Inspection on 27/11/06 for Tiltwood

This inspection was carried out on 27th November 2006.

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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tiltwood Hogshill Lane Cobham Surrey KT11 2AQ Lead Inspector Cathy Clarke Unannounced Inspection 27th November 2006 10:00 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.V321197.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.V321197.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 manager.burroughs@careuk.com Care UK Community Partnerships Limited Ms Jeni Helen Beck 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.V321197.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 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 £680 and £700 per week. Service users are responsible for additional charges for personal items such as toiletries, chiropody and hairdressing. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3 hours and was the second key inspection to be undertaken in the Commission for Social Care Inspection year April 2006 to June 2007. Mrs Cathy Clarke Regulation Inspector carried out the inspection for the service. Jeni Beck registered manager assisted the inspector throughout the inspection. A number of documents and files were examined as part of the inspection process. This inspection focused on those Requirements made at the previous inspection and those Standards previously found to be satisfactory were not fully reassessed on this visit. Seven service users were spoken to during the visit and their comments have been included in the report. This was a very positive inspection. The inspector would like to commend the registered manager for the hard work put into meeting the requirements made at the last inspection visit. What the service does well: What has improved since the last inspection? The category of registration of the home has been changed since the last inspection visit and this has enabled the service to provide a more focused approach to the needs of service users within the home. The service user guide has been reviewed and updated since the last inspection visit. Contracts have been issued to all service users. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 6 Customer service training has been delivered to all staff within the home. Falls have reduced in the home since the falls prevention programme was instigated. Medication practices have improved and there is an auditing programme in place. Professional advice regarding the eradication of mal odour in Pines Unit has been taken and the appropriate action has been undertaken. Manual handling training has been provided for the day centre worker since the last inspection visit. What they could do better: 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.V321197.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 Tiltwood DS0000029255.V321197.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. Standards 1,2, 3 and 6 were assessed during this inspection. This judgement has been made using available evidence including a visit to this service. The assessed needs of service users are undertaken prior to any new admissions to the home. Intermediate care is not offered by this home. EVIDENCE: The homes category of registration has been changed since the last inspection and no longer offers care to those with mental health status. The service user guide has been reviewed and updated and is now a userfriendly guide with pictures and the contract in back of the document. The service user or their family signs contracts. All staff have received customer care and communication training since the last inspection visit. Tiltwood DS0000029255.V321197.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 good. Standards 7,8,9,and 10 were assessed during this visit. This judgement has been made using available evidence including a visit to this service. Care plans cover all aspects of service users health care needs. Medication policies and procedures are in place and regularly audited. Service users are treated with dignity and respect. EVIDENCE: The falls in the home are being monitored and all of those service users where this has been an ongoing problem have been assessed. The falls prevention nurse has sent Tiltwood a survey and is to set up an action group to assist with the ongoing support. Falls for those service users initially at risk have reduced, however there are new residents who are experiencing falls and are being closely monitored at present. One of the new residents had been experiencing falls at home prior to admission to the home. One service user who moved into the home was continually falling and has been admitted to hospital to ascertain the reason for the number of falls. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 10 Following a falls prevention programme and subsequent assessment of all service users concerned in the programme it was felt that equipment to assist service users may be more problematic and therefore not appropriate. One service user spoken to during the visit had sustained bruising to her head and wrist following a fall, her wrist was quite swollen and the registered manager checked her medical notes and agreed to get a GP to visit to reassess her injury. GP has been advised to visit and check next day. Another service user stated that he likes to use his tripod to assist with mobility. Medication is audited weekly with tablet counts and night staff check medication on one unit per night. Gap monitoring is in place. The medication trolleys have been organised into sections with boxes for those service users with multiple prescriptions. Medication training is all up to date. Signatures of those staff competent to assist with medication are kept on file. Gap analysis is conducted and signed off by Manager. The controlled drugs register was completed satisfactorily and this is also audited separately. Please see recommendations section of this report. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 11 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. Standards 12,13,14 and 15 were assessed during this visit. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to take an active part in activities and these are individually matched to their preferences. Family and friends are welcome at the home. Service users are assisted to exercise choice and control over their lives within the parameters of their individual risk assessments. A range of choices is available on the menu. EVIDENCE: During the visit service users were taking part in activities such as card making and attending a music session in the adjoining day centre. Service users enjoyed a recent trip into Cobham to observe the turning on of the festive lights. Family and friends are encouraged to visit the home. Service users enjoy their meals and there is a varied diet available with alternative choices. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 12 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 good Standards 16 and 18 were assessed during this visit. This judgement has been made using available evidence including a visit to this service. There are policies and procedures in place for “Safeguarding Adults” and concerns and complaints. EVIDENCE: There have been no complaints since the last inspection visit. The complaints policy and procedure is accessible to service users and their representatives. The latest Vulnerable Adult investigation has been closed with no further action to be taken by the home. There is one outstanding vulnerable adult investigation, which the service and The Commission for Social Care Inspection (CSCI) are awaiting the local authority outcomes for. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 13 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 good. Standards 19 and 26 were assessed during this visit. This judgement has been made using available evidence including a visit to this service. The home has recently been redecorated and has improved since the last key inspection visit. The home is clean, and service users find the atmosphere pleasant. EVIDENCE: A number of falls have been experienced by some of the service users. An assessment into possible equipment to reduce the risk of falls has been undertaken. A full tour of the home was undertaken and it was found to be clean and tidy. Bedrooms include service users personal items. Pictures and flowers are situated in the communal hallways and the home has been improved with the recent redecoration programme. Service users spoken to have stated that they like living in the home and find the surroundings pleasant. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 14 An external professional has been engaged to clean the carpets in one of the units and the mal odorous smell has now been eradicated. The service has been awarded a gold award for the main kitchen by the Environmental health department of the local authority. This covers all aspects of the work undertaken in the kitchen. Cooking, environment, storage, temperatures and infection control. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 15 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 good. Standards 27,28,29,30 have been assessed during this visit. This judgement has been made using available evidence including a visit to this service. Staffing within the home has increased since the last inspection visit. Staff have received training and development for the tasks that they are to perform. EVIDENCE: The registered manager has been approved by the Commission for Social Care Inspection since the last inspection visit and has arranged to attend protection of vulnerable adults training and interview techniques. The registered manager and has attended supervision training and is continuing with her NVQ Level 4. An extra member of staff has been employed on night duty. The team leaders can now do the medication and supervise the care staff as and when needed. Staff are working on each unit with an extra member of staff. Eight staff are undertaking NVQ level 2 at present and nine have completed their awards. Seven staff have completed NVQ Level 3. All staff have received customer care and communication training. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 16 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 good. Standards 31,33,35, and 38 have been assessed during this visit. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of service users and the home has the required policies and procedures in place. The manager has worked with external health care professionals and The Commission for Social Care Inspection to promote and protect the welfare of service users. EVIDENCE: The registered manager has worked well to improve the standards of care provided in the home since registering with the Commission for Social Care Inspection. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 17 Falls in the home have reduced and a falls prevention programme has been undertaken. Staffing ratios have increased and the categories of registration have been changed in order to ensure that the home can meet the needs of service users with an appropriately trained and competent staff group. There are twenty service users who are subject to Power of Attorney and one subject to Guardianship. A record of all personal allowances is kept. No savings accounts are kept at the home. Individual bank accounts are set up if finances need to be managed. Health and safety policies and procedures are in place and checks to ensure compliance with these policies are undertaken. Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 18 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 3 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 19 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. Standard Regulation Requirement Timescale for action 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 OP8 Good Practice Recommendations Tiltwood DS0000029255.V321197.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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