Inspection on 30/08/05 for Tower House [Salisbury]

This inspection was carried out on 30th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Tower House [Salisbury] 12/10/06

Tower House [Salisbury] 03/02/06

Tower House [Salisbury] 07/12/04

Tower House [Salisbury] 05/08/04

Tower House [Salisbury] 08/03/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tower House 43 Manor Road Salisbury Wiltshire SP1 1JT Lead Inspector Thomas Webber Unannounced 30 August 2005 th 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 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 D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tower House Address 43 Manor ROad Salisbury Wiltshire SP1 1JT 01722 338395 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Eileen OConnor-Marsh Mrs Lisa Marie Mulholland Care Home Only 12 Category(ies) of MD(E) Mental Disorder - over 65 (12) registration, with number OP Old Age (12) of places Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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. Date of last inspection 7th December 2004 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 1990’s and is one of three registered care homes owned by Mrs O’Connor and Mrs O’Connor-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 D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 09:00 to 11:55. A tour of the premises was undertaken and the views of eleven of the twelve residents in situ were sought mainly on a group basis although some were seen on an individual basis, regarding the care and services provided by the home. Records in relation to residents’ assessments, medication, menus, complaints, staff recruitment and staffing levels were also checked to ensure that continued compliance is being achieved. All but one of the outstanding requirements from the previous inspection have been addressed. What the service does well: Residents live in a comfortable, safe and well-maintained environment, which meets both their individual and collective needs. The home is kept clean and tidy and provides sufficient communal space together with adequate bath, shower and toilet facilities. Residents have personalised their bedrooms to varying degrees but to their individual wishes. The home’s laundry and kitchen facilities are due to be improved and upgraded as part of its new extension. Residents, who expressed an opinion, stated that they were happy with their accommodation. Residents are supported and protected by the home’s recruitment practices and the home ensures that there are sufficient numbers of staff on duty to meet the needs of the residents. Staff continue to receive ongoing training. Residents spoken to commented positively about the care provided. Residents are assessed by the home who also obtain copies of all relevant assessment documentation undertaken by social services, prior to admission, to ensure that the home can meet their needs. Opportunities are available for prospective residents and their families to visit and assess the suitability of the home, prior to admission. Residents’ health care needs are being suitably met which includes the administration of their medication. Residents’ rights to privacy are maintained. The home provides residents with a range of activities as well as the opportunity to pursue their own interests to meet their social, recreational and religious needs. Residents maintain contact with their families, friends and relatives in accordance with their preferences. Residents, within their capabilities, can exercise personal autonomy and choice. Residents receive a varied, appealing and balanced diet and residents spoken to commented very Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 6 favourably about the quality and quantity of food provided, confirming that they receive plenty of food. Information is provided to residents on how to complain and appropriate procedures are in place to protect the residents from abuse. The home has received one complaint, since the last inspection, which related to aspects of care in relation to one resident. This complaint was investigated and was deemed not to be upheld but was satisfactorily resolved with the complainant. 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. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 standard(s) 3, 5 and 6 Residents are assessed by the home, prior to admission, to ensure that it can meet their needs. Copies of all relevant assessment documentation undertaken by social services are also obtained. Prospective residents and their families are provided with the opportunity to visit and assess the quality, facilities and suitability of the home. EVIDENCE: The home, as part of its admission process, obtains copies of the care programme approach and other relevant documentation prior to admission in respect to any prospective resident. In addition, the home also undertakes its own assessment wherever the prospective resident is residing at the time. Documentary evidence was available to confirm that all the above information had been received and carried out in respect to the recent admission case tracked. Opportunities are available for prospective residents to visit the home with their families or social worker prior to admission. As part of the introductory process, residents and their families meet with staff, other residentss, tour the premises and ask any questions relating to the running of the home. Evidence Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 9 was available to confirm that the most recent admission had made a pre-visit to the home withhis social worker. The home does not provide intermediate care therefore this Standard is not applicable. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 Residents’ health care needs are being suitably met which includes the administration of their medication. Residents’ rights to privacy are maintained. EVIDENCE: All residents are provided with care plans and those seen were well written and informative. Each resident is provided with a long term assessment/care plan and their long term needs are reviewed monthly. Currently short-term goals are identified one at a time and once one has been met, another is identified. Service users’ care plans will be updated and reviewed every six months or more frequently where changes occur. Risk assessments have also been established and reviewed on at least a six monthly basis. The majority of residents use one particular surgery, although residents are registered with one of three different surgeries within the Salisbury area. Residents admitted within the home’s catchment area would maintain their own GP with their agreement. Residents tend to visit the surgery for any appointments with the support of staff unless they are too frail to do so. Appointments are also made for residents in respect to other health services such as chiropodist, opticians and dentist. Written evidence was available within residents’ care plans and daily case notes and Doctors’ notes held by the home to confirm that their health care needs are being met. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 11 The home has established its own medication procedure as well as having obtained the Boots monitored dosage procedure. The policy of the home is for residents not to maintain control of their own medication and the manager reported that all staff who administer medication have been deemed competent. In addition some staff have completed an accreditation course in respect to medication. The home uses the Boots monitored dosage system and examination of residents’ drug sheets showed that these are being appropriately initialled for medication administered. Staff are instructed during their induction period about their conduct towards residents. Residents who require assistance with regard to their personal hygiene/care receive this in complete privacy. Screens are provided where residents share a bedroom. Staff assistance is also provided to residents who require help in choosing their clothes. Staff use residents’ preferred form of address and this is recorded in their respective care plans. Residents have access to a cordless telephone, which they can use in private and no charges are made for any outgoing calls. Residents’ mail is given directly to them unopened, although staff request to be informed where the correspondence relates to any appointments. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 The home provides residents with a range of activities as well as the opportunity to pursue their own interests to meet their social, recreational and religious needs. Residents maintain contact with their families, friends and relatives in accordance with their preferences. Residents, within their capabilities, can exercise personal autonomy and choice. Residents receive a varied, appealing and balanced diet. EVIDENCE: Residents can choose where and how to spend their time including pursuing their individual interests. Residents can also choose when to get up and go to bed. Staff support residents’ individual preferences rather than establishing organised activities, partly due to the residents’ lack of interests. However, some organised activities take place which include chair exercises, exercises to music, the reading of articles from newspapers and one resident attends the Greencroft centre once a week. Staff take residents out shopping on a one to one basis as well as for regular walks, weather permitting. Some residents also go out with their families when they visit. Residents’ religious needs are well catered for and communion is held in the home on a weekly basis. Some residents attend church services either with support of staff, family or by the use of the church’s mini-bus. The hairdresser visits the home on a weekly basis. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 13 The home has an open policy regarding visiting hours and residents can choose where to see their visitors, either in their bedrooms or in the front lobby area. There are a number of indicators to show that residents can exercise personal autonomy and choice according to their capabilities. Residents can bring items of furniture and personal possessions to make their bedrooms more homely, they can choose where to spend their time, where to eat, and when to get up and go to bed. All residents require support when out. Residents’ families or solicitors deal with their finances. 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. Diabetic diets are currently being catered for. Residents are encouraged to eat their meals in the dining room, although they could choose to eat their meals in their bedrooms. 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 flexibility is available, if required. Staff undertake the cooking duties, although a cook will be employed once the extension is operational. Residents spoken to commented very favourably about the quality and quantity of food provided, confirming that they receive plenty of food. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 standard(s) 16 and 18 Information is provided to residents on how to complain, although some deficiencies were identified in the recording and monitoring of complaints received. Appropriate procedures are in place to protect the residents from abuse. 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 home has received one complaint, since the last inspection, which related to aspects of care in relation to one resident. This complaint was deemed as not being upheld and was satisfactorily resolved with the complainant. Although various documentation was available in respect to the complaint, management were advised of the need to maintain all documentation relating to the investigation, which includes all interviews. Management were also advised to establish a monitoring form which would be used in relation to any complaints received. The home has robust procedures in place for responding to suspicion or evidence of abuse and these include a Whistle Blowing procedure. Copies of the shortened version of the Swindon and Wiltshire Vulnerable Adults Procedures, which are in line with the Department of Health guidance “No Secrets”, have been distributed to all staff. Management also reported that staff cover the issue of abuse during their induction programme and some staff have attended training in this area from the Vulnerable Adults Unit. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 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. The laundry and kitchen facilities are due to be improved and upgraded as part of the home’s new extension. EVIDENCE: The home provides a safe, comfortable, well-maintained environment within a Victorian property. All areas of the home are well maintained and furnished to a good standard and there is an ongoing maintenance programme for the property and renewal of the fabric and decoration is undertaken as and when required. The home provides appropriate heating, lighting and ventilation. At the time of the inspection the extension was in the process of being built to provide additional accommodation. The home provides a communal lounge to the front of the property with a dining room across the hallway. Both communal areas are comfortable, Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 16 homely, well maintained and furnished to a good standard. A seating area is also available within the main entrance hall. 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 accommodation. The home continues to be maintained to a good standard being comfortable, clean and tidy. The laundry facilities consist of an industrial washing machine, which also contains a sluice programme with the staff undertaking the laundry duties. The laundry room is due to be relocated as part of the new extension. Likewise the kitchen is also being relocated as part of this process. Residents’ clothing is labelled to ensure that their clothing is suitably returned and residents, who expressed an opinion, spoke positively about the laundry arrangements in place. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Residents are supported and protected by the home’s recruitment practices and the home ensures that there are sufficient numbers of staff on duty to meet the needs of the residents. Staff continue to receive ongoing training. 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. 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 who currently also undertake the cooking duties. Residents spoken to commented positively about the care provided. Two newly appointed staff files were checked during the inspection of Dunraven House which showed that the home is, in the main, following appropriate recruitment practices which includes obtaining two satisfactory written references, POVA first checks and subsequently satisfactory CRB enhanced checks. However, the home needs, where possible, to obtain and record all dates of a person’s previous employment history. Evidence was available in the staff files to confirm that the newly appointed members of staff had received an induction training programme, which is normally completed within six weeks. On completion of this programme staff would be considered for NVQ 2 training as well as undertaking various mandatory training. A training matrix has been established by the home, which includes training undertaken and due to be completed by staff. The Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 18 home continues to ensure that staff attend and update their knowledge through training and this was confirmed by some staff spoken to during the inspection of Dunraven House. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 This Standard is not applicable. EVIDENCE: Residents’ families, solicitors or Court of Protection deal with their finances and Mrs O’Connor-Marsh confirmed that she invoices them for everything spent on their behalf and therefore does not hold any money on behalf of the residents. She also does not act as power of attorney in respect to any of them. This Standard is therefore not applicable Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 2 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 Standard No 16 17 18 Score 2 x 3 x x x x N/A x x x Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 16 Regulation 22 Requirement The registered individuals must ensure that all documentation relating to any complaint investigation is maintained, including all interviews. The registered individuals must ensure that the laundry facilities are extended and upgraded to provide more appropriate facilities. Timescale for action 31/10/05 2. 26 23(2)(b) 31/10/05 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 16 Good Practice Recommendations The registered individuals should strongly consider establishing a monitoring form which would be used in relation to all complaints received. Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Tower House D51_D01_S28268_TOWERHOUSE_V184619_300805_Stage4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!