CARE HOMES FOR OLDER PEOPLE
Tranquility House 39 Cheriton Gardens Folkestone Kent CT20 2AS Lead Inspector
Christine Grafton Unannounced Inspection 20th November 2008 10:00 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.V373124.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. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 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 Manager post vacant 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.V373124.R01.S.doc Version 5.2 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. 28th December 2007 Date of last inspection Brief Description of the Service: Tranquility House is a large detached premises offering accommodation on four floors, located within easy reach all local amenities, including the main train and bus stations. There are 12 single and 4 double bedrooms, none of which have ensuite facilities, but all have a wash hand basin, call system, and are well furnished. There are adequate numbers of toilets and two wet rooms, with shower seats. A shaft lift provides access to all upper floors. Communal areas comprise of a main lounge, a quiet lounge, a large dining room and a conservatory. The property has a small, secluded back garden that is accessible for wheelchairs. There is a private parking area at the side of the house. Fees range between £320.00 and £450.00 per week, with additional charges for hairdressing, chiropody, aromatherapy and newspapers. The most recent CSCI report is available on request from the home. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes.
This report takes account of information received since the last inspection, including a visit to the home. An unannounced visit took place on 20th November 2008 between 10:00 hours and 16:45 hours. The visit included talking to Mrs Wratten (the registered provider), the acting manager, staff, residents, visitors and observing the home routines and staff practices. Some records were looked at and we looked round the communal areas of the home and a selection of bedrooms. Information sent to us by the acting manager prior to the visit, in the form of the home’s annual quality assurance assessment, has been used and information from the previous inspection referred to. At the time of the visit there were 18 people living at the home, including one in hospital. The atmosphere in the home was welcoming and relaxed. At the last inspection of 28th December 2007, the manager position was vacant and Mrs Wratten was managing the home, with the intention of becoming registered as manager. This has changed and a new manager was appointed in March 2008 who is currently designated as the acting manager. For the purposes of this report, the acting manager is referred to as manager and Mrs Wratten as provider. What the service does well:
People living in the home say that the staff are nice and give them the support that they need. They have opportunities to take part in activities to keep them stimulated and stop them being bored. They have people come in to entertain them and to do activities, such as an interactive music group session that was happening during the afternoon of the visit. People were enjoying this. People say they enjoy good food and always have a choice at mealtimes. They have nutritious, appetising meals and meal times are relaxed and social occasions. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 6 People say that staff listen to them and if they have any worries the staff usually sort things out. They are confident that any complaints would be dealt with. Relatives and friends are welcomed and encouraged to be involved in the care of the person. One said that their relative in the home is spoilt. The majority of the staff have a qualification in care, which means that people can be confident they will be looked after by staff that have learnt the right way to care for them. What has improved since the last inspection?
People living in the home are now being provided with a written statement of the terms and conditions of their residence, which both parties can sign their agreement to. This means that people will know what their rights and responsibilities are and what sort of service they should expect from the home. Some progress has been made to improve the pre-admission process so that peoples needs are assessed to provide staff with information about them. However, this is not being consistently done in all cases prior to their admission (see next section) but people can be confident that this will be done as soon as possible after they arrive at the home. The new manager has improved the way that care is planned and has rewritten all of the care plans for each person to ensure that care is delivered in a way that suits and benefits them the best. These mainly now show how to provide the right care for each person. However, the quality of the plans varies and more work is needed to make sure that individual risks are known, with steps to reduce risk clearly recorded. This is important for staff to have the right information to keep people safe. The manager has improved the way medications are managed. This has included the training of more staff in medication procedures and we saw that medicines were being administered safely. The provider has continued with the redecoration and refurbishment of the home so that that people live in a comfortable and homely environment. This has included, the replacement of some equipment, new armchairs, some new carpets and furniture. A new call bell system has been fitted, which gives people confidence when they need to call for staff assistance, plus a new stand aid has been provided to help move people safely. Staff have received more training to develop their knowledge and skills to meet the needs of people living in the home. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 7 What they could do better:
The provider has shown commitment to making improvements to the home and the way that it is run. However, it is important that the manager becomes registered with the commission to comply with the law, as the provider has stated that she does not wish to be the person in day to day charge of the care of people living in the home. The current management structure shows some improvement since the last inspection, but still needs to be more clearly defined, to make sure that the boundaries of the provider and manager are understood. The management then needs to demonstrate sustainability in maintaining and developing the improvements made during the past year. A number of things still need to be done to provide a better service for people living in the home. These were all discussed with the manager and provider who confirmed their intention to work towards addressing things raised. The homes statement of purpose and service users guide both need reviewing and updating to make sure the information is accurate. The pre-admission assessment format needs developing and should be used to assess each potential resident, so that the home can