Inspection on 31/07/07 for Townsend House

This inspection was carried out on 31st July 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Townsend House 06/11/06

Townsend House 06/03/06

Townsend House 22/08/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Townsend House Court Farm Lane Mitcheldean Glos GL17 0BD Lead Inspector Mrs Eleanor Fox Key Unannounced Inspection 31st July 2007 09:20 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 Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 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. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Townsend House Address Court Farm Lane Mitcheldean Glos GL17 0BD 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) 01594 542611 01594 541449 manager.townsend@osjctglos.co.uk The Orders of St John Care Trust Mrs Dorothy Jayne Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One bed in the rehabilitation unit can be used to provide respite care for service users over the age of 55 years. 6th November 2006 Date of last inspection Brief Description of the Service: Townsend House is situated in the centre of Mitcheldean, and is in close proximity to the local shops and amenities. The home is managed by The Orders of St John Care Trust. The home is purpose built, and is registered to provide both nursing and personal care for 40 older people over the age of 65 years. Four of the registered places are used to provide rehabilitation care. The home is able to provide respite care if there is a vacancy. A day centre, which serves the local community, is also integral to the home. The home provides forty single rooms, six of which have en suite facilities. A passenger lift has been installed to provide easy access to the first floor. Communal areas consist of a main lounge and dining space incorporating a conservatory, a second lounge and dining room, and a separate lounge and kitchen/dining area for rehabilitation care. Adapted bathing facilities are provided. The home is surrounded by well-maintained gardens with inner courtyards of flowerbeds. A number of rooms overlook the gardens and courtyard. Information about the home is available in the Service User Guide, known as the Residents Guide, which is issued to prospective and current residents. A copy of the most recent CSCI report is available in the home for anyone to read. The charges for Townsend House range from £348.66 to £682.00 per week. Hairdressing, Chiropody, Newspapers and Toiletries are charged at individual extra costs. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the home and takes into account the views and experiences of people using the service. Two inspectors, one of whom is a pharmacist employed by the Commission for Social Care Inspection, undertook this unannounced inspection of Townsend House over two days in July and August 2007. The pharmacist inspector carried out a specialist inspection of the arrangements for handling medication (National Minimum Standard 9 Care Homes for Older People) as part of the key inspection. This included looking at some stocks and storage arrangements for medicines, some medicine record charts, some other medication records, the medicine policy and procedures. Three people were spoken with and there were discussions with three members of staff and the care service manager. The way medicines were given to some people in the home was observed at lunchtime and some rooms were visited. The inspection took place over 5¾ hours on a Tuesday. The other inspector chose the care of three of the residents, one of whom had been admitted for rehabilitation care, for particular scrutiny. She met each of these people, read all their relevant care records and observed their interaction with members of staff. This inspector walked around the property, including the garden areas and observed the service of a selection of meals. She also observed the residents’ participation in activities and had a meeting with the activities coordinator to discuss recent developments at Townsend House. She read selected personnel and recruitment records and examined the opportunities provided for training. The complaints files were made available for inspection. The inspector examined the opportunities for residents to exercise choice and to maintain social contacts. She also spoke with some of the staff who were on duty on these days, checking their understanding of some of the home’s policies and procedures and discussing their experiences within the establishment. Finally, she had the opportunity to talk to the deputy manager, the care leader in charge of the rehabilitation unit and to the administrator, particularly in relation to general management issues and the special responsibilities of their individual roles. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 6 The inspectors extend their thanks to all the staff who provided assistance during the inspection processes. Prior to the inspection, CSCI surveys were distributed to residents and relatives of those living in the home. Eleven were returned from residents although in the majority of cases, a relative or named member of staff completed the form for them; fifteen responses were sent in from relatives and advocates. Two General Practitioners also completed comment cards. Many of their opinions are reflected in the content of this report. What the service does well: What has improved since the last inspection? There have been improvements in the care planning processes, particularly in the management of the risks that residents may develop pressure sores. Similarly nutritional care also appears to managed well now. Despite recent improvements in medication administration, some shortfalls have been identified during this visit. These are now being addressed. