Inspection on 19/12/07 for Tiltwood

This inspection was carried out on 19th December 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

Tiltwood 19/12/08

Tiltwood 27/11/06

Tiltwood 01/06/06

Tiltwood 08/12/05

Tiltwood 27/06/05

Tiltwood 14/12/04

Tiltwood 24/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Tiltwood Hogshill Lane Cobham Surrey KT11 2AQ Lead Inspector Damian Griffiths Unannounced Inspection 09:15 19 December 2007 th 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 Tiltwood DS0000029255.V352138.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. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tiltwood Address Hogshill Lane Cobham Surrey KT11 2AQ 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) 01932 866498 01932 867205 admin.tiltwood@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Manager yet to be registered. Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Old age, registration, with number not falling within any other category (50) of places Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: Tiltwood is a care home providing personal care to older people located in a residential area of Cobham, Surrey. The home is close to local shops and public amenities and can accommodate up to fifty people. The property has private parking to the front of the building and garden areas outside each of the residential units. The accommodation provided is on ground level with single bedrooms. The home has five self-contained units each with a dining area, lounge and a kitchenette. The home has a main kitchen, bathing and washing facilities and laundry. There are small communal areas throughout the home where relatives, visitors and service users can sit and relax. The current scale of charges is between £409.99 and £700 per week. Service users are responsible for additional charges for personal items such as toiletries, chiropody and hairdressing. The home offers short stay respite services and day care respite at £34.00. a day. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived at Tiltwood at 09.15 and was in the home for almost eight hours. The new manager,yet to be registered, assisted throughout the inspection. It was a thorough look at how well the home was doing and included a tour of the premises that enabled the Inspector to see the condition of the home environment , try equipment used to help residents and observe staff care practice. This inspection report takes into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The inspector spent time talking with residents at the home in order to seek their views about the home and the care they receive. Four residents, two realtives and three health and social care practititioners responded to questionnaires that the Commission sent out prior to the writing of the report. Documents sampled during the inspection included the homes ‘Welcome Pack’, residents care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, health and safety records, complaints procedures and policies and procedures. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, some details of which have been added to the report. The inspector would like to thank the residents, staff and the manager for their time, assistance and hospitality during this inspection. What the service does well: Residents were encouraged and supported to participate in seasonal celebrations and the home was actively celebrating Christmas on the day of the inspection. Tiltwood offers residents with dementia care needs day care and short respite breaks that enable potential residents to experience life at the home without pressure and in a relaxed atmosphere. The Annual Quality Assurance Assessment (AQAA) completed by the home stated: All new staff undertake a full induction process which includes Equal Opportunities and supporting diversity. The Home is built on one level so wheelchair access is available throughout. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 6 Relatives completing the CSCI survey commented: The meals, day trips and special events like Christmas and New Year are very good. The home was planning to introduce new systems of care management titled ‘Activity Based Care’ or ‘ABC’ in the New Year that has proved to be beneficial to residents in other homes managed by the Care UK organisation. Residents benefited from an efficient and safe system of medication administration. Relatives completing the CSCI survey commented: General Care, management and staff are very good. The laundry rooms were clean and an efficient laundry sorting system was in place ensuring resident’s clothes were well cared for and not lost. What has improved since the last inspection? What they could do better: The home must ensure that the residents care plans are complete, regularly reviewed, risk assessed and show how the home will meet the resident’s assessed care needs and promote and make proper provision for the health and welfare of residents, treatment and supervision with especial regard to residents risk of falling by actioning the information gathered from ‘fallsmonitoring’ and reduce the number of falls within the given timescale. The home must make suitable arrangement to ensure, so far as is practicable, in a manner that respects service users privacy and dignity, ascertain and take into account residents wishes and feelings by regularly reviewing and implementing care need assessments, lifestyle agreements and staff interaction with due regard to the disability of residents and encourage and assist staff to maintain good personal and professional relationships with residents. The home must ensure after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home and keep the care home free from offensive odours and ensure suitable facilities are provided at appropriate places on the premises and sufficient numbers of washbasins with hot and cold water are provided in all sluice rooms. Five good practice recommendations were made; That the photographic meal project, as mentioned in the last inspection report should be completed. