Inspection on 01/12/06 for Tithe Farm Nursing Home

This inspection was carried out on 1st December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Tithe Farm Nursing Home 06/06/06

Tithe Farm Nursing Home 07/02/06

Tithe Farm Nursing Home 06/07/05

Tithe Farm Nursing Home 03/02/05

Tithe Farm Nursing Home 31/08/04

Tithe Farm Nursing Home 16/03/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Tithe Farm Rest Home Park Road Stoke Poges Bucks SL2 4PJ Lead Inspector Joan Browne Unannounced Inspection 1st December 2006 09:30 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 Tithe Farm Rest Home DS0000023030.V316810.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. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tithe Farm Rest Home Address Park Road Stoke Poges Bucks SL2 4PJ 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) 01753 643106 01753 642141 ssaraogi@pressbeau.co.uk Pressbeau Ltd Mrs Pushpalata Saraogi, Dr Krishna Kumar Saraogi Mrs Alexandra Radford Care Home 35 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (35) of places Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: Tithe farm is a home for older people with Nursing needs. It is registered to provide care for up to thirty-five service users. Pressbeau Ltd who has a number of homes across the south of the country owns the home. It is situated in large grounds next to the golf course in Stoke Poges. Access to the home is via a long drive leading up to the front of the home into a small car parking area. Pressbeau Limited also has their main offices in the grounds, close to the main house. There is limited public transport with an infrequent bus service to the vicinity of the home. Fees are £850.00 per week. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home that took place on 1st December 2006. Prior to the fieldwork visit previous information about the home was reviewed and the outcome of the previous inspection noted. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that the Commission for Social Care Inspection (CSCI) is carrying out about the information that people get about care homes for older people. Comment cards were received from one resident, one relative and a health and social care professional. Overall they were happy with the care provision. Residents, staff and those family members who were visiting on the day of the inspection were interviewed. A tour of the premises was undertaken and care records and documentation were examined. The care of three residents was ‘case tracked’ from their original contact with the home to the care that they are now receiving. From the evidence seen and comments received, it is considered that this service meets the individual cultural, religious and diverse needs of residents. What the service does well: Before moving into Tithe Farm prospective residents and their relatives are given information about the home. Those who are able to are invited to visit and have lunch with other residents if possible. All residents are assessed, ensuring that the home and staff can meet their needs. Staff work towards maintaining the privacy and dignity of residents ensuring that personal care is provided in private and residents are well groomed. Activities at Tithe Farm are available and flexible to meet the needs of residents. Visitors report that they are made to feel welcome by staff. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 6 No complaints have been received about this home. Residents report that that they know who to speak to if they have a concern. The manager and head of care are highly respected by staff and residents. Staff feel well supported and in turn want to support them. What has improved since the last inspection? 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. Tithe Farm Rest Home DS0000023030.V316810.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 Tithe Farm Rest Home DS0000023030.V316810.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): 1, 2, &3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a Statement of Purpose and Service User’s Guide in place to ensure that prospective residents have the information they need to make an informed choice. Residents are issued with clear contracts and terms and conditions of occupancy. Prospective residents have a comprehensive needs assessment before admission to ensure that the home could meet their assessed needs. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide were displayed in the front entrance of the home and in the main lounge area. Three residents’ care was case tracked. Two of the residents spoken to did not seem aware of the home’s Statement of Purpose and Service User’s Guide. A third resident who was self-funding and recently admitted to the home had a copy of the Service User’s Guide in their possession. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 9 The home’s practice for ensuring that residents are given enough information to enable them to make an informed choice was discussed with the manager. She confirmed that when an enquiry is made a copy of the Service User’s Guide is forwarded to the enquirer along with other information relating to the provision of care. Information about the home can also be accessed from the home’s website. Copies of the home’s Statement of Purpose and Service User’s Guide are not displayed in residents’ bedrooms. However, the manager said that residents’ keyworkers are expected to sit with them as part of their settling in period and discuss the content of the documents in detail with them. It was noted that the home was working towards developing a welcome pack containing information about the home, which will be displayed in all residents’ bedrooms. All residents are given information about changes to the cost of their care in writing. For those residents who are funded by Social