CARE HOMES FOR OLDER PEOPLE
Tiltwood Hogshill Lane Cobham Surrey KT11 2AQ Lead Inspector
Cathy Clarke Unannounced Inspection 8th December 2005 14:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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.V262372.R01.S.doc Version 5.0 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 Care UK Community Partnerships Limited Doreen Olive Arbury Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (50), Old age, not falling within any other category (50) Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Not exceeding 50 persons within the categories OP, DE(E) and MD(E). The age/age range of the persons to be accommodated will be: Over 65 years of age The gender of those accommodated will be: Male & Female Date of last inspection 27th June 2005 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. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours and includes a follow up unannounced inspection on the 16th December to look at medication practices. Cathy Clarke, Lead Inspector for the service, carried out this inspection Doreen Arbury Registered Manager was present as the representative for the establishment. Kemasiri Wickramage was the representative for the establishment during the unannounced inspection of the 16th December 2005. A full tour of the premises took place, documents inspected included staff recruitment records, medication administration records, controlled drugs register, training certificates and policies and procedures. There were a number of service users in the home at the time of inspection. The body language and non-verbal communication skills of some service users were observed during the inspection. Several service users were enjoying activities during the inspection. The inspector would like to thank the management and staff for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection?
A new computer system has been installed and staff are recording all care onto the system. Gardens have been improved with the assistance and support of service users family. New curtains have been received for most units.
Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 6 Five care staff are undertaking Team Leader training to further develop their supervisory skills. The course is accredited by the Institute of Management. Five staff have commenced a Care Level 2 course on Dementia. Two Dementia videos have been shown to relatives and support has been given to relatives from the Alzheimer’s Association. What they could do better:
Medication practices within the home must be reviewed and improved to ensure the safety and welfare of service users. Medication administration records must be signed and accurately record the current amount of medicines held within the home. Medication must be administered as prescribed. Medication records must accurately record the details of as required medications. The carpet in room 9 and 10 must be cleaned. The floor in room 3 was sticky and must be cleaned. The armchair with the missing cushion must be removed from Chestnut unit until the cushion has been replaced. The laundry bag in the bathroom must be affixed to the frame and not left on the floor. The smell of mal odour in room 2 must be eradicated. The leak under the sink in the kitchen must be repaired and the kitchen floor appropriately sealed to ensure that glue is not rising up over the floor creating a sticky surface. Flooring in the kitchen must be deep cleaned. Kitchen overalls and hats left outside on hooks must be clean at all times. The member of staff who assists in the kitchen must undertake basic food hygiene training. Sponge mix must be kept in a sealed container. The room being occupied by two service users must be assessed to ensure that it complies with regulations. Recruitment practices must be improved to include reasons for gaps in application forms and Photographic identification is to be added to care staff recruitment files. Where new referees have had to be sought this must be recorded with the reasons for the changes. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 7 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 DS0000029255.V262372.R01.S.doc Version 5.0 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.V262372.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Intermediate care is not offered by this service. EVIDENCE: Intermediate care is not offered by the home. There are five respite beds for short-term stays. The registered manager was advised following discussion to consider a variation to the registration categories of the home in order to ensure that the service can adequately meet the needs of prospective service users admitted using the current category status. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 the following standard(s): 9 Medication practices within the home must be improved to ensure the safety and welfare of service users. EVIDENCE: The home has three medication trolleys. Each unit has a medication folder containing the signatures of staff trained to administer medication. Each service user has a current photograph on file and allergies have been identified and recorded. During the inspection the trolley for Pines and Walnut was inspected and records checked. One service users medication record indicated that medication had been given as prescribed but the number of tablets found in the medication bottle did not correspond to the signed record of administration. A controlled drugs register is used for recording the administration of controlled medications as well as a Medication Administration Record (MAR) chart. During the inspection it was noted that one of the MAR charts did not have the number of controlled drugs recorded as received.
Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 11 According to another medication record a service user had not been given her lunchtime medication as prescribed. The number of tablets contained within the service users medication box confirmed that the medication had not been administered. Signatures were missing from other MAR charts and it could not be confirmed that medication had been given as prescribed. It is recommended as good practice that when it is necessary to handwrite a medication administration record chart in the home that the member of staff writing the chart signs the chart and that a second carer checks the entry for accuracy and then initials the chart. Immediate requirements have been made relating to the practice of the administration, recording and storage of medication. Please see requirements and recommendations section of this report. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 Service users preferences and choices were respected and activities suited the service users needs. The home ensured that relatives’ and friends were always welcomed. EVIDENCE: Service users were taking part in Christmas card activities on the day of inspection. A priest visits the home to administer communion for one service user. The home can cater for the cultural or ethnic dietary needs of all service users. One of the service users daughters visits the home every day. She says that she can visit at any time and likes to bring in treats for the other service users. Two Dementia videos have been shown to relatives and support has been given to relatives from the Alzheimer’s Association. Service users have been to the Cobham Extravaganza evening where the Christmas lights were turned on. The staff were decorating the home for the Christmas period and this enhanced the festive mood of the home. Nineteen of the service users have attended a Christmas lunch at a local garden centre. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 13 Occasionally some of the service users like to visit relatives for an overnight stay. Ten members of staff have undertaken Service user involvement training. This has equipped staff with the knowledge to be able to assess the likes and dislikes of service users providing for a better understanding of the choice and controls that service users are able to exercise over their lives. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 the following standard(s): These standards were not assessed. EVIDENCE: Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 the following standard(s): 19,20,26 The service is currently being redecorated and new furniture has been purchased for all units within the home. EVIDENCE: A full tour of the premises took place and the units are being decorated with co-ordinating colours and dado rails. New curtains have been purchased. A married couple admitted to single rooms have opted to sleep in one of the bedrooms and use the other as a sitting room. The registered manager was advised to ensure that the facilities and sizes of the rooms met regulation requirements. The rooms currently occupied are not interconnecting. The carpets in rooms 9 and 10 must be cleaned. The floor in room 3 was sticky and must be cleaned. Linen bags must be affixed to laundry frames and bags not left on the floor in bathrooms. The seat off one of the armchairs in the lounge was missing. Furniture that is not fit for purpose must be removed in
Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 16 order to prevent service users from harm. The mal odorous smell from room 2 must be eradicated. The kitchen surfaces were clean, fridge and freezer temperatures were within limits and the extractor hood had been recently cleaned. There was a leak under the sink in the kitchen, which was causing a sticky substance to rise up from beneath the surface of the floor. The kitchen floor must be deep cleaned. Sponge mixes must be stored in sealed containers after opening. The overalls that are used by staff entering the kitchen and stored on coat hangers outside the kitchen door must be clean at all times. The rubbish bag in the kitchen must be affixed to its frame. Gardens have been improved with the assistance and support of service users family. Please see requirements and recommendations section of this report. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The number and skill mix of the current staff group meets the needs of the service users living within the home. Recruitment practices need to be improved to ensure that reasons for any gaps in employment details are recorded. EVIDENCE: There were sufficient numbers of staff on duty at the time of inspection and five staff have been undertaking team leader training accredited by the Institute of Management. The service is keen to generate a career path for employees. New opportunities are always advertised internally and the registered manager has confirmed that Care UK actively promotes internal staff. Staff have received induction and Dementia training. There are no vacancies within the staff group and the manager has informed the inspector that there is a more cohesive team in place. Staff recruitment records sampled during the inspection contained application forms, two references, and a medical questionnaire. Criminal record bureau clearance had been obtained. Photographic identification must be added to recruitment files and gaps in employment must be explored and recorded. Where the identified referee has not supplied a reference a note should be made in the records containing the reason for non-compliance.
Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 18 All staff assisting in the kitchen must attend a basic food hygiene training programme. Please see requirements section of this report. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 Staff and management offer a cohesive service, which is underpinned by clear and concise health and safety policies and procedures. EVIDENCE: Service users body language and non-verbal communication skills were observed and they appeared happy to be in the home and staff demonstrated a knowledge and understanding of the complex needs of service users. The registered manager is to leave the service shortly to take up a post in another Care UK home. Provision must be made to ensure the safety and security of service users during this period of change. Financial records are kept for all service user transactions and receipts are held for all purchases. There is an upper limit set for each of the service users. Some service users who are in receipt of an allowance from the local authority have individual bank accounts. Money is stored in a safe place.
Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 20 A new computer system has been installed and all care delivered to service users is being recorded. The home has a health and safety policy in place. Any incidents are recorded and reported to the Commission for Social Care Inspection. Some issues have arisen due to the changing needs of service users placed within the home and these are currently being addressed. Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X 3 X X X STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 2 Standard OP9 OP9 Regulation 12 (1) (b) 13 (2) Requirement Medication must be administered to service users as prescribed. Timescale for action 16/12/05 Accurate records must be kept In 16/12/05 relation to the receipt and current stock of medication. Staff must sign medication administration records at the time of administration. The carpets in rooms 9 and 10 must be cleaned. The floor in room 3 was sticky and must be cleaned. The armchair with the missing cushion must be removed from Chestnut unit until the cushion has been replaced. The laundry bag in the bathroom must be affixed to the frame and not left on the floor. 16/12/05 3 OP9 13 (2) 4 5 6 OP26 OP26 OP19 23 (2) (d) 23 (2) (d) 13 (4) (a) (c) 13 (3) 31/01/06 31/01/06 31/12/05 7 OP19 31/12/05 8 9 10
Tiltwood OP26 OP19 OP26 16 (2) (k) 23 (2) (b) 23 (2) (d) The smell of mal odour in room 2 31/12/05 must be eradicated. The leak under the sink in the 31/01/06 kitchen must be repaired and the kitchen floor appropriately sealed Flooring in the kitchen must be 28/02/06
DS0000029255.V262372.R01.S.doc Version 5.0 Page 23 11 12 13 OP26 OP26 OP29 23 (2) (d) 16 (2) (g) 19 (1) (b) (i) 14 OP30 18 (1) (c) (i) deep cleaned. Kitchen overalls and hats must be clean at all times. Sponge mix and dried foodstuffs must be stored in a sealed container. Recruitment practices must be improved to include reasons for gaps in application forms and Photographic identification is to be added to recruitment records. The member of staff who assists in the kitchen must undertake basic food hygiene training. 31/12/05 31/12/05 28/02/06 31/03/03 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 OP9 Good Practice Recommendations It is recommended as good practice that when it is necessary to handwrite a medication administration record chart in the home that the member of staff writing the chart signs the chart and that a second carer checks the entry of accuracy and then initials the chart. It is recommended that the registered manager ensure that the rooms, which are currently shared meet with current standards and inform CSCI of the outcome. It is recommended that where new referees have had to be sought for prospective staff this information be recorded with the reasons for the changes. 2 3 OP19 OP29 Tiltwood DS0000029255.V262372.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Surrey Area Office 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 DS0000029255.V262372.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
