Inspection on 27/06/05 for Tiltwood

This inspection was carried out on 27th June 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tiltwood 19/12/08

Tiltwood 19/12/07

Tiltwood 27/11/06

Tiltwood 01/06/06

Tiltwood 08/12/05

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tiltwood Hogshill Lane Cobham Surrey KT11 2AQ Lead Inspector Deavanand Ramdas Announced 27 June 2005 th 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 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 H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tiltwood Address Hogshill Lane Cobham Surrey KT11 2AQ 01932 866498 01932 867205 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care UK Community Partnerships Ltd Doreen Olive Arbury Care Home 50 Category(ies) of DE(E) - Dementia over 65 (50) registration, with number of places MD(E) - Mental Dissorder over 65 (50) OP - Old Age (50) Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Not exceeding 50 persons within the categories OP, DE(E) and MD(E) 3. The age/age range of the persons to be accomodated will be : Over 65 years of age 4. The gender of those accomodated will be : Male & Female Date of last inspection 14th December 2004 Brief Description of the Service: Tiltwood is a privately owned care home providing personal care to older people and located in a residential area in 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 a mature garden to the rear and side of the property that is private, secure and has wheel chair access. The accommodation provided is on ground floor with single bedrooms. The home has five self contained units each with a dining area, lounge area and a kitchenette. The home has a main kitchen, bathing and washing facilties and a laundry. There are small communal areas throughout the home where relatives, visitors and service users can sit and relax. There is a library area with a selection of books available. The registered provider is Care UK and the manager is Doreen Arbury. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector over a period of 8 hours. A tour of the premises took place and relatives, staff, service users, and other health care professionals were spoken to. The manager would like to thank everyone who participated in the inspection. Comment cards and CSCI business cards were left at the home. What the service does well: What has improved since the last inspection? What they could do better: The home must review the staffing levels in particular on night duty and in the Pines Unit. This is to make sure there are adequate numbers of staff on duty to maintain the safety of service users. Where a service user has changing needs Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 6 the home must ensure there is a review with other health care professionals to see whether the service user is appropriately placed. The practice of leaving creams and lotions in service users’ bedrooms must be reviewed and risk assessments must be completed to ensure service users who are confused are not exposed to unnecessary risks. Infection control measures must be improved by making anti-bacterial hand wash widely available in the home. 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. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4,5 The home’s Statement of Purpose is good providing service users and prospective service users with details of the services the home provides enabling an informed decision about admission to the home. The arrangements for the assessment of service users are good ensuring service users’ needs are identified. The skills and experience of the staff collectively ensure service users’ needs are adequately met. The home offers trial visits enabling service users to assess the facilities before making an informed choice prior to admission to the home. EVIDENCE: The home had a Statement of Purpose that contained information about how the home worked. The information was well presented and written in plain English making it easy to read and follow. A copy of the Statement of Purpose was in the foyer for information. The home had an eligibility criterion for admission and a pre-admission assessment policy that was issued in October 2004. Assessment of needs covered the areas of health, social and personal care. The inspector noted the home had an ongoing training programme and some staff were doing the Certificate in Dementia training at a local college. The home works with other health care professionals to meet the needs of service users. The inspector noted the district nurse was present at the home during the inspection. Following a discussion the district nurse stated she Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 9 worked from Cobham Health Centre and visited the home regularly. She remarked care is excellent and staff had always followed through guidelines. The inspector had a meeting with a family that stated they were happy with the admission procedure of the home and they had the opportunity to visit the home and meet the staff prior to the admission of their relative. They stated, ‘the home did an initial assessment before the move’. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 The home has a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The health needs of service users are well met with evidence of good working with other health care professionals taking place on a regular basis. Personal support is offered in such a way as to promote and protect service users’ privacy and dignity. EVIDENCE: The home had care plans that were drawn up after an assessment. The inspector sampled a number of care plans that contained personal details, lifestyle and interest, assessment of needs, risk assessment, handling assessment, pressure area assessment, nutritional assessment, a cognitive functioning assessment, an incontinence aids assessment and a property list. Each area of assessment had a care plan that was regularly reviewed and updated by staff. The manager stated team leaders were responsible for care plans. Daily observations on service users were recorded, dated and signed. The inspector noted all service users had named key workers, the GP visited the home weekly and the district nurse visited regularly. One service user was referred to the Continence Advisor. The inspector discussed one service user with the manager that stated the service user would be reassessed as to the suitability of his placement. The inspector observed, staff treated service users with privacy and dignity that was reflected in the aims and objectives and the Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 11 philosophy of the home. The home also had a policy on Safety, Privacy and Dignity issued in October 2004. Observations confirmed staff addressed service users by their preferred names and the manager was observed to knock on bedrooms doors and sought permission before entering service users’ bedrooms. Relatives stated care is very good. One service user stated ‘it is good here I recommend it’. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The home had a planned menu. The inspector noted the menu offered variety and choice. Dining areas were pleasant and tables had tablecloths, knife, fork, spoons and condiments. Food was kept hot in a heated food trolley. On the day of the inspection service users had a lunch of chicken, potatoes, carrots and peas. Dessert was rice pudding or treacle sponge. The meals were nicely presented and mealtime was relaxed and unhurried. The inspector noted staff prompting service users to eat their meals and offering verbal praise. One staff assisted a service user to move closer to the dining table to make it more comfortable to eat lunch. Staff stated they made drinks available for service users throughout the day due to the recent hot weather. The inspector had a meeting with staff that stated food could be improved. This was discussed with the manager that stated Anglia Crown was the company that provided food to the home and the company had been invited to do a food tasting session at the next Relatives Meeting on the 15th September 05 and that staff had been invited to attend to taste the food. Relatives stated the food is good and one service user stated ‘the food suits me fine I prefer English food’. