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

This inspection was carried out on 6th June 2006.

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

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

Other inspections for this house

Tithe Farm Nursing Home 01/12/06

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 Caroline Roberts Unannounced Inspection 6th June 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 DS0000023030.V294258.R01.S.doc Version 5.1 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. DS0000023030.V294258.R01.S.doc Version 5.1 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 DS0000023030.V294258.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Tithe farm is a home for older people with Nursing needs. Pressbeau Ltd who has a number of homes across the south of the country owns the home. Tithe farm 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. DS0000023030.V294258.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the un-announced inspection carried out at Tithe Farm on the 6th June 2006. The majority of all inspections conducted by The Commission for Social Care Inspection will be unannounced. The lead inspector was Mrs Caroline Roberts who was accompanied by Mr Guy Horwood. The inspection consisted of meeting with residents, staff and visitors, viewing records and documents pertaining to the provision of care and the running of the home. Evidence gained from this has formed the judgements for this report. The inspector toured the building, gaining permission from a number of residents to enter their bedrooms and viewing a further number from the doorway. The inspector met and discussed the inspection findings with the deputy manager and provider before leaving. The inspector found staff polite, helpful and welcoming, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector would especially like to thank the residents for their time and for allowing the inspector into their home. What the service does well: What has improved since the last inspection? On going internal redecoration. The information relating to health is detailed well within the care plans; evidence of regular review was also seen. DS0000023030.V294258.R01.S.doc Version 5.1 Page 6 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. DS0000023030.V294258.R01.S.doc Version 5.1 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 DS0000023030.V294258.R01.S.doc Version 5.1 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 the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All of the assessments evidenced were completed fully and clearly demonstrated that the home was able to meet the identified needs of the individual prior to admission to the home. Intermediate care is not provided at this service. EVIDENCE: The inspector viewed both the statement of purpose and the service user guide. Residents spoken with during the inspection said they were not aware of these documents, but the inspector noted both documents were available in the entrance hall of the home. Both documents give residents and their representatives a clear picture of what the home offers. Evidence from the case tracking exercise indicated that potential residents are visited prior to admission to the home and a pre-assessment undertaken to establish if the home can meet their needs. The content of the assessment is DS0000023030.V294258.R01.S.doc Version 5.1 Page 9 variable dependent on who conducts the assessment, comments such as needs assistance do not provide adequate information. Once admitted to the home for a trial period a fuller assessment is undertaken and any risk assessments this then forms part of the plan of care. Intermediate care is not provided in this home. DS0000023030.V294258.R01.S.doc Version 5.1 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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. There are care plans in place for each resident, which cover a broad range of health and care needs. Residents are registered with a GP and have access to health and specialist services in accordance with assessed needs. Medication in the home is stored appropriately with no excess stock. The care afforded to residents noted on the day of inspection is far below what is expected of a care home to provide EVIDENCE: The inspectors viewed a number of care plans, some as part of the case tracking exercise, all were found to contain satisfactory information in relation to the individual’s health needs and how the home was to meet these. Nutritional assessments, tissue viability assessments and moving and handling assessments were completed fully and subject to review. DS0000023030.V294258.R01.S.doc Version 5.1 Page 11 As part of the case tracking exercise the inspectors tracked care being given, to equipment used, and staff knowledge about those residents. Day and night plans and risk assessments for medical and nursing and environmental risks are clear and contained information staff need to care for the residents. Daily records of care are kept to ensure all needs are met on a daily basis and the deputy manager regularly updated plans. The care plan document is a very large, the content of the care plans is satisfactory in relation to the health and medical needs with some health information being very good, however the social care needs part of the care plans seen contained limited information and require further development to allow the home to meet the holistic needs of residents. It was concerning and disappointing to note that at 10.45 am 11 residents were still in bed waiting for staff to provide personal care to them, 6 of the residents did not have access to a call bell or drinks to hand. One resident who had been assisted to wash and dress was left in her bedroom this room felt quite cold despite the hot weather and the resident was quite distressed, the inspectors rang the call bell and waited 10 minutes with no answer eventually they went and informed the deputy manager who asked a member of staff to assist the resident, the inspectors observed the assistance given and would remind the staff that residents should be consulted/communicated