Inspection on 07/02/06 for Tithe Farm Nursing Home

This inspection was carried out on 7th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tithe Farm Nursing Home 01/12/06

Tithe Farm Nursing Home 06/06/06

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 Gill Gentles Unannounced Inspection 08:00 7 February 2006 th 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.V268187.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. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 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 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.V268187.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2005 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. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the morning of Tuesday 7th February 2005. Mrs. Gill Gentles and Mrs. Nicky Cahill carried out the inspection over a two and half hour period. Both inspectors concentrated on looking at separate records, talking with the manager, residents and staff working in the home. The focus of this inspection was to ascertain that the previous requirements issued had been achieved and concentrating on the standards that had not been assessed during the previous inspection in June / July 05. What the service does well: What has improved since the last inspection? There is a policy and training is in place in relation to the protection of vulnerable adults; ensuring residents are not at risk from abuse. There are sufficient nurses, on each shift, to ensure that residents medical needs are being met as and when required. There have been major improvements in the recruitment practices in the home, ensuring residents are protected from potential abuse. Improvements have been made in relation to training ensuring residents needs are being met by trained competent staff. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 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. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 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.V268187.R01.S.doc Version 5.0 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): These standards were not assessed during this inspection. As during the previous inspection all standards were met. EVIDENCE: Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Care plans continue to contain limited information potentially putting residents at risk by not identifying personal and social needs. Healthcare records were limited therefore there was no evidence of the home meeting healthcare needs. The home’s arrangements for personal care ensures residents privacy and dignity are respected at all times. EVIDENCE: The manager and deputy have instigated a new care plan format into the home since the previous inspection. If utilised to its full potential it will be a good system. The new care plans are made up of several different coloured sheets depicting:• Risk Assessments • Behaviour • Social well being • Communication Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 10 • • • Promotion of health Elimination Nutrition There is also a section for the original needs assessment, Life biography, and internal care reviews. Two plans were viewed and found to be lacking in information important to managing and ensuring residents care and nursing needs are met. The home is in the process of transferring all the old Care Plans on to the new format, however the home is failing to ensure that all information is incorporated within the new plans e.g. life biography’s were incomplete, records were not signed or dated, risk assessments were incomplete. The outcome is that the information is not completed in any detail pertinent to individuals living in the home. The manager was advised to slow the process down and concentrate on a small number of Care Plans being developed, once complete continue gradually with all plans. One again the manager was reminded to incorporate information relating to residents entire life not just medical/nursing needs. The manager is required to ensure Care Plans are developed in detail to meet resident’s current and changing needs. All Care Plans incorporate a section that focus’s on “health care” needs however, these sections were incomplete. One plan had no information and the other had statements without answers such as how did one lady get her wound? How do you keep the suture site pressure relieved? How do you reassure when anxious and sad and what makes this person feel this way? All this information needs to be incorporated within the plans to ensure that all staff are able to meet individuals care and nursing needs. It is required that all health care needs are identified in the plans in greater detail. All residents appear to be treated with respect with privacy being adhered to. Personal care is given in either the bathroom or bedrooms, and visiting health care professionals meet residents in private. Staff were observed knocking on doors before entering. Residents appear to wear their own clothes and choose their own make up and hairstyles and all seen looked well cared for. Screening is provided in all the double bedrooms. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 15 The home is managed in a way that promotes independence encouraging residents to express autonomy and choice. Residents receive a varied, wholesome and nutritious diet, ensuring that individual tastes and needs are catered for. EVIDENCE: Residents are encouraged to maintain autonomy and choice to the best of their individual abilities. Residents are encouraged to handle their own affairs with the support of either their family or a representative. The home does manage some money for residents, although records were not viewed during this inspection, previously they have been maintained appropriately by the organisation. The home advertises advocacy services and holds regular family representative meetings at least four times a year, the dates for these were on the notice board and individual letters are sent out near to the date. Records are maintained in accordance with the Data Protection Act 1998 with access for the individual residents if they require. The chef continues to gather information relating to residents likes and dislikes regarding food. Alternative meals are available, and choices given to residents if they do not like the main meal available. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 12 Residents continue to be encouraged to eat their meals in the dining room; however, service users are welcome to eat in their rooms, if they wish. The home also caters for partners who visit during mealtimes. The home continues to have set mealtimes, however, these are approximate, depending on individual needs. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 13 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): 18 There is a policy and training is in place in relation to the protection of vulnerable adults; ensuring residents are not at risk from abuse EVIDENCE: The home has a policy in place regarding Protection of Vulnerable Adults. At the previous inspection staff had not received the appropriate training required. It was apparent during this inspection that the manager has ensured that training has been made available. The manager is reminded that all staff need to complete Protection of Vulnerable Adults training with refreshers annually. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 14 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): EVIDENCE: These standards were not inspected during this inspection, however, the dining room has been re-decorated and changed into a lounge/quiet room and the middle room that was the lounge area is now the dining room, which appears to work well. It is the centre of the home over-looking the large gardens with access onto a small patio area which creates a homely ambience. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 There are sufficient nurses, on each shift, to ensure that Service Users medical needs are being met as and when required. There have been major improvements in the recruitment practices in the home, ensuring residents are protected from potential abuse. Improvements have been made in relation to training ensuring residents needs are being met by trained competent staff. EVIDENCE: The home now has an adequate mix of nursing and care staff to appropriately support resident’ needs. At the previous inspection a requirement was issued to increase the numbers of nurses on each shift, which has been achieved. There are adequate numbers of staff employed to work waking nights to meet resident’s needs. Following an enforcement notice being issued to the home regarding their recruitment practices after the last inspection in July 2005, the manager has greatly improved her systems. Three personnel files of new staff employed in the home were viewed and found to contain all the appropriate information as required in schedules 2 and 4 of the National Minimum Standards. A reminder was given in relation to ensuring new work visas are applied for before the deadline. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 16 Staff training records were perused and it is noted that the manager has worked hard to ensure that the training levels for staff have improved. The home now has a training development plan for the coming year and training sessions in-house or by external facilitators takes place at least monthly. Records confirmed that out of 29 care and nursing staff and 7 ancillary staff:• 16 have Moving and Handling • 25 have completed fire training • 13 have First Aid • 4 have Food Hygiene • 10 have Infection Control • 6 trained in Health and Safety Other training that has been made available with between 6 and 10 staff having attended such as:• Dementia • Care Planning • Continence • Medication Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 17 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): These standards were not assessed during this inspection. EVIDENCE: Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X x Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 Requirement Timescale for action 30/04/06 2 3 OP8 OP38 To ensure that all care plans are written with the resident or a representative and encompasses their whole life. PREVIOUS TIMESCALE OF 30/11/05 NOT MET 12(1)(2) To ensure that all residents healthcare needs are incorporated in the Care Plans. 13(4)(a-c) Produce generic risk assessments for the internal and external areas of the building for all service users, staff and visitors. 30/04/06 30/04/06 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 OP1 Good Practice Recommendations It is recommended that the manager incorporate a more detailed account of staff qualifications and experiences within the Statement of Purpose. Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 20 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 Tithe Farm Rest Home DS0000023030.V268187.R01.S.doc Version 5.0 Page 21 - 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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