demonstrate that it can meet the needs of people being admitted. The manager needs to continue with the development of the care plans and make sure they contain details of any risks identified with the actions to minimise risk. This is important so that staff know how to care for people safely and to make sure that peoples needs are met. Moving and handling assessments must contain details of how to move the person safely, especially where they are immobile and need hoisting, to make sure that staff know how to move them safely. Information from the daily records needs to be summarised on a monthly basis to inform the care plan reviews, so that things do not get overlooked. The complaints procedure needs to be developed so that people know who they should address their complaints to, how long they should expect to wait for a response and how long it should take to complete the investigation. Action must be taken to prevent the spread of infection within the home. This must include improving procedures for dealing with soiled articles and bodily waste so that it is done in a safe way that protects people living and working in the home. They also need to review their arrangements for the sluicing of commode pans and then implement any necessary changes. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 8 There needs to be more vigilance in adhering to good recruitment procedures at all times, to protect the people living in the home. They must make sure that all the safety checks specified in law have been completed before new staff start working at the home, to protect people. They also need to make sure that new staff receive induction training and keep records to show that it has been done properly. They must make sure that the environment is regularly assessed for any risks and that prompt action is taken to deal with any safety hazards identified. This is important to make sure the home remains safe for everyone living and working there. They need to develop their quality monitoring systems to measure their performance against what they say in their statement of purpose. A recorded annual development plan would help to structure planned changes and measure success. 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. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 9 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.V373124.R01.S.doc Version 5.2 Page 10 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People considering moving into the home are given sufficient information to decide if it is right for them. They know what they will get for the fees that they pay. Although improvements have been made so that people now have an assessment that provides staff with some information about them, it is not being consistently used, so people still cannot be assured that their needs can be met when they move into the home. They can be confident that upon admission their needs will be assessed and a plan of care will be drawn up that does give an indication of the care they need. It is not the general policy of the home to admit people for specialist intermediate care, so standard 6 was judged as not applicable at this inspection visit.
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 11 EVIDENCE: People can read about the home in the statement of purpose, which is kept in the hallway for all to see. This includes the service users guide, which contains most of the information that people need to know about the home. Some things stated are now incorrect and need updating, for example, it refers to an entertainments coordinator post, which is no longer accurate and the details and numbers of staff specified need review. The manager spoke of her goal to review and revise these documents. The last inspection identified poor outcomes regarding needs assessment and people not being given a written statement of their terms and conditions of residence for which requirements were made. These have been met in that people are now being provided with written information about their fees and the services provided at the home in the form of a written agreement. We looked at a selection of care plans, including three for people admitted since the last inspection. The manager has introduced a new pre-admission assessment document that she uses when she goes out to assess people before deciding if the home can meet their needs. The format, if fully completed should provide sufficient information for a decision. Of the three pre-admission assessments we looked at, one was blank and the other two had minimal information that would not be sufficient to show that the home could meet the persons needs. However, upon admission, in one case, a detailed assessment document had been completed providing enough detail for staff to be able to provide the right care. A copy of the care management assessment had been obtained for another and the third assessment following admission contained minimal information. The manager has worked hard on producing detailed care plans for each individual. On balance, although more work is needed to develop the assessment process, the improvements seen do show that there is now a certain amount of information to inform a judgement about suitability. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 12 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 & 10 People who use the service experience adequate, quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from having a plan of care that provides staff with most of the information needed to make sure that their health and personal care needs are met. However, care plans need to be further developed to make sure that all risks are identified and actions to minimise risk are recorded. Improvements to the home’s policies and procedures for dealing with medicines now provide more protection to the people living in the home. EVIDENCE: We looked at six care plans and saw that improvements have been made since the last inspection and the requirement made has now been met. They comprise of a thorough assessment covering a wide range of needs, including, communication, nutrition, the help needed with personal care and moving