with during any personal care. It became evident to the inspectors that two care staff had provided care to a resident in full view of the other resident sharing the bedroom, when the staff were questioned as why this had taken place one replied the manager was aware and had ordered a screen but they did not have yet. This practice is totally unacceptable and does not promote or maintain the resident’s privacy or dignity. This was discussed with the deputy manager and provider who were shocked and upset that this had taken place, they immediately ordered a screen and made arrangements for one of the residents in the shared room to occupy one of the vacant single rooms. A requirement is served that staff should receive training in promoting privacy and dignity. One gentleman was seen to be trying to walk across his bedroom to his walking aid which had a packet of sweets on, this resident was described as being at risk of falling, a nurse was made aware and assisted this man back to his seat this was not done appropriately and as a consequence the mans outer thigh was caught on the arm of the chair, even then the walking aid was not given to the resident, the deputy manager was made aware of this. Staff spoken with appeared to have a good knowledge of the needs of the residents and appeared busy throughout the course of the inspection. The deputy manager made arrangements for another member of staff to come on DS0000023030.V294258.R01.S.doc Version 5.1 Page 12 duty, this member of staff arrived at approximately 11am and when asked why she had come in said it was because of the inspection. Comments received from residents such as: “The care is not what I would call regular” “You can be left to wonder why you have a call bell they never answer” “It is usually lunch time before they get me up” “They are always so busy they do not have time for you” Provide further evidence that the staffing levels and skill mix is not adequate to meet the current residents needs, a requirement is served that the provider and manager are to undertake an assessment of residents needs and ensure that adequate staff or on duty in such numbers that residents needs are met fully, the outcome of this assessment is to be forwarded to the commission within the agreed timescale. There was evidence in care plans that residents are registered with a G.P and have access to specialist health services, as recorded on their medical record sheets. The home reported to receive a good support service from the local GP’s. Health intervention is recorded within the daily reporting sheets The medication administration procedures were found to be satisfactory, no unexplained gaps were noted on the medication administration sheets, medication is stored appropriately with systems in place for the receipt and disposal of medications. DS0000023030.V294258.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Residents interests and previous lifestyle are taken into consideration when developing care packages and contact with family and friends is encouraged. The food is well presented and appeared appetising and nutritious. EVIDENCE: The home employs a dedicated activities organiser. A structured programme of activites is offered on a daily basis, meetings are arranged to include the views and wishes of the residents. Church services are aranged via the local church. Routines in the home are arranged around residents needs as much as possible. The home do not have restrictions on visiting hours, except visiting during the night would need to be pre-arranged and under exceptional circumstances. Family and friends can meet in residents own bedrooms or one of the lounges, family can stay for meals with prior arrangement. Residents and families are encouraged to manage their own finances, although the home do offer residents access to the resisdents saving scheme for small DS0000023030.V294258.R01.S.doc Version 5.1 Page 14 amounts of personal finance, for which procedures are followed including clear documentation and receipts for all expenditure. Most of the bedrooms in the home show that residents are able to bring items of their own furniture to personalise their rooms. The home has 1 dining area of which is pleasently decorated and offer ample room for the residents to ejoy the meal in a congenial setting. Meals can be taken in the residents own bedroom if wished. 3 cooked meals aday are offered with drinks readily made available. Menus are varied and reflective of the season. DS0000023030.V294258.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The home operates a transparent approach towards complaint investigations. POVA policies are available in the home and staff are trained in this area. EVIDENCE: The home has a complaints procedure. The residents and relatives are made aware of the procedure through the statement of their terms and conditions of residence and the service user guide copies of which, are displayed in the entrance area. It was noted that the home has not received any formal complaints since the last inspection. The training records seen indicated that some staff had received POVA training and further staff are planned to attend in this years training plan, this will be monitored at the next inspection. POVA policies are available for staff. DS0000023030.V294258.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Qulaity in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Residents live in a safe and very well maintained environment EVIDENCE: The home was found to be clean and fresh with no unpleasant odours detected during the inspection. The kitchens were inspected and all areas and equipment was found to be clean. The home have a plan of refurbishment and replacement of furniture, which was shared with the inspectors, this is a plan for 06/07. A few areas were brought to the attention of the provider and deputy that need attention now including: • The quiet lounge carpet needs cleaning. • Room 8 broken furniture to be removed, chair to be cleaned. • Room 13 carpet needs cleaning. DS0000023030.V294258.R01.S.doc Version 5.1 Page 17 • • Toilet 1 needs redecorating and new flooring provided. Room 12 window restrictors need fixing. The laundry is adjacent to the building and provides adequate facilities for the laundry provision in the home. The home has an infection control policy and training records evidenced that all staff receive training in personal care and infection control. The home uses the red bag system for segregating soiled and infected laundry. DS0000023030.V294258.