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 7 The manager applies to attend the Surrey multi-agency procedures for safeguarding adults. That the home review it’s level of staffing in view of the high number of falls recorded and the proposed implementation of ‘Activity Based Care’. Complete the required recruitment procedure as stipulated by Care UK and the national minimum standards by ensuring that all personnel files are checked for missing documentation and fill gaps in employment records. That a quality assurance survey be conducted to properly assess areas such as care planning, risk assessment, activities, health, meals, complaints systems, safety, protection, training and staff/resident interaction as highlighted in this report should all be included in the audit. The results should be forwarded to the CSCI and all other involved. 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. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were inspected and the quality in this outcome area was good. A pre-admittance assessment, useful information and a variety of ways to experience life at the home without the necessity moving-in were available to assist potential residents and their relatives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five resident’s files were inspected including a resident new to the home who had received assessments from the local social care team and a ‘pre-admission assessment’ from the home. Potential new residents and their relatives/advocates were able to take time to view the home before making a decision. A welcome pack included an assortment of useful information for the resident. There was an opportunity to access day care facilities and shortterm stays/ respite that allowed residents to experience the home without making a long-term commitment. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 10 The care need assessment included all major areas of care support required including: mobility, communication, personal care, diet and social care needs. The welcome pack did not include details of how to contact the CSCI the manager agreed to rectify this as soon as possible. 50 of residents completing the CSCI survey (four completed) indicated that they did not get enough information about the home before they moved, however, one resident commented: I am happy with the decision. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 were inspected and the quality in this outcome area was adequate. The falls prevention system in place did not seem to benefit the majority of the residents at risk. Care plans did not include details that would of benefited residents social care needs, privacy and dignity but routine administering of residents medicines was good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tiltwood operated a computerised system where care plans and related components such as risk assessments monitoring charts were inputted by the care staff. The five residents files inspected were paper copies made available to care staff, relatives and residents. Most of the residents consulted were not too concerned about the content of their care plans; however, one resident had signed a care plan inspected. Care plans held a comprehensive account of care needs as detailed in the care needs assessment but there was little detail recorded about; risks to residents, social activities and their likes and dislikes. Risk assessment was basic and on Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 12 some files seemed to be a ‘one off event’ and did not relate to the areas highlighted in the care needs assessment or detail care staff intervention. One diabetic resident ‘likes’ had been identified as chocolate but no reference to risk had been considered. One service user consulted by the inspector stated that nobody liked her and she did not like herself. The residents care plan did not comment on the state of her mental health or any new or ongoing strategy for this resident. A resident completing the CSCI survey commented: I do not always get the support I need. Since the last inspection the home has informed CSCI, as required under regulation 37 of the Care Home Regulations (2002), of any event, which adversely affects the well-being of any resident in their care. A high number of accidental falls had been recorded at Tiltwood. The local social care ‘falls’ team where working with the home to reduce these incidents and the manager was able to show evidence of joint work that had enabled one resident to receive a ‘pressure alarm’ fitted to the bed that would alert care staff whenever she left the bed and was at risk of falling. Regulation 37 records showed that there were a number of residents that had falls in their own bedrooms but there was no further evidence of similar strategies to assist other residents. This was brought to the attention of the home at the last inspection but high levels of falls continue to be recorded. It is therefore necessary to require the home to ensure that the safety and welfare of residents is promoted and adequate risk assessments are put into place and the home actively seek to reduce the amount of falls occurring within the given timescale as notified in the requirement section of this report. 