Services or by the Primary Care Trust the home’s finance department would write directly to the funders. Residents are issued with contracts and statement of terms and conditions of occupancy, which covered the following areas: • Room to be occupied • Overall care and services covered by fee • Fees payable and by whom • Additional services to be paid for over and above those included in the fees • Period of notice e.g. permanent or respite care • Rights and obligations of the resident and the provider and who is liable if there is a breach of contract The manager stated that she keeps copies of residents’ contracts in a separate file in her office to ensure that confidentiality was not breached. The home has an assessment tool that covers individual’s health and social care needs. There was evidence in place to indicate that residents have a preadmission assessment before admission to ascertain if the home would be able to meet their needs. Residents whose care was case tracked were visited by the home’s staff either in hospital or in their own home. One particular resident described visiting the home with relatives to spend some time and being treated with respect and understanding. An individual staff member was allocated to spend some time with them, which enabled them to feel comfortable and to ask questions about life in the home. The home does not provide intermediate care. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure that residents’ diverse health and personal care needs are adequately met. However, further improvement in the detailing of information in care plans is needed to ensure that residents receive the appropriate care. EVIDENCE: Three residents’ care plans were looked at in detail. The care plan format in place was comprehensive and consisted of several colour-coded sheets covering the following areas of care needs: • Risk assessments • Behaviour • Social well being • Communication • Promotion of health • Elimination • Nutrition Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 11 The standard of recording was variable and depended on which member of staff was completing the plan. It was evident that care plans were reviewed monthly and relatives are invited to be involved in the development of individuals’ care plans. A copy of a letter was seen in a particular resident’s file inviting the relative to be involved in the development and reviewing of the care plan. This is deemed as good practice. Some plans seen did not always have an action plan relating to needs identified. For example, in a particular care plan it was identified that the individual was confused. However, there was no information recorded in the plan of care detailing how staff should care for the individual’s confusion. In the care plan section relating to communication the following was noted: ‘X has restricted speech.’ There was no action plan in place to indicate how staff should communicate with the individual. In a second plan seen it was highlighted on the body map that the individual had rashes on the ankles. However, there was no information detailing what treatment if any had been prescribed to treat the individual’s rashes. It was noted that the care needs analysis risk forms in place were reviewed every three to six months or when required. It is recommended that where risks have been identified staff should be willing to support residents to take some risks. If risks are not encouraged it may have an impact on residents’ rights. Daily report writing focussed on personal care, eating and drinking and not on individuals’ psychological and social care needs. However, staff spoken to were able to describe the care they were providing to residents but their good practice was not always incorporated in the daily report writing. Staff support residents with personal and oral care and information relating to individuals’ health care was recorded in the care plans seen. It was evident that continence assessments were in place and staff are able to access the continence adviser for advice if required. Those residents with continence problems would be provided with the appropriate aids and equipment. Waterlow assessments were in place in care plans seen and they were reviewed monthly. Residents at risk of tissue damage are provided with mattresses and cushions to minimise the risk of pressure damage. Residents have access to a general practitioner who visits the home as and when required. Residents are able to access health care treatment such as physiotherapy and audiology from the National Health Service via the general practitioner. There was evidence in care plans seen that residents have access to chiropody, dental and optical treatment when required. The home ensures that residents are provided with the appropriate aids and equipment such as zimmer frames, wheelchairs, feeding cups, plate guards, cutlery and hoists to promote independence and to support both residents and staff in daily living activities. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 12 The home uses the Manrex monitored dose system. The medication administration record ( MAR) sheets were checked and overall staff recording practice was satisfactory. However, as a good practice staff need to be consistent when recording handwritten entries on the MAR sheets and ensure that two staff members check entries, which should be dated and signed to minimise the risk of errors being made. The storage of the Controlled medication complies with the Misuse of Drugs (Safe Custody) Regulations 1973. The Controlled drug register and medication were checked and were in order. A record is kept of all medication entering and leaving the home. There were no residents self-administering their own medication at the time of the inspection. However, one resident expressed a wish to self-medicate. This information was passed on to the manager to be acted on. Staff confirmed that their competencies in the administration of medication are regularly assessed. Some staff were undertaking an accredited training course in the safe handling and administration of medication. Residents and relatives spoken to confirmed that they were treated with respect and dignity by staff. Personal care is provided in private ensuring that dignity is maintained. Staff are expected to knock and wait for a reply before entering residents’ rooms. Some residents have their own personal telephones installed in their bedrooms so that they can receive calls in private. All residents appeared well groomed with attention to detail. It was noted that residents’ preferred term of address was recorded in care plans seen. A requirement was made at the previous inspection for a ceiling screen to be provided in the shared bedroom. It is pleasing to report that the requirement had been complied with. Staff spoken to confirmed that they had undertaken training in promoting residents’ privacy and dignity. They also had a good understanding on the diverse needs of the residents that they were caring for and were observed interacting with residents in a sensitive manner. The following comment was noted from a relative about the care: ‘You can’t fault the care it is of the highest standard.’ Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents’ leisure social and dietary needs were being met in pleasing surroundings convenient to them. EVIDENCE: Some residents spoken to said that they were able to choose what time they wished to rise and retire. Overall they felt that the lifestyle experienced in the home matched their expectations. Some residents chose to remain in their bedrooms. It was noted in the care plans seen that life biographies were in place as well as individuals’ religious observance, leisure, social and cultural interests. The home has an activity organiser who works part-time. She was not on duty on the day of the inspection. Staff confirmed that activities are facilitated daily either by themselves or the activity organiser. Some plant pots that residents had painted were on display in the lounge area. Residents spoken to confirmed that at least twice monthly entertainers visit the home to perform. Residents confirmed that in the warm weather they are taken for walks in the grounds and spend a lot of time sitting in the garden enjoying the wildlife. The manager confirmed that the activity programme was planned around residents’ preferences and choices. Board games, quizzes, and painting Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 14 are some of the activities that are on offer. There are also theme lunches and the chef prepares cultural foods monthly such as Italian, Mexican and Indian. Relatives spoken to during the inspection confirmed that they are no restrictions on visiting and that staff are hospitable and always make them feel welcome and offer them refreshments. The following comments were noted: ‘Staff are excellent and always make time to talk to me.’ ‘I visit every day and staff always offer me a meal.’ The home has communal areas where residents can entertain their visitors, in addition to the privacy of their own room. Wherever possible residents are encouraged and supported to exercise choice and control over their lives and to look after their finances for as long as they wish to and are able to. One particular resident spoken to had full control over her finances with some support from relatives. There were no residents using the services of an advocate at the time of the inspection. It was evident that residents are made aware that they can be admitted to the home with personal items such as small pieces of furniture like an armchair or dressing table to keep in their bedroom. Residents are provided with three meals daily. Hot and cold drinks and snacks are available throughout the day and night. The lunchtime meal was observed. Tables were appropriately set with tablecloths and the appropriate cutlery. A choice of drinks was on offer. Choices on the menu were fisherman’s pie, poached fish, mashed potatoes, chips peas and sweetcorn. Dessert was treacle-spiced pudding with vanilla sauce. Mealtime looked a social occasion. Residents spoken to were complimentary about the meal also a visitor who visits daily. They said that lunch was always tasty. They also confirmed that the chef would provide them with an alternative meal if they did not like what was on the menu. It was noted that pureed meals were served attractively and looked appealing. Staff were observed feeding residents who needed assistance however, they were standing up to do this task. This practice should be reviewed. Arrangements are in place to ensure that residents are consulted about their food likes and dislikes, which was recorded in care plans seen. Residents have a choice of eating in the dining room or in their bedrooms. Residents’ dietary needs are catered for. Some residents chose to have soup or Bovril and their requests were granted. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which indicates that complaints are listened to and acted upon. Staff have had training in the protection of vulnerable adults this should ensure that residents are not placed at possible risk of harm or abuse. EVIDENCE: Information on the pre-inspection questionnaire indicated that the home had not received any complaints about the service. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The home has a complaints procedure a copy of which is recorded in the Service User’s Guide. Residents spoken to said that if they had a complaint or a concern they would discuss it with the manager or deputy manager and they were confident that it would be acted upon. The Commission has not received any information concerning any suspicion or evidence of abuse or neglect made to the service since the last inspection. The home’s training matrix indicated that staff have had training update in the protection of vulnerable adults. Staff spoken to were aware of their responsibilities if they suspected or witnessed a resident being abused. Relatives and residents spoken to during the site visit felt very supported by the staff and were satisfied with the care provision. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 16 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in premises that are well maintained, safe, and clean and in pleasant surroundings creating a homely environment. EVIDENCE: Tithe farm is located on the outskirts of Stoke Poges next to the golf course. It is a listed building with many of its original features maintained. It has large grounds that are well maintained. There is limited public transport access. Records indicate that the building complies with the requirements of the local fire service and the environmental health department. There is a maintenance plan in place and areas of the building have been recently refurbished. At the previous inspection requirements were made for maintenance work to be carried out. It is pleasing to report that the home has fully complied with the requirements. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 17 The home has two lounges, a dining area, four bathrooms or shower rooms, seven toilets, twenty-three single bedrooms, six double bedrooms and six bedrooms with en-suite facilities. Bedrooms seen were personalised with residents’ personal belongings, family photographs and mementoes that reflected the individual characters of residents. The premises were found to be clean and free from offensive odours in all areas of the home. Laundry facilities are sited across the courtyard from the main house to ensure that soiled linen does not get carried through areas where food is stored or prepared. The home operates a red bag system for separating soiled laundry, which is intended to reduce the risk of cross infection Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the home’s staffing levels, which should ensure that residents’ diverse needs are adequately met. Ongoing training is facilitated in the home to ensure that residents are cared for by staff who are trained and competent to do their jobs. The home’s recruitment practice, complies with current legislations thus ensuring that residents are cared for by staff who are appropriately vetted. EVIDENCE: The staff rota seen reflected that there are two registered nurses and five carers covering the morning shift and two registered nurses and five carers cover the afternoon shift. The numbers on the night shift are reduced to one registered nurse and two carers. Information recorded in the pre-inspection questionnaire indicated that the home has not used the services of agency staff recently. At the previous inspection a requirement was made for residents to be assessed to ensure that sufficient staff are on duty to meet their needs. It is pleasing to report that the requirement has been complied with and there are now sufficient staff on duty to care for residents appropriately. Residents spoken to appeared to have confidence in the staff team. The following comments were noted from residents: ‘Staff are very kind.’ ‘Staff are excellent.’ Staff providing personal care were over the age of eighteen. The home employs contract cleaners who Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 19 ensure that the home is clean and hygienic. The home meets the standard that 50 of care staff should hold a national vocational qualification (NVQ) in direct care at level 2. Fourteen of the seventeen care staff working in the home had obtained an NVQ qualification in direct care at level 2 or 3. Files for three members of staff who were recently appointed were examined. All files contained two references, PoVA first checks and criminal record bureau (CRB) clearances. Interview notes, declaration of health statements and terms and conditions of employment were in place. Recent photographs to confirm proof of identity were seen in two files. It is recommended that all files should have recent photographs of staff members to confirm proof of identity, which should be in place when staff commence employment. The home has a planned training programme in place. The training matrix seen indicated that staff had undertaken mandatory training updates. Staff spoken to confirmed that the home provides training on a regular basis. Recent training facilitated in the home were moving and handling, fire prevention, food hygiene, protection of vulnerable adults, dementia awareness and wound management. Some staff recently commenced a distant learning health and safety training course and said that they were finding it beneficial. Staff confirmed that the manager and deputy manager were very proactive in ensuring that training is facilitated and they are appropriately trained to meet the needs of the residents. A requirement was made at the previous inspection for all staff to undertake training in promoting privacy and dignity. The requirement had been complied with. Staff spoken to were able to demonstrate how they were promoting residents’ privacy and dignity. