Inspection on 20/02/06 for Tranquility House

This inspection was carried out on 20th February 2006.

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

Tranquility House 20/11/08

Tranquility House 28/12/07

Tranquility House 15/12/06

Tranquility House 27/10/05

Tranquility House 26/01/05

Tranquility House 17/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Tranquility House 39 Cheriton Gardens Folkestone Kent CT20 2AS Lead Inspector Lois Tozer Unannounced Inspection 20th February 2006 10:30 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 Tranquility House DS0000036015.V283995.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. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tranquility House Address 39 Cheriton Gardens Folkestone Kent CT20 2AS 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) 01303 244049 TINAWRATTEN@AOL.COM Mrs T.Wratten Mrs Veronica Anne Miles Care Home 20 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (19) of places Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with DE(E) to be restricted to 1 (one) whose DOB are 11/01/1921. 27th October 2005 Date of last inspection Brief Description of the Service: Tranquillity House is a large detached premises offering accommodation over four floors for up to 20 Service Users over the age of 65, requiring residential care. The Home is located within the town of Folkestone and all local amenities are within easy reach (main train and bus stations being 5 minutes walk away). There are 12 single and 4 shared bedrooms available. Although no bedrooms are provided with en-suite facilities, all have a wash hand basin, call systems, and are well furnished. Residents are encouraged to bring personal possessions to furnish their bedroom, the Home having adequate storage space to enable Residents who wish to fully furnish their room themselves to do so. A shaft lift provides access to all upper floors. Communal areas comprise a main lounge, a reading / quite area, a large dining room and spacious conservatory. The property has a secluded, small back garden, where work to enable wheelchair accessibility has been completed, and small private parking area. Mrs Tina Wratten is the sole proprietor of the Home. Although Mrs Wratten employs a registered manager, Mrs Veronica Miles, Mrs Wratten works in the Home on a regular basis. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 20th February 2006 between 10.30am and 4.30pm. The owner, Mrs Tina Wratten was present, who, with the assistance of the deputy manager, willingly assisted the inspection process throughout the day. The manager has recently been suspended from post pending an adult protection investigation. In the interim period, the owner is taking day-to-day charge of the home. There are currently eighteen people living at the home, feedback was gathered from five residents through face-to-face conversations. Paperwork seen included individual support plans, medication and administration documents, policy and procedure, service user finances and training matrix. Medication and finances were the focus of this inspection. All five service users said they were happy at the home, and liked the staff. All felt they could raise concerns if they had any, but did indicate that they would have to be pretty serious to warrant raising issues. One service user said that they, due to their own personal preferences, didn’t like the food available (although well prepared, freshly cooked, and enjoyed by the majority), they were always offered an alternative, and it was something they wanted. Two service users said that they enjoyed having an entertainments person come round, but said that it was pretty boring quite a lot of the time. One said it was ok if you could read still. A staff member, when asked about activities, said that it was difficult to get people involved, and few attended. What the service does well: Residents like the food very much and appreciate the attention to detail about likes and dislikes. Residents made it clear that they know who to make complaints to and feel that they would be listened to. Ongoing investment has ensured that the home remains comfortable and homely. Residents like the décor and appreciate the wide range of communal space. Staff try to get to know residents in a non-intrusive manner and are perceived by residents as friendly and helpful. Where possible, residents are supported to get out of the house and into the community. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 6 Individual’s rooms are decorated to their own taste, and furnished as they wish. What has improved since the last inspection? What they could do better: Since the last inspection, October 2005, very little evidential work has taken place to improve the major shortfalls in medication management and administration. The majority of requirements made remain outstanding. Although key staff, including the manager, have received medication training, major errors are occurring, and as a consequence of one incident, has resulted in the manager being recently suspended from duty, pending investigation. A requirement that the owner assesses and ensures that the registered manager is competent to run the home was made, and this was indeed carried out. However, as so little progress was made on the major requirements, and subsequent findings at this inspection have made it necessary for this requirement to remain. Staff, at this inspection, were not working as a team, and as such, were leaving their team members and service users vulnerable. Key examples were staff leaving one person to administer medication, be the only person ‘on the floor’, and answer the door – this type of practice opens up the potential for errors. Staff, including a volunteer, were taking breaks together, thus insufficient people were available to meet service users needs. The role of people within the home (volunteer) was not clear, and this should be made so, to prevent visitors from becoming a distraction. Adult protection training is outstanding for the majority of the team, and the findings during this inspection highlight that it is essential the whole team revisit the ethos of supporting people. This would include persons who work informally in the home too. Environmentally, one end of the conservatory is used as a service user smoking area, however the other end is the place of preference for a nonsmoking service user who has severe breathing difficulties. In foul weather, staff are also using this area to smoke, and as such, this has become an unhealthy atmosphere. The conservatory was not a smoking area in the past, and steps must be taken, as soon as possible to limit the effects of passive Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 7 smoking. Staff should be discouraged from using service user facilities as a group ‘break out’ area. 