25 of residents completing the CSCI survey (four completed) indicated that they received the support they needed. The majority indicated that support was received ‘usually and sometimes’. During the tour of the premises a care worker was observed waking a resident asleep in front of the television (approx 11am) to give her a newspaper, rather than waiting on the convenience of the resident. The home is required to demonstrate how it respects the privacy and dignity of its residents. The manager informed the inspector that the homes organisational body, ‘Care UK’, has embraced a new philosophy of care. Titled ‘Activity Based Care’ or ‘ABC’ the organisations homes are implementing this approach to care that will mean structured care support focused around each individual resident. It is believed that this approach will improve the quality of care at the home and address issues of privacy and dignity. Care staff took responsibility for administering all residents’ medicines. The inspector observed staff while they dispensed medication from the medicine trolley on one of the units. The trolleys provided staff and residents with an Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 13 efficient and safe system. Medicine administration records were all in order and protocols were in place. Please see the requirements section of this report. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15 were inspected and the quality in this outcome area was adequate. Residents ‘assessed’ lifestyle choices did not match their experience at the home but residents were supported to maintain contacts with their relatives and meals at the home were popular. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection Christmas parties had been organised and photos of seasonal celebrations throughout the year could be seen, such as the Halloween party in October. Resident’s religious beliefs were respected and access to religious services was available. Equipment for residents with physical disabilities such as walking frames and bathing equipment were being provided, however, more equipment should be available in relation to falls prevention. The Annual Quality assurance Assessment (AQAA) completed by the home stated: All new staff undertake a full induction process which includes Equal Opportunities and supporting Diversity.The Home is built on one level so wheelchair access is available throughout. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 15 One residents realtives completeing the CSCI survey stated: Details of how the home was applying residents assessed lifestyle choices were limited, for example; Mrs X likes chocolate, TV and nails? (having nails painted). Daily records did not show this level of ‘activity based care’ and staff observed were seemingly oblivious to service user need and care staff practice in this setting, for example; a resident sitting at one of the tables in the kitchenette area of her home was consulted by the inspector, she said; ‘she was all on her own and nobody wanted to be with her’, however, the staff member was sitting in the unit office, opposite to her, typing up daily records. As in the previous section staff were observed to be distant from the residents in their care, but, ensuring daily health care and personal care needs were being met but not engaging with residents, for example, exploring the possibility that the resident may wish to sit with staff while they record what the resident has done that day. Residents completing the CSCI survey commented: I would like more activities on the unit. And: I would like more information about the various activities concerning different entertainment. The home is required to ensure that the resident’s ‘wishes and feelings’ are taken into account. The daily record detailed bowel movements and washing regimes were being completed but did not show how successful activities were, what resident choices were being made or how the resident was feeling. There were no other sources available providing this information. The manager and staff were preparing a photographic collage and life record for one resident, however, there was no evidence to suggest that this good practice was being extended to other residents. Family and friends of the service users were encouraged and supported to visit the home. The relatives of one late resident were observed visiting the home and thanking managers and staff for the care their relative had received. The home had been awarded an ‘Golden Food Award’ (2006) by the local council, however since then the inspector was informed that the home had changed it’s food supplier’s and now meals were pre-cooked and frozen and known as ‘Cook/Chill’ meals. Residents completing the CSCI survey commented about the food: The meals are nice I like them all. I have a good appetite and always hungry and therefore would like more food. Quality is good, but quantity not enough. Residents could access the service of a dietician if required. It was recommended that a quality assurance survey be conducted to properly assess the impact of the change of meals at the home and to produce a photographic pictorial account of the different meals available for residents. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 16 Please refer to the recommendation and requirement section of this report. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 were inspected and the quality in this outcome area was adequate. The home needed to do more work with it’s complaints procedures and safeguarding of adults training that was due for review. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents completing the CSCI survey (four completed) commenting on who to speak too if unhappy and knowledge of the homes complaints system made the following statements: I am happy and don’t need to speak to anybody. I do not know who to speak to if I need anything. I do not know which person to speak to. I do not know what person to speak to only my wife. The two relatives completing the CSCI survey, however, indicated that they were aware of the complaints procedure. The entrance hall displayed contact details of CSCI and detailed the homes complaints system but the ‘Welcome pack’ was found to be without CSCI details. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 18 The home had recorded six complaints all had been resolved within the level one stage of the complaints procedure. CSCI had received one complain about the home earlier on in the year concerning malodour. The Annual Quality assurance Assessment (AQAA) completed by the home stated: We have an extensive complaints procedure which is displayed in bedrooms and within the welcome pack and statement of purpose, however, it was apparent that there had been some oversights within the homes publications. The manager agreed to rectify this as soon as possible and it was recommended to conduct a Quality Assurance audit in this area. Social care practitioners completing the CSCI survey were confident that the home dealt with safeguarding adults appropriately. The home provided protection of vulnerable adults training dependent on a computerised version that provided clear details of abusive behaviour and tested staff at the end of the programme. The manager was committed to extending the training programme to ensure staff where able to discuss and actively participate within a ‘live’ staff group. The manager had details of the Surrey multi-agency procedures but was recommended to apply to attend the Surrey training course when next available. Staff whistle blowing procedures detailed in the staff handbook did not contain contact details of agencies such as CSCI and independent organisations this may hamper the process therefore the manager agreed to review the organisations policy document. Please refer to the recommendation section of this report Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 19 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): Standards 19,20,21,22, and 26 were inspected and the quality in this outcome area was adequate. Plans for refurbishment were in place and improvements to resident’s communal bathrooms had been made however more needed to be done to ensure the safety of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was conducted and the entrance hall was cheerfully bedecked with Christmas decorations that welcomed the visitor. The units comprised of a sitting room area with tables at the rear in a kitchen dining area. Resident’s bedrooms were accessed from a corridor leading from the sitting area. The furniture clustered around the television set was functional and unattractive. The home plans to completely refurbish the area including the replacement of this style of furniture. Each unit had access to a safe courtyard area where raised flowerbeds had recently been installed. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 20 Due to refurbishment of the bathrooms there were a number of discarded pieces of bathroom equipment including an entire bath that had been placed in a communal area. The area had not been cordoned off and posed a risk to the residents as well as occupying a space reserved for their relaxation. The old baths were having to be replaced due to delays from the supplier of the new bathing equipment and were waiting to be re-installed. The manager was asked to cordon off the area and complete risk assessments in and around all the areas likely to be affected. A service users bedroom was inspected and found to be malodorous. The home had received an unrelated complaint about this problem earlier on in the year. The manager was able to provide details of a decoration programme with details of refurbishment and furniture replacement. The laundry rooms were clean and the housekeeper/domestic was observed to be efficiently maintaining the clothes sorting system in place to ensure that resident’s clothes were not lost. The staff room situated in an attic were in need of cleaning and refurbishment; this was discussed with the manager who admitted that the staff have the freedom to use the room as a place to relax, therefore, was left out of the general loop of cleaning and maintainence this being the responsibility of the staff who use it. The homes sluice rooms inspected were without hand wash basins and the sluice in one room was in need of re-positioning as it was in the centre of the room creating a space shortage and rubbish was building up behind it due to difficulties getting behind it. All sluice rooms had alcohol and hand cleaning liquid soap inside but would not protect staff or service users if faecal matter was accidentally handled. The home is required to ensure that the health safety and welfare of the residents and care staff is guaranteed. Please refer to the recommendation and requirement section of this report Tiltwood DS0000029255.V352138.