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 13 around, health care needs and any associated risks. On the whole, the plans contain the information and guidance for staff to meet the needs of people living in the home. One care plan we saw contained particularly good detail for staff to be able to provide the right care for the person, with guidance to reduce risks. The care plan had been updated as things had changed and we saw that other health care professionals had been involved. Others have a reasonable amount of information, with some evidence of changing needs. Although the detail varies, some with more than others, good progress has been made to develop a person centred approach. For example, we saw some detailed instructions for care and personal hygiene in one care plan that describes things that are very individual to that person. Where a person has diabetes, information has been added to the care plan so that staff know what to do if the persons blood sugar level becomes too high or too low. The care plan contains good detail relating to diabetes that includes nutrition, weight and how to assist at mealtimes. The home liaises with the community nursing team who visit regularly to give insulin injections and provide any nursing care that other people might need, such as dressings. The care plan for this person does not currently show details of the differing insulin doses, which are kept separately and recorded in the records belonging to the community nursing team. These details need to be included in the care plan, as integral to the record of care. Risk assessments are being completed and contain guidance for staff to reduce risk. However, in one case, where a person cannot stand without staff assistance and the use of a hoist for transfers, the mobility assessment had nothing recorded about this and the care plan was lacking in detail. The manager indicated that this had been fully recorded in the previous care plan, which had been put away when it was reviewed and rewritten this month. This important moving and handling information must be transferred to the updated care plan, so that everyone knows how to move the person safely. Daily records have improved and provide a reasonable amount of detail. Records could be developed further by making sure that important details from the daily records are summarised on a monthly basis to inform care plan reviews. This is so that things do not get overlooked. Care plans do show details of contacts with health care professionals and of some health care needs being met. The lunchtime medication administration round was observed. This was done in a safe and competent way. Medication is safely stored and all medication administered was properly signed for. Since the last inspection, a total of thirteen staff have completed their medication training and the manager has started to do competency assessments. This means that the requirement made at the last inspection has been met.
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 14 We spoke to six people to ascertain their views of the home. Five said that they feel well cared for and indicated that their privacy and dignity is respected. We observed staff interacting with residents and saw them using good communication skills and showing respect and understanding. We saw staff assisting people in a caring and supportive manner. Tranquility House DS0000036015.V373124.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 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from having some opportunities to take part in activities that suit their needs. They benefit from the relaxed mealtimes and enjoy their food and the choices available to them. EVIDENCE: Social profiles are being introduced as part of the person centred care plans. These contain details of peoples past interests, their preferred daily routines, personal relationships that are important to them and if they have any preferences about religious observance. There is an activities programme displayed in the hall that shows the home arranges some group activities, including visiting entertainers, arts and crafts, aromatherapy and a twicemonthly interactive music session. This is entitled Js Workshop – Music for the Healthy and it took place during the afternoon of the visit. It was well supported and people were clearly enjoying this activity. The manager has introduced an activities record that shows who has taken part in activities and whether they have enjoyed them or not. The daily records now also provide more details about how people have spent their time.
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 16 People spoke about their daily routines, indicating that they can choose how they spend their time. Some people need help to get up and go to bed. They indicated that in the main staff help them at their preferred times, but staff are not routinely recording this, so there is no way of knowing whether their choice is always being met. For example one person spoke of being brought downstairs very early on the morning of the visit, but was unclear as to why and it had not been recorded in the daily records. This is an area for future development that was discussed with the manager. A visiting relative said about a person living in the home saying, He is spoilt. They went on to say that they visit the home at different times, several times a week and are always welcomed. People spoke about receiving visitors and keeping in contact with relatives and friends. The manager also keeps in touch with family members to let them know how things are going. Some people go out with relatives or friends and one person spoke about going out alone, until this was considered too risky. Now they need a staff member to accompany them. We saw in the care plan record that this had happened, but if people need staff assistance to go out, it has to be planned according to staffing numbers on duty. People say they enjoy good food and have plenty to eat. There is a choice of dish at each meal. We observed the lunchtime meal being served and saw that it was relaxed and unhurried, with people taking their time to enjoy their food. The meal was well presented and looked and smelled appetising. Where people needed assistance to eat their meals, we saw staff helping them in a respectful way. People say they have drinks and snacks in between meals and they know they can have a hot or cold drink whenever they want. Tranquility House DS0000036015.V373124.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 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that their concerns and complaints will be listened to and acted upon. There are systems in place to follow up complaints and safeguard people from harm, but these need to be developed further to make sure that people fully benefit from them. EVIDENCE: There is a complaints procedure on display in the hallway. The manager says that this is contained in the welcome pack that she gives to all new people admitted to the home. The procedure does give the CSCI address, but does not include the telephone number, or state who people should address their complaints to, for example, the manager, or provider. Also it does not indicate the process for investigating complaints and how long people should expect to have to wait to know the outcome. The procedure would be of more benefit to people if these things were added and also if details of the local Social Services address and telephone number were to be included. The provider and manager told us that complaints are taken seriously and acted upon. They keep complaints records. People say that they can talk to staff if they have a worry or concern and that staff listen to them and usually sort things out. They know they can go to the manager, or provider as well if they want to and are confident that any matters will be dealt with.
