CARE HOMES FOR OLDER PEOPLE
Tordarrach Nursing Home 11 Hall Road Wallington Surrey SM6 0RT Lead Inspector
Alison Ford Unannounced Inspection 16th November 2005 13:15p 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 Tordarrach Nursing Home DS0000019129.V258147.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. Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tordarrach Nursing Home Address 11 Hall Road Wallington Surrey SM6 0RT 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) 020 8669 1494 020 8669 3533 tordarrach@yahoo.com Dr R Obaro Mrs Ayodele Obaro Mrs Victoria Olufunto Akindele Care Home 20 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th April 2005 Brief Description of the Service: Tordarrach is a home providing nursing care to older people, the majority of whom at the time of the inspection had dementia. The home is a domestic style property enlarged and converted to provide accommodation for 20 service users. It is situated in a pleasant tree-lined road in Wallington, close to local amenities. Communal space and bedrooms are arranged over the ground, first and second floors There is passenger lift serving all floors. There are eight single and six double bedrooms. The home has a large dining room with adjacent lounge. There are toilet and bathing facilities on each floor a large, accessible garden to the back and parking facilities at the front. Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second annual inspection, which was unannounced and took place over two and a half hours. The Registered Manager, of the home, was present for the visit and was welcoming and receptive to the inspection process. A partial tour of the premises was undertaken and a sample of care plans was assessed. At the last inspection, all of those standards considered by The Commission to be key to the inspection process, were assessed and this report should be read in conjunction with the one following that visit on 12th April 2005. This inspection focussed on gaining the views of residents in the home and eight residents and one relative, who was visiting the home, were spoken with. Since the last inspection, there had been one concern that was dealt with by the home, and this had resulted in a member of staff ceasing to be employed there. What the service does well:
This home provides care for up to twenty elderly people many of who have advanced stages of dementia. The atmosphere in the home is friendly and welcoming and all of the residents spoken with were complimentary about the staff and management team. One resident told the inspector “you could never find anything better “. A resident that was also spoken with at the last visit said, “it was still just as nice to be in the home.” Residents were very complimentary about the food despite the fact that many of them require liquidised meals and they have a good relationship with the chef who is very involved with them. During the inspection he was observed coming into the lounge and talking and joking with the residents as he asked for their opinions. Care plans inspected confirmed that service users changing needs are identified and that they have access to other members of the primary healthcare team. . Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 6 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. Tordarrach Nursing Home DS0000019129.V258147.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 Tordarrach Nursing Home DS0000019129.V258147.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): 3,6 Potential service users are able to access all the information that they require prior to moving into the home to allow them and their relatives to make an informed choice as to the suitability of the placement. The home undertakes a comprehensive assessment of the healthcare needs of service users prior to their admission and regularly reviews these to ensure that they continue to be met. EVIDENCE: Three care plans, of residents admitted since the last inspection were seen. Prior to admission, all residents have a full health needs assessment either by a senior member of the staff or by their care manager. These were seen in the care plans and the regular reviews include, where possible, input from the service user. This home does not offer intermediate care; therefore this standard does not apply. Tordarrach Nursing Home DS0000019129.V258147.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 Resident’s health care needs are all documented in their care plans and these are assessed regularly to ensure that they remain met. Residents are treated with kindness and dignity, which respects their individuality and privacy. EVIDENCE: All residents have a comprehensive care plan and three of these were examined at this inspection. They all contained assessments of physical and mental health, risk assessments, continence and tissue viability assessments. Other healthcare professionals are consulted as required. Personal care is given in service users own rooms and visitors could be received there if desired. A relative of one resident was spoken with and confirmed that his mother was happy and always looked well cared for.
Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 10 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 The majority of the residents in this home feel that the activities offered to them suit their preferences and expectations and provide interest in their daily lives. EVIDENCE: The advanced stages of dementia of many of the residents, limits the amount of choices that they are able to make and the activities that they can participate in. One resident stated that she would like more exercise based sessions although the others did not support this request. It was recommended that the views of residents should be monitored regularly to ensure their lifestyle is matching their expectations. On the day of the inspection an activities co-ordinator was playing a ball game with residents in the lounge. Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 12 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 This home provides a comfortable, clean and safe environment for residents to live in which suits their needs and they have been encouraged to bring in their own possessions to enable them to personalise their rooms and feel at home. EVIDENCE: The home, a converted private house, is situated in a pleasant tree-lined road and is homely and well maintained. Ramps facilitate access in through the front door and out to the attractive large garden. The home was clean and generally odour free on the day of the inspection. Service users bedrooms are pleasant and they have all been personalised by their occupants. They do not have lockable facilities in their rooms; although they could be made available, it has been perceived as not being required. A previous recommendation was made that this facility should be offered and the
Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 13 service users response documented in the care plan. This has not been done and is repeated now as a requirement. One bedroom had water damage to the ceiling and this must be repaired. Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 14 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 appropriate numbers of staff on duty however; training is not sufficient to ensure that resident’s healthcare needs continue to be met. EVIDENCE: On the day of the inspection staffing levels were in accordance with those previously set. Some staff training had taken place during the year however it appeared that not all staff had participated. Sessions that previously occurred with an outside trainer have apparently now stopped. The Registered Manager must ensure that all staff undertake a minimum of three days training per year. In view of the advanced stages of dementia of many of the residents in the home, an action plan must also be drawn up outlining how staff will receive ongoing training in dementia awareness. Two new members of staff were spoken to during the inspection and the induction programme that was to be given to one of them was seen. Confirmation was given that pre-employment checks had been undertaken in line with current legislation however the Registered Manager was not able to produce evidence of this. In future, the Registered Manager must be able to access all of the information required to complete the inspection process. It is recommended that staff without previous experience in caring for elderly people should also have a period of working in a supernumery capacity within the home.
Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 15 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): 31,33,38 Evidence is not available to ensure that resident’s welfare is always protected, there is no system, to monitor their views and they cannot be certain that their health and safety would be protected in the event of a fire. EVIDENCE: Since the last inspection a new Registered Manager has been appointed although she has worked in the home for some time. Some of the records that were requested were only available to the Registered Provider however she is not always in the home. In future The Registered Manager must be able to supply all of the information requested during the inspection process. Previous requirements had been made to implement a quality assurance system in the home, in order to monitor the views of residents and their relatives, however as yet this has not occurred. In addition there are no meetings held for either residents or their relatives to gather their views of the
Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 16 services that they are receiving in the home. Both of these issues must now be addressed. A fire safety officers visit, made in September 2005, resulted in several requirements being made. Although the timescale has not been reached, work has not started to ensure compliance. Fire risk assessments need to be completed; the fire plan must be displayed at all call points; staff training needs to take place; self closing devices need to be fitted to some doors; fire exit doors need to be openable from inside without a key and there must be evidence that equipment is checked in line with current legislation. Staff spoken with confirmed that fire drills have taken place recently however there was no record available for this. All of these issues must now be complied with, within the required timescales. Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 17 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 1 Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP19 OP19 Regulation 23(2)(b) 23(2)(m) Requirement The Registered Manager must ensure that the ceiling in room 10 is repaired. The Registered Manager must provide evidence that residents have been offered a lockable facility in their bedrooms. The Registered Manager must ensure that evidence to show that staff pre-employment checks have been undertaken is available for inspection. The Registered Manager must provide an action plan detailing how all staff will receive a minimum of three days training per year. The Registered Manager must provide an action plan illustrating how staff will receive ongoing training in dementia awareness. The Registered Manager must be able to provide all of the evidence required during the inspection process. The Registered Manager must ensure that a quality assurance tool designed to monitor
DS0000019129.V258147.R01.S.doc Timescale for action 30/01/06 30/01/06 3 OP29 19(1)(b) Schedule 2 18(1)(c) 01/12/05 4 OP30 30/01/06 5 OP30 18(1)(c) 30/01/06 6 OP31 17(3)(b) 01/12/05 7 OP33 24(1) 30/01/06 Tordarrach Nursing Home Version 5.0 Page 19 8 OP38 23(4)(a) (b)(c)(d) residents and relatives views of the home is introduced. The Registered Manager must ensure that all of the requirements issued at the Fire Safety Officers visit are complied with. 13/01/06 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. 2. Refer to Standard OP12 OP30 Good Practice Recommendations It is recommended that resident’s views on the activities that they would like to participate in be monitored regularly. It is recommended that new, inexperienced staff undertake some shifts in a supernumery capacity when they are first employed. Tordarrach Nursing Home DS0000019129.V258147.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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