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 8 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 Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with adequate information so that they may make an informed decision regarding their admission to the home. In the majority of cases, they may also be assured that their needs will be met, as there is normally an effective assessment process in place. EVIDENCE: In recent weeks the Statement of Purpose and Service User Guide, known as the Residents Guide, have been fully reviewed and updated; the new information has now been provided to current and prospective residents. There are also copies of these documents in the front hall of Townsend House. Contracts outlining the terms and conditions for admission to the home had been provided to each of the residents selected for particular scrutiny. Signed copies of the completed documentation were seen in their personal files. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 10 Residents and/or their advocates are also provided with clear details about any additional financial contributions to which the resident may be entitled. Copies of these letters were also seen in the files. Records observed on this visit showed that a full assessment is normally undertaken of each prospective resident prior to admission to Townsend House; this is conducted by one of the senior staff. The information obtained is documented and retained for reference when completing the admission processes. These forms give clear details about all the relevant aspects of the person’s care needs. In some cases the details were supported by information provided by other health and social care professionals previously involved in the care of the individual. However, members of staff working in the four-bedded rehabilitation unit do not always have the benefit of such detailed information. As a result it was reported that there have been some inappropriate admissions to this specialised area in recent months. Action is now being taken to rectify these issues. Short-term rehabilitation care is provided in the dedicated 4-bedded unit within the home. The service users have the support of a multi-disciplinary staffing team to prepare them to return to independent living. One person who was nearing the end of her stay described the care she had received and confirmed that she now felt much more confident to go back to her own home. She had just cooked some food in the specially equipped kitchen. Weekly meetings are arranged, which include each of the disciplines to assess, discuss and plan each person’s progress. The average stay in this area is six weeks. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home may be assured that their care needs are being met in a manner that respects their privacy and dignity. People who use this service are generally protected by the home’s policy and procedures for dealing with medication but some areas for improvements in practice are identified so as to reduce possible risks to these people. EVIDENCE: Clearly written care plans are developed for each resident; those relating to the people chosen as part of a case tracking exercise were read in detail on this visit. In each case a comprehensive assessment had been undertaken followed by the preparation of specific care plans. These provided the information required to guide the staff who were giving care. Each document Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 12 had been reviewed appropriately and appeared to reflect the resident’s current condition. Where residents had been identified as at risk of developing pressure sores, detailed guidance for staff and the provision of appropriate pressure relieving equipment had been arranged. Observation of the resident and the records showed that one person had benefited from the particular nutritional care that had been given in recent months; this person’s general health and well being had improved noticeably, as was also confirmed by the person’s relatives. There were also records to indicate that care from other healthcare professionals is sourced when required. The pharmacy provides most medicines each month in a monitored dose system and printed medicine charts on which staff record the medicines administered. There are records of medicines received, administered and disposed of to help make sure there is no mishandling. Handwritten changes or additions on the charts were double signed as checked. The medicines needed by people who live in this home were in stock ready to give according to the doctors’ directions. The correct arrangements are in place for the disposal of medicines no longer needed. Sample checks of medicines in stock were largely correct indicating that the medicines are administered as recorded. Since the last inspection some errors involving medication have been reported to us. The company have investigated these and appropriate action has been taken to safeguard people living in the home and reduce the risk of reoccurrence. The inspection shows that aspects of the action plan developed as a result of these incidents are in place. Regular audits of medication are carried out although it would be better if there was more evidence in these of check counts of medicines remaining in stock as this helps to assess if the medicine records are accurate. Suitable arrangements are in place for staff to support people living in the rehabilitation unit with looking after their own medicines and taking these themselves. People spoken to in this unit were all were very complimentary about the home and support they receive