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 13 Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18. The complaints process in this home is good with information about complaints available to service users. The policies and procedures at the home ensure the welfare of service users are safeguarded protecting them from abuse. EVIDENCE: The home had a complaint procedure and a whistle blowing procedure issued in October 2004. The manager stated the home kept a record of complaints. The inspector sampled the complaint records and noted the last complaint had been made on 16.5.05 and the management took appropriate action. At a meeting with staff they stated they were made aware of the complaint policy and whistle blowing policy during induction training. A team leader stated she would not hesitate to use the policies if appropriate. The inspector noted the complaint procedure and the ‘Residents Charter’ were displayed in service users’ bedrooms. Relatives stated they had copies of the complaints procedure. One relative remarked, the manager always address your problems and concerns. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The standard of the environment within this home is good providing service users with an attractive and homely place to live. However the home must introduce anti-bacterial hand wash for staff and service users and do a risk assessment on creams and lotions left in service users bedrooms to ensure the environment is safe for service users. EVIDENCE: The property was well maintained. The gardens were pleasant and some areas had been landscaped. The manager stated the Surtees garden had been adopted and maintained by a relative. The inspector noted the grounds were private, safe, secure and had wheelchair access. A service user was observed sitting and relaxing in the garden with her relatives. The home had a good standard of décor throughout. On the day of the inspection the home was found to be clean, well ventilated and free of mal odour. Bedrooms were well presented and personalised with family pictures, paintings, flowers, ornaments, radio, television, books and other items of personal interest. The home had an aid call system. The lounge, cosy corners and dining areas were well furnished and lighting was appropriate. Carpets throughout the home were clean and well maintained. The home was fitted was aids and adaptations such as grab Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 16 rails, assisted toilets and baths and had hoists to enable service users to maintain their independence. Bathing and washing facilities were clean and hygienic. The inspector noted new baths were fitted to some of the bathrooms. The home had infection control measures. The inspector observed regular hand washing by staff and gloves and aprons were available. Anti-bacterial hand wash was not widely used throughout the home. This was discussed with the manager. The inspector noted creams and lotions were kept on top of wardrobes in some service users bedrooms. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The staffing at the home must be reviewed to ensure there are adequate numbers of staff to maintain supervision and a safe environment for service users. The arrangement for staff training is adequate ensuring staff have the skills to appropriately support service users. EVIDENCE: On the day of the inspection it was noted the staffing was appropriate. On duty were the manager, two team leaders, nine care assistants, an activity coordinator, and two domestic staff. Two of the care assistants had NVQ in Care and three were working towards the qualification another two were studying for the Certificate in Dementia Care. The inspector checked the duty rota and noted it reflected the numbers of staff on duty. The inspector spoke to relatives that stated they would like to see more full time staff and less agency staff employed. This was discussed with the manager who stated 10 staff had been recruited subject to Criminal Record Bureau checks and references. The inspector had a meeting with staff and they stated the staffing levels at the home were in need of review. They remarked dependency levels on the Pines Unit had increased with some services users becoming more demanding and challenging with only one staff on duty on the afternoon shift. Night duty arrangements were also in need of review to ensure adequate cover whilst the team leader is giving out medications. The home had an ongoing training programme and a training plan that was displayed in the manager’s office. It included training in induction, fire safety, understanding dementia, dementia in care home, continence, POVA, and first aid. The inspector sampled staff induction files and found the induction programme to be based on TOPSS Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 18 standards. A Team Leader’s workbook was sampled and was dated, signed and completed. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32. The manager is supported well by senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their role and responsibilities. The management style at the home creates an open positive atmosphere that benefits service users. EVIDENCE: The home has an experienced manager who has the NVQ Level 4 in Management, RMA and is an NVQ assessor. She reports to the Operations Director. The manager stated she has regular supervision and she is well supported to do her job. During a meeting staff stated the manager was approachable, friendly and solved problems. One staff, remarked communication could be improved by involving care staff in the handover. Other staff felt communication at handover was satisfactory. This was discussed with the manager who stated a process was in place for handover and it was the responsibility of team leaders to brief care staff. Relatives stated ‘the management is open and keeps you informed’. The manager has set clear lines of accountability for staff and has regular team meetings with team leaders, care staff and night staff. The inspector sampled Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 20 minutes of meetings and found they were well attended. The staff meeting held on the 17th May 05 was attended by 17 staff. Staff reported they had regular supervision. A supervision planner with the names of staff and dates of supervision was displayed in the manager’s office. The inspector sampled induction files and noted supervision was appropriate and had taken place regularly. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x x x Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 22 No. 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 NMS 26 Regulation 13(3) Requirement The registered person must ensure anti-bacterial handwash is widely available throughout the home to prevent the spread of infection and maintain a safe environment for service users. In view of the registration of this home to care for service users with dementia the registered person is required to risk assess the practice of leaving creams and lotions in service users bedrooms. The registered person must undertake a review of staffing levels on night duty and the Pines Unit to ensure that at all times suitably experienced staff are working at the care home in such numbers as appropriate for the health and welfare of service users. Once completed a copy of the outcome of the review must be sent to the Commission. The registered manager must undertake a review with other health care professionals to assess the suitability of the home to meet the needs of one service user. Timescale for action 01. 08. 05 2. NMS 9 13(4) 01. 08. 05 3. NMS 27 18(1)(a) 01.09.05 4. NMS 7 14(2)(a) 01.08.05 Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 23 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 NMS 7 Good Practice Recommendations The procedure for communication is to be reviewed and written guidelines put in place to ensure staff understand the process for handover of information during shift changes. 2. Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tiltwood H58_s29255_Tiltwood_v220900_270605_stage4.doc Version 1.40 Page 25 - 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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