CARE HOMES FOR OLDER PEOPLE
Tower House 43 Manor Road Salisbury Wiltshire SP1 1JT Lead Inspector
Thomas Webber Unannounced Inspection 3rd February 2006 10:35 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 Tower House DS0000028268.V278635.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. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Tower House Address 43 Manor Road Salisbury Wiltshire SP1 1JT 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) 01722 338395 Mrs Eileen O`Connor-Marsh Mrs Lisa Marie Mulholland Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (12), Old age, of places not falling within any other category (12) Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 12 service users with Old Age OR with a Mental Disorder, over 65 years of age at any one time. 30th August 2005 Date of last inspection Brief Description of the Service: Tower House is a private residential home registered to offer accommodation and personal care to 12 older people with a mental health disorder. The home has been in operation since the mid 1990s and is one of three registered care homes owned by Mrs OConnor and Mrs OConnor-Marsh and the registered manager is Mrs Mulholland. Tower House is a large detached Victorian property situated in Manor Road and is within easy walking distance of Salisbury city centre. Tower House is in close proximity to its other sister homes, Dunraven and Dunraven Lodge. The premises provide both single and shared accommodation for residents use with all bedrooms being provided with en-suite facilities. Residents bedrooms are located on the first and second floor levels, which are accessed by use of a passenger lift. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, undertaken during the course of one day from 10:35 to 12:20. A tour of the premises was undertaken and the views of nine residents were sought on an individual and group basis regarding the care and services provided by the home. Standards assessed during this inspection included food menus, complaints, accommodation, staffing levels and health and safety. What the service does well: What has improved since the last inspection?
A monitoring form has been established by the home which will be used in relation to any future complaints received. Improvements have been made to the dining room, laundry and kitchen facilities.
Tower House DS0000028268.V278635.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. Tower House DS0000028268.V278635.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 Tower House DS0000028268.V278635.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): EVIDENCE: These Standards were not checked during this inspection, as the core Standards had been satisfactorily assessed at the last inspection. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 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): EVIDENCE: These Standards were not checked during this inspection, as the core Standards had been satisfactorily assessed at the last inspection. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 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): 15 Residents receive a varied, appealing and balanced diet. EVIDENCE: A satisfactory and varied menu is in operation, which provides a choice at breakfast with set meals at lunch and teatime. However, alternatives would be provided for these meals if required to meet the residents’ individual preferences. Residents are encouraged to eat their meals in the dining room, although they could choose to eat their meals in their bedrooms, if they wished. Drinks are also available to residents at other set times of the day and staff facilitate this. Mealtimes tend to be at set times, although some flexibility is available, if required. A cook is now employed to undertake these duties, although staff occasionally undertake this role. Residents spoken to commented very favourably about the quality and quantity of food provided, confirming that they receive plenty of food and that alternatives are available to meet their preferences. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 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): 16 Information is provided to residents on how to complain complaints/concerns would be listened to and acted upon. EVIDENCE: The home has established an appropriate written complaints procedure and each resident has been provided with a copy. The procedure informs complainants that they can contact the Commission for Social Care Inspection at any stage should they wish to do so. The manager is aware that all documentation relating to any complaint investigation must be maintained, including all interviews. However, the home has not received any complaints since the last inspection, therefore the previous requirement has not been actioned. A monitoring form has been established and will be used in relation to any future complaints received. Residents spoken to commented that they had no complaints/concerns but felt confident that, if they did, these could be discussed with the manager or staff who would listen and take appropriate action. and any Tower House DS0000028268.V278635.R01.S.doc Version 5.1 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, 20, 21, 24 and 26 Residents live in a comfortable, safe and well-maintained environment, which meets their individual and collective needs. The home is kept clean and tidy and provides sufficient communal space together with bath, shower and toilet facilities. Residents have personalised their bedrooms to varying degrees but to their individual wishes. However, there are still some outstanding building works to the existing and new part of the new extension. EVIDENCE: The home provides a safe, comfortable, well-maintained environment which is furnished to a good standard. There is an ongoing maintenance programme for the property and renewal of the fabric and decoration is undertaken as and when required. At the time of the inspection the new extension, which is to provide additional accommodation, was near completion. However, there was still work to be completed to the existing building that included the extended dining room and kitchen, which has now been relocated to the lower ground floor. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 13 The home provides a communal lounge to the front of the property with a dining room across the hallway. The lounge is comfortable, homely, well maintained and furnished to a good standard. A seating area is also available within the main entrance hall. As stated in the previous Standard, some outstanding work remains to the extended dining room which, in turn, has temporarily affected the level of heating to this area. The proprietor is aware of the need to ensure that this alternation is completed as a matter of priority. The home has a non-smoking policy and therefore any residents admitted who wish to smoke must do so outside. The home provides sufficient bathroom and toilet facilities to meet the needs of the residents and these are located within close proximity to residents’ bedrooms and the communal areas. In addition, all residents’ bedrooms are provided with en-suite facilities. Residents’ bedrooms are suitably furnished and they can bring limited items of furniture and personal possessions to make their bedrooms more homely. Residents have personalised their bedrooms to varying degrees but to their individual wishes. Residents’ bedroom doors have not been fitted with locks, although these could be fitted at the request of residents. However, all residents are provided with a lockable storage space within their bedrooms. Residents, who expressed an opinion, stated that they were happy with their level of accommodation and that their rooms are kept clean and tidy. The home continues to be maintained to a good standard being comfortable, clean and tidy. The laundry facilities have been relocated to the lower ground floor, as part of the new extension, and provides suitable facilities to meet the needs of the home. Due to its relocation, the proprietor was advised and agreed to appoint additional staff to undertake these duties as apposed to care staff undertaking these tasks. Residents’ clothing is labelled to ensure that their clothing is suitably returned and residents spoke positively about the laundry arrangements in place. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 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 The home ensures that there are sufficient numbers of staff on duty to meet the needs of the residents. EVIDENCE: The deployment of staff ensures that there is a minimum of two members of care staff on duty throughout the waking day with one member of waking night staff on duty and one care staff sleeping in each night. The above staffing levels exclude those hours worked by the manager. Domestic staff are also employed to work throughout all three homes, providing a full clean in each home once a week with additional cleaning undertaken daily by the care staff. Residents spoken to commented very positively about the care provided by the staff. Tower House DS0000028268.V278635.R01.S.doc Version 5.1 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 and 38 The home is run and managed by a person who is appropriately qualified and has considerable experience within the care setting. The health, safety and welfare of the residents and staff are promoted and protected. EVIDENCE: The manager has appropriate management and supervisory experience in the relevant care setting she manages. She has sucessfully completed the NVQ level 4 and the Registered Managers’ Award and has undertaken periodic training to update her skills and knowledge, including Dementia. The manager ensures that there are safe working practices within the home and these comply with the relevant legislation. The manager reported that health and safety is covered by staff during their induction and through NVQ training. Risk assessments are in place to ensure a safe working environment. All bedroom windows are fitted with window restrictors. Examination of the fire log book showed that it is being appropriately maintained.
Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 16 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 2 3 X X 4 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 17 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. Standard Regulation Requirement Timescale for action 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 Tower House DS0000028268.V278635.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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