from staff. In the rest of the home medicines are administered by nurses (or sometimes care staff on the rehabilitation unit) who attend training about the safe handling of medicines. Medicines are stored safely and records kept of the temperature in the office and medicine fridge. There are suitable arrangements in place for storing and recording controlled medicines. Twice daily checks of these medicines are written in the record book. The medicines in stock were in agreement with the entries in the record book and sample checks of entries in the book were correct. Most medicine containers have opening dates and times written on the labels, which is good practice to make sure stock is rotated properly and helps with audit checks. There is a medicine policy and procedures so that staff should Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 13 know how the home expects medicines to be managed. There is a recent medicine reference book available for staff to refer to if they need information about the medicines they are using. The following points are noted for attention – • Where a variable dose of medicine is allowed staff must record the actual dose given as this will help to make sure the right amounts of medicine are used. This was raised in the last inspection report. • The intervals between medicine administration times must be sufficient. For example paracetamol doses must be given at least four hours apart. The times printed on the medicine charts are 0830, 1230, 1730 and 2200. On the day of inspection the nurse was finishing the morning doses at 1030 and began administering the lunchtime doses at 1245. There is a potential risk of not leaving a sufficient space between doses that needs managing. • Staff generally complete the medicine charts when they administer medication but very occasional gaps were evident. There was one particular example where doses for a prescribed calcium and vitamin D supplement were not signed for one person on 29, 30 and 31 July 2007. Inaccurate records can put people at risk of receiving the wrong doses of medicines. • Some people living in the home are prescribed creams or ointments. There is a need to clarify and improve recording for application of this medication. Some charts were marked as ‘self-medicating’ but in fact carers are applying the medication. Records of when these creams are applied are variable so it is not always possible to know what treatment has been used. Some of this medication is printed on the medicine charts but records of application are not always made on these. Alternative ways of making these records were discussed. This was raised in the last inspection report. • Some medicines are prescribed to use ‘as required’. One nurse said that she asks people if they need the medicine in question and they are able to say. At lunchtime staff asked people if they needed any painkillers. It is best practice if there are written protocols readily available with the medicine charts for each person and each medicine prescribed ‘as required’ to clearly describe to staff how that medicine is used for the benefit of the particular person. • Some records for ‘refused’ doses need to be clearer so that stock checks are more accurate. Records need to show if the dose was prepared and then destroyed (because it was refused) or if the dose was not prepared so remains in stock. • The medicine trolley when not in use is clamped close to a south-facing window and during the inspection the sun was shining on to the trolley. There are blinds in place but there is still a potential for considerable heat gain and too high a temperature within the trolley at these times. • The security on some of the wooden cupboards used for medicine storage should be improved for example by fitting more substantial locks. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 14 • • • Some medicines such as creams and ointments are stored in bedrooms. This must be assessed as safe for all people living in the home and a lockable space used if needed for protection. There is a protocol about the use of ‘homely remedy’ medicines but a review is strongly recommended as the doctors signed this in July 2005. The suitability of including aspirin in this list should be considered because of the potential for interactions with other medicines and increased risk adverse effects in elderly people. The homely remedy medicines are stored separately but two of the containers in this section were dispensed for particular people. Staff must be clear that these containers cannot be used as a homely remedy stock. The latest Medical Device Alert about lancing devices (MDA/2006/066 06/12/06) should be looked at again to see about using a lancet that will be safer for staff to use with less risk of a needle stick injury. Throughout the visit, members of staff were observed and overheard addressing the residents in a respectful but friendly fashion. All personal care appeared to be given in privacy. One group of residents who spoke to the inspector were most positive about the staff, confirming that they were kind and considerate and that they would do anything for them. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given the opportunity to take part in a number of interesting and entertaining activities, and to benefit from a varied and nourishing diet. EVIDENCE: Following the appointment of a dedicated activities organiser earlier in the year, the residents now have the opportunity to take part in a wide range of activities. One person was particularly pleased to be able to continue a lifelong interest in gardening and another described the newly convened bird watching club, which she was clearly enjoying. One to one activities are also undertaken for those people who have shortterm memory difficulties. These include reminiscence chats and hand and nail care. During conversation, residents confirmed that they are able to get up and retire when they wish and are able to spend their days how they would like, as far as practically possible. One person was happy to sit quietly by the window in her bedroom, saying, “I never tire of this view.” Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 16 A newsletter provides residents and their friends and families with information about what is happening at the home. Friends and relatives are welcome to visit at any time so long as the resident is content to see them. Two relatives and a close friend spoke with the inspector during her visit. Each said they were satisfied with the care the residents were receiving. One lady commented that, “the staff are so friendly. I hope I will be able to live here if I have to move into a home.” Residents were observed exercising choice in a variety of ways particularly in relation to their food and how they spent their time. Personal preferences and special requests had also been recorded. One person preferred to have personal care from someone of the same sex; this request was being respected. Advice on how to source advocacy, if required, is displayed prominently in the home. The service of the mid day meal was observed on this visit. The majority of residents sat in one of the two dining rooms with a few preferring to remain in their bedrooms. They were provided with a good choice of food and generous helpings were offered, as appropriate. Those residents requiring assistance to eat their food were usually helped in a patient and particularly sensitive manner. However, it was observed that some people would have benefited if plate guards had been provided as these residents were clearly having difficulty in managing their food. It was later confirmed that these aids are available in the home, if required. A food hygiene issue during the service of the meal was also identified; this is now being addressed. The kitchen appeared clean and well organised. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living at Townsend House may be assured that they can expect to live in a safe environment and that any concerns they raise will be promptly and appropriately addressed. EVIDENCE: A clearly explained Complaints Procedure has been prepared for Townsend House. A copy of the document is provided to each prospective resident and/or relatives with other information about the home. The details are also displayed within the home. The complaints records were provided for inspection. These showed that any complaints or concerns had been addressed promptly, investigated and, where necessary, remedial action taken. One resident confirmed this when she described a problem that she had experienced. Once identified, the issue was addressed and there had been no further recurrence. The home provides a fully documented policy to address all forms of abuse. The policies are readily available for staff to read. Abuse issues are covered in the Induction Programme, which each newly appointed member of staff undertakes. There has also been recent formal training on the subject. There are no records of any abuse issues occurring in the home since the last inspection. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 18 POVA (Protection of Vulnerable Adults) legislation is correctly followed at Townsend House. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, clean and reasonably well-maintained home. EVIDENCE: During a walk around the building it was observed that the whole home was decorated and maintained to a reasonable standard. Sturdy furniture had been provided throughout the property to suit the needs of the residents living at Townsend House. Although some floor coverings in communal areas were very worn and stained, it was confirmed that these are scheduled for replacement shortly. The colourful internal gardens were looking particularly attractive on this occasion. Residents mentioned that they enjoyed sitting out in the shaded Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 20 areas during the good weather; some had been responsible for assisting planting and maintaining the beds. The whole property appeared clean and reasonably fresh; there was only slight evidence of mildly offensive odours in a few areas. Although not specifically identified to any of the staff, a further visit to these areas later the same day showed that the issues had been appropriately addressed. It was a warm day but windows had been opened to ensure that the home was maintained at a comfortable temperature. The laundry is equipped with industrial style machines; it was tidy and organised with washing segregated appropriately. Due to water problems in the county, Townsend House was also taking responsibility for the laundry requirements of another home, as an emergency measure. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive care from a stable competent group of staff who are subject to careful recruitment processes. EVIDENCE: There were thirty-four residents living in the home at this time with three people in the dedicated rehabilitation unit. During the inspection it was observed that there was always at least one carer on duty in the unit. In the main home there was usually one nurse and six carers on duty each morning, a nurse and four carers each evening and a nurse plus two carers during the night to care for the people living at Townsend House. Those questioned considered that these numbers were adequate at the current time. However, three relatives have remarked in the questionnaires that the home is sometimes short of staff. The residents have confirmed that the staff are normally available when they need them. One person did say, “the staff come as soon as I ring my bell, or as quickly as they can. I never have to wait long.” Records show that the home is progressing towards ensuring that at least 50 care staff are trained to National Vocational Qualification, Level 2 in Care or equivalent. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 22 Personnel files relating to five of the staff employed since the last inspection were read in detail. Each person had completed an application form providing a full employment history. Records had been maintained of the interview processes and POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed. Two written references were provided for each applicant. There was also comprehensive evidence that each person had been fully inducted to his or her respective post. Thorough induction is provided at this home. Two members of the team who spoke to the inspector confirmed this. Records were provided to show that staff are given the opportunity to attend appropriate training to assist them to undertake their duties effectively. The staff attend mandatory and other courses as required. Some people were attending an ‘update session’ on manual handling during the inspection. Individual training records are also maintained for each member of staff. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The financial interests and the health, safety and welfare of people using the service are safeguarded by the robust management systems in place. EVIDENCE: The Manager of the home, a trained nurse, has considerable experience in the care of elderly people. She has completed the Registered Manager’s Award and records show that she has kept herself updated in current care practices. Her deputy, also a trained nurse, and the home’s administrator support her in her role. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 24 There are procedures in place to monitor the quality of the service provided by Townsend House. Quality assurance questionnaires are circulated to residents and their families on an annual basis. Any issues identified for improvement are then addressed. The home is awaiting the results of an audit conducted recently. Medication processes are monitored on a regular basis and action taken to rectify any shortfalls. Accidents, incidents, and care plans are also audited once a month. Action plans are drawn up for staff information and attention. These were seen during the visit. The administrator looks after the personal monies for some of the residents. These are kept in individual envelopes and are locked away securely. All transactions are fully documented and countersigned. Checks of the files relating to the residents selected for case tracking showed that these are all recorded accurately. Each resident’s status in relation to ‘Power of Attorney’ is also maintained on file. Health and safety is generally addressed well at this home. Records were provided to show that maintenance of equipment is undertaken in a timely fashion. Water temperatures are maintained within specified safe levels. The Fire Risk assessment in place is currently being reviewed and updated. However, staff are receiving regular training in fire safety and prevention. The most recent Environmental Health inspection report comments that, “Practices and premises are to a very high standard.” Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 25 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 3 3 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 26 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. Standard OP3 Regulation 14(1a and b) Requirement Timescale for action 30/09/07 2. OP9 13(2) 3 OP9 13(2) 4 OP15 16(2j) A full assessment must be undertaken on each person prior to admission to the home to ensure that Townsend House is able to meet all his or her needs. When any medication is 30/09/07 administered to people who live in the home this must be at correct dose intervals and clearly and accurately recorded (including refusal of medicines). There must be up to date medicine care plans to clearly describe how to use any medicines prescribed to use ‘as required’. This will help to make sure people receive the correct levels of medication. When any medication is stored in 31/08/07 bedrooms the arrangements must be assessed as being safe for everybody living in the home. Due attention to good hygiene 31/08/07 protocols must be observed when serving food to residents. Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 27 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 OP9 Good Practice Recommendations Move the medicine trolley away from the window where there is a risk of too high a temperature being reached when the sun is shining. This will help to make sure people who live in the home receive medicines that are of the correct potency. Improve the security of some of the wooden cupboards used for storing medicines. Review and update the policy for the use of homely remedy medicines. Include counts of some remaining medicines as part of the regular audit process as this helps to provide evidence that the medicine records are accurate. Residents should be provided with plate guards and other aids when required so that they may eat their food independently. At least 50 of the care staff (excluding registered nurses) should be trained to NVQ, level 2 in care, or equivalent. 2 3 4 5 6. OP9 OP9 OP9 OP15 OP28 Townsend House DS0000064611.V338501.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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