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 18 Since the last inspection staff have attended training on the protection of vulnerable adults and staff that we spoke with have a good awareness of adult protection procedures. One care plan had guidance for staff on dealing with behaviour and the daily records show that staff are following this. The provider has introduced good procedures for dealing with residents monies to safeguard their best interests. Tranquility House DS0000036015.V373124.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 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The provider continues to improve and maintain the home to make sure that that people live in a comfortable and homely environment. However some practices to maintain safety and prevent the spread of infection in the home need improving to fully protect people from the risk of harm. EVIDENCE: We looked at the communal areas of the home and a sample of nine bedrooms. The provider has continued with the redecoration and refurbishment programme to improve the environment for the people living in the home. Since the last inspection there has been a new call bell system fitted. This means that people can be confident when they call for assistance
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 20 that staff will hear the bell and people say that staff respond promptly. They have changed the main lounge and dining room round, so that there is more room in the dining room for people to move around and they have more space at the tables. New armchairs have been provided in the lounges and people say that they are very comfortable. A number of rooms have been redecorated, three bedrooms have had new carpets fitted and one bedroom has had new furniture provided. This has made them look homely. As well as this, they have replaced some equipment and bought some new, such as a stand aid hoist to help move people safely. There has been a new washing machine and tumble drier and a new boiler fitted. This demonstrates the providers commitment to ensuring that the home is maintained and pleasant for people to live in. The provider also spoke of plans to provide new dining tables and chairs and to refurbish the kitchen next. At the last inspection, they needed to show that there is a planned maintenance and renewal programme for the ongoing upkeep and improvements in the home. Although they do not have a written improvement programme, it is clear that there has been good progress in this respect. At the time of the visit the home smelt fresh and clean, apart from one ground floor toilet, which had a strong odour. The toilet was clean and has an extractor fan, as there is no window. We discussed with the manager that the extractor might need regular cleaning and some form of air freshening device might make a difference. Also there was some brown staining on the floor around the toilet pan in the ground floor shower room, where the manager said they keep finding a leak and this needs to be addressed. Some safety hazards were seen on the tour of the building, for example, wardrobes are not routinely fixed to walls to prevent the risk of them being pulled over. A set of ladders was lying propped against the wall in a narrow fire exit route corridor, so there was not enough space for people to safely walk through. This should be kept clear for safety in the event of a fire. The laundry was generally untidy with no separation of clean and dirty laundry items. Poor procedures were seen for dealing with clinical waste. There was no clinical waste bin, with the yellow clinical waste bag stretched over a radiator in the laundry with the top open, posing a safety hazard. The laundry room sink was badly stained and there were some dirty knickers soaking in a plastic container in the sink. There is no separate wash hand basin for staff use in the laundry. There is no sluicing facility for the cleaning of commode pans. As none of the bedrooms have ensuite toilet facilities, most people have a commode in their room. The manager stated that staff empty and clean the commodes in the shower rooms. All of these things pose a risk of infection, which must be addressed and a requirement has been made. Tranquility House DS0000036015.V373124.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 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from being cared for by competent staff that understand their needs. Staff training has been developed and recruitment practices have improved so that people are better protected. EVIDENCE: There are three carers on duty every day, plus the provider and manager work on weekdays and cover dual management and care roles. There is also a part time cleaner and a cook on duty every morning. The manager stated that staffing levels are set according to the numbers and dependencies of people living in the home. People say that there are always staff around when you need them and we saw that staff responded promptly when people needed assistance. The staff-training programme has progressed well during the past year and there is now twelve staff that have completed their National Vocational Qualification (NVQ) in care level 2, with four more staff working towards it. Gaps identified in the mandatory training at the last inspection have been addressed, with courses completed on fire safety, first aid, moving and handling and infection control. A staff-training matrix has been devised so that
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 22 gaps can be identified quickly. It also shows where courses are planned, for example COSHH training booked for December 2008. However, there needs to be a process for checking that staff are putting into practice what they have learnt. For example, the training matrix indicates that eight staff have completed their infection control training this year, but good practice principles were not being followed. The manager has rearranged staff files since the last inspection and they are now well ordered. A full employment history is being requested and interview records kept showing that any gaps have been followed up. The manager and provider both said that they always get two written references, apply for a criminal records bureau check (CRB) and have evidence of a Protection of Vulnerable Adults register (POVA) first check before a person starts work at the home. Two staff files were checked and we saw evidence of written references, records of verbal references, CRB and POVA checks, plus all the other required documentation. However, some of these were dated after their start date dates. There was no evidence of induction training, but the manager said that new staff do not give care to people for the first week, which they spend being shown the safety procedures, going through the homes policies, being shown round and being introduced to the people living in the home. The manager stated her intention to start using the Skills for Care Common Induction Standards in liaison with a local college. The staff that we spoke with praised the management saying they feel valued and supported. They also praised the training opportunities they have had during the past year, saying it has developed their knowledge. The manager has responded to the requirement made at the last inspection, but still needs to make sure that staff do not start work at the home before all the information specified in the regulations has been obtained. A record of the induction training is also to be kept. Tranquility House DS0000036015.V373124.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 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home where their best interests are promoted. However, the current management structure of the home needs to more clearly define the responsibilities of the provider and manager, to make sure they work within set boundaries to safeguard the people in their care. The quality monitoring systems need to be developed to ensure that peoples views influence any changes made and so that the home can measure its success in achieving its aims and objectives. Some safety procedures need to be strengthened to make sure that people are properly protected at all times.