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. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 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 Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 The needs assessment does draw out specific care needs, however has not considered the service user category that the home is registered to provide care to. Support staff do have the skills and experience to meet service users care needs. EVIDENCE: Assessments have drawn out individuals specific support needs, and the plans inspected, and the service users met, indicated that they were having the general care and support they need. However, the assessment process is not prompting the consideration of the legal registration category or the service stated as provided in the statement of purpose. The manager is not taking steps to ensure that persons who are out of category, for example, have long term mental health needs, have a variation to registration submitted prior to being admitted. The manager is not a stranger to this process, and must endeavour to ensure that categories of registration are not breeched. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, The individual plans have improved, but greater attention to accuracy of information is required. Healthcare needs, within the plan and environmentally need reviewing. Medication management continues to have serious shortfalls, and must improve without further delay. Service users feel that they are treated with respect. EVIDENCE: The service users plans have improved in the way they are presented, and are written in a clear manner, however, some seen have information that is simply not accurate. Health care needs described are not in line with legal practice and although the care needs have been regularly reviewed, they have not picked up inaccurate initial information. The manager must ensure that the plans are accurate, as staff are required to follow them. General health care is well supported, but environmental situations are not conducive to particular service users health needs, and the home have a duty of care, regardless of preferences, to ensure that no service user is put unduly at risk. Specifically, the area where service users, and now staff, are permitted to smoke is in direct contact with a person who has breathing difficulties and uses breathing aids. This must be reviewed and the situation made safe. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 11 Although some aspects of medication management have improved, training is being cascaded through the team, the reporting of incidents has improved, several of the requirements have not been met, and further shortfalls and errors have been found. These were fed back in detail, and need urgent attention, as many of the errors are fundamental to the well being of the individuals. Policies, procedures and internal competency assessments need to be implemented without further delay, by 1/4/06 latest. Handwritten directions were not accurate, and had not been counter checked so mistakes could be picked up. As required medication, where dose levels varied, quantity given was not being noted. Controlled drugs need greater monitoring. The team work of staff during medication administration time was poor, and one staff member was left to administer and meet service user / visitor demands while other staff took a break. Service users said that they were happy with the way they were supported by staff and that their privacy and dignity was upheld. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Social contact with staff seems to have improved, but service users still feel boredom, and some appear disorientated. The standard of food is very good, and is enjoyed by all. EVIDENCE: The routine of daily living, for most service users, revolves around personal care, eating and drinking. Service users who are still able to read and make decision easily said that they make their own entertainment and occasionally enjoy a visiting singer. One service user has been supported to make a reminiscence book, which was unavailable at the time, but staff said this had worked well. Staff said that activities are hard to organise, as few people want to join in. The type of activities and the way they are being offered needs reviewing, and it is recommended that ideas for activities are sought from many of the publications and resources available. Keeping records of what activities have been offered, and what’s been a success is vital to ensure the same rejected activity is not repeatedly offered. Most residents who commented said the food was very good. One said that they didn’t like the food, but the home did do everything to provide what was individually desired, to meet personal preferences. Fresh ingredients are used, and the way meals are presented is attractive. Staff were attentive to make sure people had a drink, were sitting comfortably and had all they needed before moving on. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 13 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, 18 Service users feel confident and comfortable raising concerns with the owner. Adult protection training still needs cascading to all staff. The home takes allegations of poor practice seriously. EVIDENCE: The complaints system works for all service users, as the owner makes sure she spends time with each person on a regular basis. Concerns are dealt with quickly, but many of the service users ‘wouldn’t like to complain or rock the boat’. It is important that this is borne in mind, as boredom and a restricted social life may be what many expect from residential care, and should be carefully monitored, as it is unlikely to be raised as a complaint. The previous inspection raised the requirement that staff training must include adult protection and awareness of what constituted abusive practice. Several have received this input, but the majority have not. The induction currently being used by the home (TOPSS) does cover abuse, however, it was not possible to ascertain if new staff had been inducted thoroughly in this way, as, in the absence of the manager, the documentation was unable to be located. As highlighted above, poor practice in medication management is evident, and this has led to a current adult protection investigation. It is vital that the whole staff team are fully aware of adult protection issues, and as such, are required to have robust training. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 14 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): None of these standards were inspected. EVIDENCE: Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 15 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): 29 The recruitment process has been reviewed and takes into account the requirements of the Care Homes Regulations. EVIDENCE: The home has recently reviewed recruitment processes and has updated the necessary paperwork. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 16 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, 35 The day-to-day management of the home still needs to improve to ensure requirements are met and that monitoring systems are in place to highlight shortfalls in a pro-active manner. The security and management of service user finance needs to improve. EVIDENCE: Although the manager was not present at the time of inspection, there was little evidence that requirements had been addressed adequately. Training in respect of medication had been obtained, but the manager herself had not taken account of updated knowledge, and as a consequence, was currently suspended from duty. The policies and procedures regarding medication management had not been improved to cover the required areas, and consequently, the findings were poor (standard 9). The manager must be competent to run the home and meet it’s stated purpose, aims, objectives and keep up to date with good practice issues – as at present, this is not the case. The majority of service user money held by the home is appropriately Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 17 managed, although the storage and recording systems would benefit from modernisation. A small number of service users had large cash balances, and the storage, monitoring and banking arrangements of these was not adequate. Some valuables were also held, but the property sheet was stored in the same place! The insurance cover provided, the owner advised, would not cover these sums. A more robust, safe system needs to be implemented, and an advocacy service sought for those who have no next of kin, to, wherever possible, give distance between the manager / staff of the home and service users financial affairs. Where this is not possible, a strict risk assessment needs to be conducted, and the care manager, or legal representative advised. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 18 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 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 1 X X X Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES 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 Requirement Where pre-admission assessment highlights that an individual may be outside the registered category for the home, clarification will be sought from CSCI, and if appropriate, a variation for registration sought. Submit request for variation should named service user continue to reside at the home after 15/03/06 Service user plans shall be reviewed to ensure they have accurate support information and due regard for social needs. Previous requirement, timescale extended from 01/01/06; Greater assessment of individual’s need for social contact with staff & increases such contact. This includes activities Registered provider shall ensure that service users are protected from the effects of passive smoking. Previous requirement, timescale extended from 1/12/05 All OP9 - With reference to the DS0000036015.V283995.R01.S.doc Timescale for action 20/02/06 2 OP7 14 15 15 01/05/06 3 OP7OP12 01/05/06 4 OP8OP18O P20 OP9 13 01/05/06 5 13 18 01/04/06 Tranquility House Version 5.1 Page 20 Royal Pharmaceutical Society of Great Britain guidance; Medication management to be improved with rapid effect; seek professional assistance where required Manager and staff to seek and obtain training that meets the service needs (including diabetes management) Medication administration records must be accurate - ‘as required’ medication must show quantity given. Previous recommendation and 01/04/06 thereafter requirement, timescale extended from 01/01/06; After suitable training, documented internal competency assessment must be implemented and conducted on a regular basis. Previous requirement, timescale extended from 14/11/05; 01/03/06 Handwritten entries must be accurate & countersigned as a safeguard. Fully review all medication policy and procedure, make robust and have all staff to sign up to it. Controlled drugs to be documented in sequentially numbered book. (Previous requirement, timescale previously 1/11/04 & extended to 1/4/05 & 14/11/05) Revise policy and procedure with staff to understand what to do in the event of an error and the importance of following the procedure itself. (Previous requirement, timescale DS0000036015.V283995.R01.S.doc 6 OP9 13 18 7 OP9 13 18 8 OP9 13 01/04/06 9 OP9 13 18 37 01/04/06 10 OP30 13 14/11/05 Page 21 Tranquility House Version 5.1 previously 1/11/04 & extended to 1/4/05) Revise policy and procedure with staff to understand what to do in the event of an error and the importance of following the procedure itself. 11 OP18 12 13 18 19 Previous requirement, timescale extended from01/01/06; Staff training and input must include adult protection & abuse awareness. Manager to be aware of neglect aspect re medication omission and incorporate all such considerations into the policy and training provision and monitor practice through supervision. Previous requirement, timescale extended from 01/12/05; Registered Provider to ensure that the registered manager is competent to run the home and meet its stated purpose, aims, and objectives. 01/04/06 12 OP31 9 26 01/04/06 13 OP35 12 16 20 18 19 14 OP36 Management & storage of 01/05/06 service user money and valuables shall be reviewed and made safe. Policy and procedure to reflect new system. Staff supervision to be 01/05/06 sufficiently frequent and effective to improve the shortfalls within the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 22 No. 1 Refer to Standard OP28 Good Practice Recommendations Ensure induction packs are reviewed by September 2006 with the Sector Skills Council review, providing ‘Common Induction Standards’ thereafter, see www.skillsforcare.org.uk Previous recommendation; Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 2 OP33 Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Tranquility House DS0000036015.V283995.R01.S.doc Version 5.1 Page 24 - 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!