CARE HOMES FOR OLDER PEOPLE
TNP House 15 Comberford Road Tamworth Staffordshire B79 8PB Lead Inspector
Jane Capron Unannounced Inspection 6th December 2005 9.45 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 TNP House DS0000005029.V271489.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. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service TNP House Address 15 Comberford Road Tamworth Staffordshire B79 8PB 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) 01827 316177 01782 68857 TNP Homecare (UK) Limited Janine Owen Care Home 12 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (7) TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th July 2005 Brief Description of the Service: TNP is a family run residential care home registered for 12 service users over the age of 65, 5 of whom may have dementia care needs and 7 may have physical disabilities. The home is set in a large detached house with a single storey extension at the rear. The property is located in a pleasant area of Tamworth. It has a rear garden with provision for service users to sit outside. The home is surrounded by mature shrubs and hedges and is set back from the road. There is adequate car parking space at the front of the home. The home has two lounges and a separate dining room, although some of the service users choose to eat and sit in their bedrooms. The home provides accommodation in six single bedrooms and three shared bedrooms. Ensuite facilities are provided in five of the single rooms and in one of the shared rooms. The home has a vertical shaft lift to the first floor. The home provides two assisted baths and has sufficient toilet facilities. During the summer months the home arranges outings for the service users. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over a five and a half hour period. Discussions were held with the owner/manager, staff, several residents as well as a visitor to the home and a district nurse who visits the home regularly. The inspection included an examination of a sample of care records, and records relating to Health and Safety. The medication administration procedures were examined as well whether the home was meeting the health and personal care needs of the residents. The views of residents were sought over a range of issues relating to living in the home. Since the last inspection there have been no additional visits and no complaints have been received What the service does well:
The home provided residents with a relaxed and homely environment. All residents spoken to stated that they liked living on the home. They could not speak too highly about the quality of the staff with comments such as ‘the staff are kind and helpful’ and ‘the staff are angels’. One resident stated that staff always responded so quickly to the nurse call alarm that she thought they ran when they heard the alarm. Another resident stated that ‘you had the freedom to do what you liked’. The home had a stable staff group with many of the staff having worked at the home for a number of years. Staff were well trained with seven out of the eleven staff having achieved NVQ level 3 and one staff in the process of completing NVQ level 2. In addition staff were undertaking a distance learning course in the administration of administration and were due to start a similar course in infection control. Staff had received training in dementia care needs. Staff were observed as showing respect towards residents and ensuring that their privacy was respected. Staff and residents had relaxed and friendly relationships. Residents spoken to confirmed that they were given choices. They could eat in their bedroom or in the dining room. Choices were provided over meals and over times to get up and go to bed. The residents were having their personal care and health care needs met. The home had developed good working relationships with healthcare specialists and District Nurses were regular visitors to the home. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 6 The healthcare visitor to the home stated that the home always referred appropriately and acted on any advice given. The home’s owner/ manager had achieved the Registered Managers Award and had a high commitment to the residents and worked alongside the staff. She and staff worked closely together and she was open to their suggestions about how the home could be improved. The owner/ manager had daily contact with the residents and was fully aware of their individual needs. 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. TNP House DS0000005029.V271489.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 TNP House DS0000005029.V271489.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): 3,4,5 The home’s admission procedures ensured that an assessment was completed on all prospective residents in order that the home could clearly decide whether they could meet the needs of the resident. The quality and level of staffing along with the good multi disciplinary work practices ensured that the needs of the residents were met. All prospective residents were able to visit the home to decide whether they felt it would meet their needs. EVIDENCE: All prospective residents had an assessment to identify their needs and for the home to decide whether the home could meet their needs. The assessments included the necessary areas including health and personal care, and social interests and family involvement. A recently admitted resident confirmed that she and her family had visited the home before making the decision to move in. She said that she had all the information she had needed to make an informed decision to move to the home.
TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 9 Residents spoken to felt that home was a good place to live and that their health and personal care needs were being met. They found the staff to be kind and caring and that the staff provided them with the level of support they needed to have their personal care and health care needs met. The home had developed positive relationships with health care professionals including district nurses, CPN and the GP. Staff were well trained and had the knowledge and skills to meet the residents needs. Staff had received training in caring for people with dementia care needs. Staff were observed as treating residents with respect, dignity and sensitivity. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, The home had developed individual plans of care but these needed to be expanded to ensure that all needs were identified in order that staff had the necessary information to fully meet the needs of the residents. The health needs of the residents were being met through good multidisciplinary working. The homes medication procedures and practices were ensuring that the medication needs of the residents were being met. The care practices of the staff were providing residents with care that showed them respect, dignity and upheld their right to privacy. EVIDENCE: Residents had individual care plans, which showed the health and basic personal care needs of each resident. Needs such, as nail, hair care, dental and eye checks and social needs were not fully identified and two files did not contain a photograph of the resident.
TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 11 Whilst the staff were clearly fully aware of the needs these were not adequately recorded and therefore any new staff member would not be provided with the full information. The home also needed to ensure that all elements were regularly reviewed. Residents spoken to felt that the staff supported them to have their personal care needs met and provided the necessary level of support enabling them to be as independent as possible. The health care needs of the residents were being well met. Residents received dental and eye checks and received services from the chiropodist. The home had good working relationships with health professionals and residents benefited from good contact with District Nurses, CPNs and GPs. Residents had received flu injections. The District Nurse confirmed that the home was alert to the prevention of pressure sores and referred appropriately to her and followed any advice she gave. The residents that needed it had pressurerelieving aids including cushions and mattresses. The weight of residents was monitored with action taken over significant weight gains or losses. Sampling of medication showed that the home was administering medication. Medication was stored correctly. Staff were in the process of doing an in-depth medication course through distance learning supported by a tutor coming to the home. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 The residents enjoyed living in the home and most felt that their social and recreational needs were met however there was a need for the home to demonstrate that they were providing a range of suitable activities for all residents. The home provided residents with choice in such things as most meals, times for rising and going to bed and where and how to spend their time although choice would be increased by ensuring that residents were always aware of the choices at lunchtime. Visitors were welcomed to the home and the home supported residents to maintain and develop relationships with friends and relatives and others living in the home. EVIDENCE: The home did provide some group activities including a theatre group coming to the home and school groups providing singing. The home also had some young people coming to do activities with residents as part of their Duke of Edinburgh award. Staff also spent time talking with residents. A number of residents choice to spend time in their rooms watching TV, doing crosswords, reading and doing word searches. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 13 The home also tried to take residents out but this had recently stopped due to the need for repair to the home’s vehicle. Residents were able to exercise choice over their lives and one resident commented that she had ‘the freedom to do what you like when you like’. Residents had choices over their breakfast and tea but although residents could have a choice at lunchtime this was not always made known to the residents and they were not always made aware of what was on the menu. The staff did however know most of the likes and dislikes of residents and would put an alternative meal for someone who they knew did not like a meal. There may be times however when a resident may want an alternative meal even if the meal on the menu is one they liked. Residents were able to exercise choice over when to get up and go to bed and respecting and encouraging choice was important to the staff. A staff member who worked nights stated that the number of residents up when she came on varied and that there was no time when residents had to go to bed. She stated it very much varied and some residents liked to stay up late to watch a film whilst some chose to go to bed early. The times for getting up were flexible with some residents choosing to get up very early and others preferring a later time. The home has a good number of visitors and a visitor spoken to during the inspection said that she was always made welcome. Observation showed that the home made all visitors welcome offering them drinks and refreshments. Visitors were able to see residents in private in their bedrooms or in any of the communal areas. One resident went shopping in Tamworth once a week supported by staff and went out on occasions with the owner/ manager to help with food shopping. Other residents went out with relatives. Residents were able to bring in personal items with them and the home would try to accommodate as much as possible if a resident wanted to bring something. The home had recently agreed to take in larger piece of furniture that was important to one resident and this had been accommodated in the dining room. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, The home had a complaints procedure and residents spoken to were aware of how they would complain and felt confident that any concerns would be addressed. EVIDENCE: The home had a complaints procedure that was displayed in the hallway. Residents said that they knew how to complain and felt that the staff would deal with any concerns they raised. A relative spoken to said she would have no hesitation in raising issues and that believed her concerns would be appropriately responded to. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20, 22,25,26 The home’s decoration and furnishings generally provided residents with a homely environment. There were some health and safety aspects of the environment that required to be addressed to ensure that the residents were enjoying safe and comfortable surroundings. The home provided the equipment for residents to maximise their independence. The cleaning regimes and hygiene procedures provided residents with a home that was clean and tidy and reduced the likelihood of the spread of infections. EVIDENCE: The home was suitably located and was in keeping with the local community. The home was adequately decorated throughout but certain areas would benefit from decorating. The home was satisfactorily furnished. The home had a very homely and friendly atmosphere throughout.
TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 16 The home had suitable communal facilities. There were two lounges and a separate dining room. The more physically dependent residents used the smaller lounge. Both lounges had TV facilities and a range of easy chairs. The home had suitable kitchen and laundry facilities. The home had the necessary equipment including two hoists, walking aids and wheelchairs and rails. All rooms had a nurse call arm fitted and residents stated that staff responded promptly when they rang them. The home had a vertical lift. The home had central heating in all rooms and the radiators were individually controlled. The home was generally well heated but it was noticed that the small lounge felt quite cold. This was to be immediately addressed by the owner/manager. The home had a number of radiators that were not covered and could cause a hazard to residents. Taps that were accessed by residents were regulated but the home was not checking whether the temperature was at a suitable level. The home was clean and tidy and had infection control procedures in place. There were adequate supplies of gloves and aprons and staff were seen using new gloves for each resident. The home had cleaning schedules. Staff were due to have infection control training early in 2006. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The homes staffing levels were sufficient to meet the needs of the residents. The residents were benefiting from staff group that was well trained and from a high number of staff qualified in current care practices. The home’s recruitment and selection procedures obtained the necessary references and police checks but residents would be more protected through the home ensuring that prospective staff provided confirmation of their identity and a full employment history. EVIDENCE: The residents thought highly about the staff feeling that they were very caring and that they would go out of their way to do things to improve residents’ lives. The home provided the level of staffing to meet the needs of the residents. The home has a supportive staff group that support each other and will cover for each other’s absences. There was always a minimum of two staff on duty at all times. The cook, who was also a qualified care staff member, once having finished her cooking duties would assist with feeding residents. The owner/ care manager worked as a care staff member several shifts a week and would cover for staff sickness and holiday. The home had two waking night staff. The home had a high number of qualified staff. Seven of the eleven care staff had achieved NVQ level 3 and a further staff member was finishing her level 2. Staff were keen to develop their knowledge and skill.
TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 18 Staff were undertaking a distance-learning programme on medication and following this were to undertake a similar course in infection control. The home had a very stable staff group with few staff changes. A number of the staff had worked at the home for several years. The home’s recruitment and selection procedures provided for the obtaining of two references and a satisfactory CRB. One file seen did not show evidence that the identity of the person had been confirmed and the application did not show a full employment history. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36, 38 The residents benefit from a home with a manager that is well trained and is highly committed to meet the care needs of the residents. The home’s system for assessing the quality of the service is based on seeking the views of residents and relatives. The residents were generally protected by the homes’ health and safety procedures but there were significant areas that required to be addressed. EVIDENCE: The owner/ care manager had the necessary skills and experience to effectively manage the home. She had completed NVQ level 4 and the managers award and undertook periodic training to keep her skills and knowledge updated. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 20 The home had a number of systems in place to measure the quality of the service. Most of these tended to be informal system but the home did seek the views of residents and relatives through questionnaires. The home did not manage the money of any residents and expenses were invoiced with the fees. The home did take account that residents were appropriately receiving their personal allowance either in money or in goods. The home had health and safety procedures in place and staff had undertaken the necessary mandatory training. Training in infection control was due to start in the near future. Servicing of equipment was being completed and checks were taking place on fire equipment and fire prevention was taking place. The covering of radiators was still not completed. And the home did not have a current electrical installation certificate. The home had no formal system for supervision but the manager and staff met regularly and worked closely together and the manager was always available to the staff and informal supervision was ongoing. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 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 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 3 X 3 X X 1 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 22 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. 2. 3. Standard OP36 OP25 OP25 Regulation 18(2) Requirement Timescale for action 01/03/06 07/12/05 01/01/06 4. OP38 5. OP38 6. 7. 8. OP12 OP7 OP29 That all staff are provided with individual formal supervision. 23(2)(p) To ensure that the small lounge is kept at a suitable temperature 13(4)(c) To ensure that water temperatures are monitored to ensure that water is kept at the recommended temperature. 13(4)(c) That an electrical installation check be completed. NIC or equivalent. (Previous timescale not met) 13(4)(c) That significant progress is made towards covering the outstanding radiators. (Previous timescale not met) 16(m)7(n) To evidence that residents are being offered a range of activities. 15(2)(b) To ensure that all care records are reviewed and that a photo of residents is on file. 19 To ensure that the recruitment Schedule and selection procedures include 2 the obtaining on a full employment history and confirmation of identity. 01/02/06 01/02/06 01/02/06 01/01/06 07/12/05 TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 23 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. 2 Refer to Standard OP24 OP14 Good Practice Recommendations. That redecorating take place in the corridors and communal areas that require it. To ensure that residents are always made aware of meal choices. TNP House DS0000005029.V271489.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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