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Qulaity in this outcome area is Poor. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Current staffing levels and deployment of staff do not meet the needs of the residents. Recruitment practices need to be consistent to ensure the safety of residents. Training is projected and planned to ensure mandatory training is undertaken by all staff. EVIDENCE: From examination of the rotas it was ascertained that 6 staff are on duty throughout the waking day and three at night. Most of the staff on duty during the inspection were nurses. Due to the care observed during the inspection a requirement has been made that the provider and manager are to undertake an assessment of residents needs and ensure that adequate staff or on duty in such numbers that residents needs are met fully, the outcome of this assessment is to be forwarded to the commission within the agreed timescale. The recruitment files for 3 staff were inspected, one was found to contain all the required documents as detailed in Schedule 2 The Care Homes Regulations 2001. The second identified that one reference was received after the person had commenced employment. DS0000023030.V294258.R01.S.doc Version 5.1 Page 19 The third was for a kitchen assistant who was working on the day of the inspection undertaking a taster day to see if the job was for him, he did not have any references, POVA first of CRB once the deputy manager was made aware of this he was sent home immediately. This was discussed with the provider as the manager was on holiday to establish how this had happened; he agreed to look into to ensure that this does not happen again. A requirement is served that the manager is to ensure that no staff commence employment in any form prior to receiving all of the required documentation. The home provide supervision to all care staff and training plans are in place which identify that mandatory training is undertaken by all staff. DS0000023030.V294258.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Quality assurance policies are in place in the home. Small amounts of finances can be held by the home, this is well managed. The home carry out the required health and safety checks to ensure residents live in a safe environment. EVIDENCE: The manager was on holiday during this inspection, the deputy manager assisted the inspectors with all aspects of the inspection process. The home has an internal quality assurance process the date of the last internal quality assurance process was not available. This will be monitored at the next inspection. DS0000023030.V294258.R01.S.doc Version 5.1 Page 21 Regulation 26 reports act as a quality assurance, the reports for April and May 06 were viewed neither indicated that residents views are directly sought, due to some of the comments received during this inspection it is advised that the providers seek the views of the resident about the running of the home. The home holds small amounts of personal finance, for which procedures are followed including clear documentation and receipts for all expenditure. There are detailed Health and Safety policies in the home. These serve as a training manual and reference document for staff to use. These cover policy areas such as fire prevention and care of substances Hazardous to Health (COSHH). These policies ensure that the health and safety of the residents and staff are maintained at all times. Records made available for inspection purposes evidenced that regular service agreements are in place to further ensure safety: Lift service on 23/5/06 5 yearly electrical wiring certificate 24/7/03 Fire alarm service on 12/1/06 Gas service 26/1/06 Nurse call system 29/12/05 Water chlorination on 11/11/05 Boiler service 26/5/06 DS0000023030.V294258.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 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 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 DS0000023030.V294258.R01.S.doc Version 5.1 Page 23 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 OP7 Regulation 15(1) Requirement The manager needs to further develop the social care information within the care plans. The manager must ensure that residents have access to their nurse call bells. Drinks must be available for residents at all times especially in the hot weather. The shared room is not to be used by two people until a privacy screen has been purchased and installed. The manager must ensure that resident’s privacy and dignity is respected at all times. The manager must ensure that staff communicate and consult with residents prior to providing any form of assistance. The provider and manager are to undertake an assessment of residents needs and ensure that adequate staff or on duty in such numbers that residents needs are met fully, the outcome of this assessment is to be forwarded to the commission. DS0000023030.V294258.R01.S.doc Timescale for action 01/09/06 2. 3. 4 OP8 OP8 OP10 23(2)n 16(4) 16(2)c 06/06/06 06/06/06 06/06/06 5 6 OP10 OP10 12(1)a 12(1)(2) 06/06/06 06/06/06 7 OP27 18(1)a 28/06/06 Version 5.1 Page 24 8 OP10 18(1)c 9 OP29 19(1) The manager is required to 01/09/06 ensure that all staff receive training in promoting privacy and dignity. The manager is to ensure that 06/06/06 no staff commence employment in any form prior to receiving all of the required documentation. The areas as detailed in the environmental section of this report are to be addressed. 01/10/06 10 OP19 23(2)b RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000023030.V294258.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000023030.V294258.R01.S.doc Version 5.1 Page 26 - 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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