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): Standards 27,28,29 and 30 and were inspected and the quality in this outcome area was adequate. Staff training was in place and met the basic care needs of the service users but staff needed to attained further training skills to forge better relationships with service users This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four staff files where inspected for details of robust recruitment procedures, staff qualifications and skills relevant to the residents in their care. Comments from residents completing the CSCI survey (four completed) indicated that there was mixed feelings about how supportive the staff were; Sometimes I say something needs doing, but it doesn’t get done at the time. It takes too long after asking. And: (staff) they are lovely. The inspector was informed that the home was almost fully staffed and had just one vacancy. Staffing levels in the morning consisted of seven plus two ‘floating’ staff assisting where needed and similarly in the evening there would be seven staff plus one ‘floating’ staff and six staff awake throughout the night. It was recommended that the home review it’s level of staffing in view of the high number of falls recorded and the proposed implementation of the ‘Activity Based Care’. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 22 Staff files inspected were from staff members on duty on the day of the inspection and evening care; proof of training was evidenced in the form of certificates acquired from training that was relevant to meeting the residents care needs and included; first aid, and medication administration for evening care staff, customer care, communication, challenging behaviour and dementia care. All staff had received an induction and further training in all areas of basic care needs including: safeguarding of vulnerable adults, infection control, health and safety, manual handling, food hygiene. The Annual Quality assurance Assessment (AQAA) completed by the home stated: All new staff have a full and detailed induction process which includes reading certain policies and procedures and completing statutory training on our computerised system. It was not clear what percentage of staff had attained level 2 of the National Vocational Qualification (NVQ). It is expected that the home should have attained a rate of 50 of all staff to level 2 NVQ. Comments from residents completing the CSCI survey (four completed) and observation during the inspection, as previously mentioned, indicated that some care staff needed further training: I would like them to be more available. Maybe I am not strong enough in asking them? And a relative completing the CSCI survey stated: staff are not always trained to a substantial level, e.g. level two NVQ. The manager recognised that more staff training was required relating to ‘safeguarding adults’ and improved communication and was committed to ensure that this was implemented as soon as possible. The Annual Quality assurance Assessment (AQAA) completed by the home stated: Staff are currently in the process of completing Dementia care training called Yesterday, Today, Tomorrow which focus in depth Alzhiemers Disease. All staff files inspected for evidence of a robust recruitment procedure had supplied an enhanced criminal record check, photo identity confirmation and documentations however one staff member had only one reference, and two other files contained limited detailed employment history well below the Care UK’s own requirement of a minimum of 7 years. The Annual Quality assurance Assessment (AQAA) completed by the home stated: All potential new staff undertake a full interview process with two competent staff. All processes are put in place to ensure equality and the safety of our residents. We will not commence employment until all required documentation is in place. It was recommended that to safeguard residents and complete the required recruitment procedure as stipulated by Care UK and the national minimum standards all personnel files be checked. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 23 Please refer to the recommendation of this report. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35,36 and 38 were inspected and the quality in this outcome area was adequate. The service needed to ensure that the home was run in the best interests of the residents and that their health and safety was being promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new manager had been in post for three months successfully completing her probationary period with the home and will be applying for registration with the commission in the New Year. Operating an open door policy the manager was committed to improving the quality of care for residents and promoting staff excellence, however, there was a lot of work needed to ensure that the home complied with national minimum standards. The manager was relying on the new programme and implied philosophy of ‘Activity Based Care’ being introduced to improve care practice and attitudes. Staff separated themselves from the residents to complete, necessary, tasks concerning Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 25 residents without involving them; reports were about what was done to residents such as being taken to the toilet and being washed and did not reflect how residents social care needs were being actively supported. Resident’s physical needs were, therefore, well looked after; one of the relatives completing the CSCI survey commented: General Care. Management and staff are very good, however falls related to residents’ dementia care needs and physical disability required more preventative measures to reduce the amount of falls. Regular Regulation 26 inspections were conducted by the organisations home care managers however it was recommended that a Quality Assurance audit be completed to establish