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 24 EVIDENCE: At the last inspection, the provider had applied to become the registered manager of the home, but since then has changed her mind. A new manager was appointed in March and the improvement plan submitted indicated they would be making an application for registration, which has not happened yet. This needs to be done to comply with the law. The provider stated that she deals with the financial aspects of the management, her husband deals with maintenance and environmental issues and the manager deals with the overall care management. However, we saw that there is some blurring between the provider and manager roles, as the provider also does some care work and does involve herself in the care management. For example admitting a person without completing the preadmission assessment. The provider stated it is not her intention to manage the home. Therefore the current management situation needs to be reviewed to make sure there are clear boundaries between who is doing what. The manager has worked hard to improve the homes record keeping and has made significant changes in the care planning that have resulted in better outcomes for the people living in the home. She does not yet have the recognised management qualification, but indicated her commitment to work towards it. The manager has made efforts to develop a quality monitoring system. She has given out questionnaires, started formal staff supervision meetings and held staff meetings. Residents meetings have not been held yet, but the manager and provider talk to people on a daily basis and have a good rapport with relatives and other visitors to the home. This all needs to be formalised to form part of the homes quality assurance processes and the results need to be collated so that an action plan can be devised, based upon peoples views. The AQAA was submitted on time and contained some useful information, but did not have much detail of evidence to support statements made. The home does not do an internal annual audit and does not have a written development plan. It was discussed with the manager and provider that the annual selfassessment could be used to inform this and it should take account of feedback from the quality monitoring processes. The plan needs to be regularly reviewed and updated as things change. The provider has introduced sound procedures to safeguard the financial interests of people living in the home and keeps very good records of any monies held on their behalf. The home has informed us that the relevant safety checks are undertaken. This includes carrying out environmental risk assessments and regular safety
Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 25 checks. However, this needs to be strengthened to ensure safety, as some safety hazards were identified at the visit and have been referred to under the Health and Personal Care and Environment sections of this report, namely moving and handling, environmental risks and poor infection control practices. These need to be addressed, but in addition, the management need to make sure that their quality monitoring systems include regular health and safety checks with records of action taken when safety risks have been identified. Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 26 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 2 3 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 Standard No Score 16 3 17 x 18 3 2 x x x x x X 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 27 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 OP26 Regulation 13(3) 16(2)(j) 23(2)(k) Requirement Suitable arrangements must be in place to prevent infection, toxic conditions and the spread of infection within the home, in accordance with relevant legislation and published professional guidance. Consult with the Infection Control Unit and Environmental Health Authority regarding procedures for dealing with clinical waste in the home and implement any changes identified. This relates to the correct segregation and removal of clinical waste, sluicing facilities for the cleaning of commode pans and appropriate hand washing facilities in areas where clinical waste are handled. 2 OP31 8(1) As the registered provider is an individual who is not and does not intend to be in day to day charge of the care provided to residents, the person appointed to manage the home must make
DS0000036015.V373124.R01.S.doc Timescale for action 30/01/09 30/01/09 Tranquility House Version 5.2 Page 28 an application to be registered with the commission, to be in compliance with Section 11 of the Care Standards Act 2000. 2 OP38 13(4)(a) (b)(c) To keep all persons in the home 30/01/09 safe, the environment must be risk assessed and action taken to prevent accidents. For example, keeping all fire exit routes clear and fixing wardrobes so that they cannot be pulled over. Environmental risk assessments should then be regularly reviewed and updated with actions specified to address any new risks identified. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tranquility House DS0000036015.V373124.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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
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