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is run by an experienced manager. Audit systems are in place to ensure that residents are consulted about their care. Health and safety records were generally in good order. However, food storage practice needs to be improved to comply with current legislations. EVIDENCE: The manager is a registered nurse and has been managing the home since October 2004. The deputy manager who is also a registered nurse supports her. Both hold the registered manager’s award at NVQ level 4 and are currently working towards achieving the NVQ assessor’s award qualification. They both appeared very experienced and familiar with the conditions and Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 21 diseases associated with old age and strive continuously to improve the provision of care. There are clear lines of accountability within the home and with any external management. There seemed to be an open, positive and inclusive atmosphere in the home. Care staff confirmed that the manager and deputy manager were approachable and supportive and they are encouraged to ask questions if unsure. Regular staff meetings are held The manager said that the organisation carry out annual quality audits across all their care homes. The results are analysed and an action plan is developed to meet any issues raised. The provider carries out monthly visits and records of visits are maintained in the home. Quarterly residents’ relatives meetings are held. The manager said that the attendance at meetings is growing. Comment cards were received from one resident, one relative and one health and social care professional. The resident confirmed the following: A contract had been issued. That enough information was obtained about the home before deciding it was the right place. Care and support is always available. Staff listen and act on what is said. Staff are usually available when needed. There is always medical support if needed. Activities are usually arranged. Meals at the home are usually liked. Is usually aware how to make a complaint. The home is always fresh and clean. The relative respondent commented that the care provided overall was good. The health and social care respondent reported the following: Good communication with the home. There is always a senior member of staff on duty to confer with. Staff demonstrate an understanding of residents’ care needs. That medication is appropriately managed. Specialist advice is incorporated into residents’ care plans. Additional comment included: ‘I have always found the staff team helpful prepared to listen and accommodate the needs as expressed of residents’. The home holds small amounts of money for residents to purchase toiletries, newspapers, chiropody treatment and hairdressing. Clear documentation and receipts for all expenditure were in place. One resident in the home at the time of the inspection was handling her own finances. Three residents were subject to Power of Attorney and two subject to guardianship. Staff spoken to confirmed that regular supervision and annual appraisals take place. The management team divide the responsibility of supervision session to ensure all staff are supported. The training matrix seen indicated that staff have had moving and handling and fire awareness training to ensure safe working practices. It was noted that only one staff currently holds a first aid certificate. It is required that there should be an appointed first aider on every shift and that person should have received emergency first-aid training. Arrangements must be made for Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 22 staff who are left in charge of the home to have first-aid training to comply with the Health and Safety (First-Aid) Regulations 1981. It is recommended that there should be a nominated first-aider on each shift. It was noted that opened packets of food and sauces in the kitchen refrigerator were not labelled and dated. It is required that all opened packets of food and sauces are dated to comply with the food safety regulations 1995. Regular servicing of the boilers, central heating system, electrical equipment and hoists are carried out. Water chlorination tests are carried out annually to eliminate the risk of Legionella. Thermostatic valves are fitted to all hot water outlets. Water temperatures in some residents’ bedrooms and bathrooms were checked and they were within the appropriate range. The fire panel is checked weekly and records are appropriately maintained. The accident book was examined and all accidents and incidents appeared to be recorded appropriately. The manager said that the home has an accident and incident policy and all accidents sustained by residents are reported to relatives and they are kept informed of the individual’s progress. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 X 2 Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 24 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. Standard OP7 Regulation 15(1) Requirement The registered manager must ensure that needs identified in care plans are supported by an action plan outlining how needs should be met. The registered manager must ensure that opened packets of food and sauces are labelled and dated. The registered manager must ensure that staff who are left in charge of the home undertake first-aid training to comply with the health and safety (First-Aid) Regulations 1981 Timescale for action 31/01/07 2 OP38 16(2)(j) 31/12/06 3 OP38 13(4)(c) 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the registered manager should ensure that all handwritten entries on the medication DS0000023030.V316810.R01.S.doc Version 5.2 Page 25 Tithe Farm Rest Home 2 3 4 OP15 OP29 OP38 administration (MAR) sheets are checked and signed by two staff members. It is recommended that the registered manager should review the unacceptable practice of staff standing up and feeding residents. It is recommended that the registered manager should ensure that all staff members’ files contain recent photographs to confirm proof of identity. It is recommended that the registered manager should ensure that there is a nominated first-aider on each shift. Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tithe Farm Rest Home DS0000023030.V316810.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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