residents, relatives staff and social care/health care practitioners views on the quality of care within the home. Areas such as care planning, risk assessment, activities, health, meals, safety, protection, training and staff/resident interaction as highlighted in this report should all be included in the audit. The Annual Quality Assurance Assessment (AQAA) completed by the home stated: All new staff undertake a full induction process which includes Equal Opportunities and supporting Diversity, the AQAA showed that 50 of the care staff were from an ethnic background however the home had not explored, what if any, affect this may have on the interaction between staff and residents as observed previously in this report. These issues could be explored sensitively within staff supervision for all staff; however, supervision records indicated that regular face-to-face supervision had not occurred amongst care staff. The homes policy and practice regarding resident’s finances was inspected and samples of accounting examined. The home kept accurate records of resident’s income and outgoing with a running account balance. Good relationships with next of kin and advocates meant that resident’s expenditure was closely monitored so that a resident requiring chiropody, hairdressing and other needs was provided. The homes annual health and safety responsibilities including regular fire safety checks, equipment and fire drills were well monitored. Electrical appliance, equipment, gas service certificates were in place as were water temperature records and legionella safety checks. The home was cluttered with objects requiring storage due to the organisation of Christmas parties and safety was compromised by the storage of a bath in a communal area. Resident’s safety was being compromised further by the high number of falls that have occurred. Since the last inspection fifty-eight accounts were recorded in total from December 06 to November 07. The manager did not show that the safety of the service users had been considered by providing updated risk assessed care plans and this was not picked up by the regulation 26 internal inspection audits. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 26 Please refer to the recommendation and requirement section of this report. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X 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 3 3 2 2 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) (2)(b) Requirement The home must ensure that the residents care plans are; monitored, regularly reviewed, risk assessed and show how the home will meet the resident’s assessed health, personal and social care needs. That the home is conducted so as to promote and make proper provision for the health and welfare of residents, make proper provision for their care, treatment and supervision with especial regard to residents risk of falling by actioning the information gathered from ‘fallsmonitoring’ and reduce the number of falls within the timescale. The home must make suitable arrangement to ensure, so far as is practicable, in a manner that respects service users privacy and dignity, ascertain and take into account residents wishes and feelings by regularly reviewing, implementing care need assessments, lifestyle agreements, recording daily outcomes and monitoring staff DS0000029255.V352138.R01.S.doc Timescale for action 19/02/08 2. OP8 12(1)(a) 14 (2)(a) 18/03/08 3. OP12 12(3) (4)(a) 19/02/08 Tiltwood Version 5.2 Page 29 4. OP19 16 (20(j) (K) interaction with due regard to the disability of residents. The home must ensure after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home and keep the care home free from offensive odours. The home must ensure suitable facilities are provided at appropriate places, such as sluice rooms, in the premises and sufficient numbers of washbasins with hot and cold water. The registered provider must encourage and assist staff to maintain good personal and professional relationships with residents. 19/02/08 5. OP26 23(2)(j) 19/02/08 6. OP30 12(5)(b) 19/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations It was recommended that a quality assurance survey be conducted to properly assess the impact of the change of meals at the home and to complete the project, as mentioned in the last inspection report, to produce a photographic pictorial account of the different meals available for residents. The manager had details of the Surrey multi-agency procedures but was recommended to apply to attend the Surrey training course when next available. It was recommended that the home review it’s level of staffing in view of the high number of falls recorded and the proposed implementation of the ‘Activity Based Care’. It was recommended that to safeguard residents and DS0000029255.V352138.R01.S.doc Version 5.2 Page 30 2. 3. 4. Tiltwood OP18 OP27 OP29 5. OP33 complete the required recruitment procedure as stipulated by Care UK and the national minimum standards all personnel files be checked for missing documentation and complete employment records. It was recommended that a quality assurance survey be conducted to properly assess areas such as care planning, risk assessment, activities, health, meals, safety and protection, training and staff/resident interaction as highlighted in this report should all be included in the audit. The results should be forwarded to the CSCI and all others involved in the home. Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Tiltwood DS0000029255.V352138.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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