry out their roles. What they have done is to assess and identify individuals staff’s training needs and instigated contacting training providers. The recruitment records for three staff were reviewed to assess that service users are protected by the employment practices carried out by the home. All three had been recruited during the last twelve months, two since the reregistration of the home in December 2006. Applicants are required to complete an application form and provide evidence of training and qualifications. Of the three employees records seen, two had completed these and one had submitted a CV as they had been recruited through an employment broker providing qualified nurses from overseas for an Adaptation Programme. Three written references are requested and for the nurses from overseas, copies of references in English are provided from their last employer or training establishment. Applicants are required to complete a health declaration and provide proof of their identity. Copies of their eligibility to work in the United Kingdom are also kept. The completion of a Criminal Records Bureau check is recorded on an employment checklist held with the individual’s employment records. Photographs of the individual and any proof of professional Nursing and Midwifery Council registration status are also obtained. There was minimal evidence of an interview and selection process for two of the applicants but there was no recorded information about the decision to employ, the completion of a probationary period or induction process. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and safety of service users, staff and visitors is not promoted and protected by the training given to staff for safe working practices. EVIDENCE: The registered manager is an experienced registered nurse who has been working in the role since 2005. A deputy manager and a part-time administrator support the manager with the day-to-day running of the home. Relatives stated that they thought that the senior staff are approachable and friendly and that the home has a pleasant and relaxed atmosphere. The home has previously sought the opinion of service users and their relatives about the services they provide through surveys and is in the process of repeating the exercise. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 24 They have recently implemented relatives support group/meetings and provided a newsletter to keep service users and relatives up to date with activities and information about the home. There are new policies, procedures and audit monitoring tools that have been provided to the home, however not all of these have been implemented. The provider is carrying out regular audit monitoring visits that include reviewing the premises and consultation with service users, relatives and staff. The home manager has put monitoring processes in place for checking the bed rails, pressure relieving mattresses and standard of cleaning. The manager provided information that the home does not handle or administer service users money and that any extra purchases made, such as chiropody or hairdressing are invoiced to the responsible person for the individual. None of the current residents in the home are capable of managing their own finances. The staff in the home record the personal possessions brought in when service users are admitted and amend and add to this when they are informed of changes by the relatives. The home has been provided with new policies, procedures and guidance for safe working practices and is in the process of re- issuing these to staff in the staff handbook. As previously stated there has been an identified deficit in key training for staff for safe working practices that should be met through the planned training programme. The manager provided information prior to the inspection that they have ensured that the appliances, electrical, gas and water systems are serviced regularly. Evidence of some of the safety checks, LOLAR and the arrangements for the safe disposal of contaminated waste were reviewed during the visit and supported that suitable systems are in place. They ensure any accidents or incidents are recorded and are placed in the service users care plan records if relevant to the individual. Safety notices are posted around the home including the kitchen and laundry. Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 25 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 1 1 X 2 X 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Not applicable 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 OP8 Regulation 13 Requirement That the home ensures that service users have access to routine dental, sight and hearing treatment and tests. That the staff are provided with the necessary training for safeguarding adults from possible abuse. That the home is kept in a good state of repair internally with a regular programme of refurbishment. That the home ensures that there are sufficient bath, shower and toilet facilities to meet the needs of the service users. That the home has sufficient storage facilities for the equipment and clean linen ensuring that the control of infection is not compromised. That adequate screening in the shared bedroom accommodation is provided to ensure service users privacy. That care staff are provided with the necessary NVQ training and qualifications to carry out their roles. DS0000068703.V338400.R01.S.doc Timescale for action 30/08/07 2 OP18 13 30/08/07 3 OP19 23.2.b 30/09/07 4 OP21 23.2.j 31/12/07 5 OP22 23.2.l 30/08/07 6 OP24 12.4 11/08/07 7 OP28 18 11/07/08 Tilford Park Nursing Home Version 5.2 Page 27 8 OP38 18 That the staff are provided with the appropriate training to protect service users and others with safe working practices. 31/12/07 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 2 Refer to Standard OP3 OP7 Good Practice Recommendations That the home incorporates seeking service users personal history in greater depth in the initial assessment of need before they are admitted to the home. That service users care planning documents should be available at all times for staff to ensure that they have the required instruction of how to meet the needs of the individual. That staff ensure that service users interests and hobbies are recorded to enable them to plan and meet their needs more effectively. That a method of recording and monitoring minor concerns and comments is implemented and used for quality assurance purposes. That the home commences using the new quality assurance monitoring tools that have been provided. 3 4 5 OP12 OP16 OP33 Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Tilford Park Nursing Home DS0000068703.V338400.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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