CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Tudor Bank Ltd Tudor Bank 2 Beach Road Southport Merseyside PR8 2BP Lead Inspector
Mr Mike Perry Unannounced Inspection 09:00 3rd April 2007 X10029.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 Tudor Bank Ltd DS0000057949.V330569.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 and Care Homes for Adults 18 – 65*. 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. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Tudor Bank Ltd Address Tudor Bank 2 Beach Road Southport Merseyside PR8 2BP 01704 569260 01704 567938 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) Tudor Bank Ltd Mrs Mary Elizabeth Pagett Care Home 46 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number disorder, excluding learning disability or of places dementia (18) Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. Service users to include up to 28 Dementia (over 65 years of age) and up to 18 Mental Disorder, excluding learning disability or dementia Date of last inspection Brief Description of the Service: Tudor Bank is a large detached nursing home set in its own grounds and occupying a position close to both Southport sea front and town centre. It provides nursing care for two resident groups of both younger adult and older persons with mental health needs. Tudor Bank Ltd owns the home and the responsible individual is Mr Himat Gami. Externally the home has a black and white Tudor style appearance and the original building has been added to over recent years with two purpose built extensions in order to meet the requirements of the Care Standards Act 2000. There is an enclosed rear garden, which is accessed from two of the day areas. The front of the building is given over to parking. The home has its own mini bus, which is well used for trips out. The Registered Manager of Tudor Bank is Mary Pagett who is a qualified nurse. The current fees for the service range between £501.50 to £1,390 per week. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 11 hours over two days. All day and recreation areas were seen and some of residents bedrooms. Care records and other records kept in the home such as policies and procedures where also viewed. The inspector spoke with residents and visitors to the home as well as members of staff including 2 trained nurses and the manager. A social worker for one of the residents was spoken with by phone. A number of ‘comment cards’ were given out to residents and relatives as part of the inspection and 14 of these were returned and some comments are reflected in the report. During the inspection a two-hour observational tool was used to look in some detail at the care of residents with dementia and how staff responded to and meet care needs. All of the ‘key’ inspection standards the home is expected to achieve were assessed. The inspection was very positive and the management were responsive and open to comments made. The feedback from both resident and relative interviews was again very positive. All relatives and residents spoke of the caring nature of the staff in the home. There were no requirements made following the inspection but there were some recommendations for good practice and these are listed at the end of the report. What the service does well:
Care files contain various assessments carried out by staff so that care needs can be identified and a programme of care can be agreed. This includes preadmission assessments from a senior nurse in the home as well as copies of further assessments from care professionals such as social workers and health care professionals. Elderly residents have ongoing assessments of more physical needs such as moving and handling, nutrition and pressure sore risk.
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 6 The assessments are thorough and include attention to any risk factors so that residents can exercise some choice and live their daily lives safely. One resident for example had risk factors associated with smoking assessed and a plan agreed that this behaviour would be confined to certain areas of the home. Residents spoken to where able to recall how they had been admitted to the home and generally felt that this had been a positive experience in that staff had taken the time to support and answer any questions. The care plans drawn up for residents are comprehensive and cover all assessed care needs. Health needs are addressed in some detail, both psychiatric care and general health. For example management of diabetes for one resident includes reference to weight loss and healthy diet. Details of care for residents who have pressure sores are also good with supporting documentation including wound charts. Resident spoken to stated that they could access medical support when needed and were reviewed by psychiatric services on an ongoing basis. Residents spoken with were very happy with the approach of the care home in helping make decisions. The care home has regular resident meetings weekly to provide information and seek residents’ views on relevant matters. Residents are encouraged to make decisions within the context of risk assessments so that they can develop social skills and abilities. A social worker spoken to was pleased with the way one resident was being supported generally and is encouraged to be as active as possible but within the confines of their ability to adapt to responsibilities. Staff in the elderly care areas were seen to be carrying out personal care sensitively and with patience. Observations were conducted and carers assisting with moving and handling, feeding and toileting and residents dignity was given a high priority. Staff were observed to be warm and supportative when carrying out care so that the residents feeing of identity and inclusion was evident in their appearance of well being. Comments from relatives regarding the care received by relatives included: ‘Anything at all the nurses always contact us. All are very efficient’. ‘Excellent care. [Resident] has a quality of life. ‘Staff never raise their voice’. He is always clean and tidy and looks well’. ‘This nursing home is by far the best in Southport. Having had to search for a home for my dad none of the others was good enough’. The personal exercise of choice and control over resident’s daily life in the home is a difficult balance to achieve given the lack of mental capacity of the elderly resident group. There were examples however of how the home were
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 7 trying to achieve a good balance. For example staff interviewed were aware of individual residents likes and dislikes in terms of dress and food preference. The home is very relaxed and there is a positive atmosphere. Staff were seen consistently interacting and supporting residents. The younger age group are encouraged to use local facilities for recreation and residents were seen constantly coming and going to town, shopping or visiting The mixture of resident groups in the home [both young and older people] did not cause any great issues and both groups seem well integrated with each other evidencing the homes ability to meet a variety of diverse needs. The food in the home was generally highly praised. There is a choice daily and diets are accounted for. The mealtime for the elderly residents in the lower lounge was observed. These are very dependant residents and staff were observed to be very patient and supported residents in facilitating a positive experience so that elderly residents enjoyed their meal. For 43 residents in the home there was the manager, one/two trained nurses and 8/9 care staff on duty so that care needs can be both monitored and addressed. The comments from residents and relatives were very supportive of the staff and felt that they worked hard to achieve a very good standard of care. Staff recruitment records were comprehensive and contained evidence of all of the recruitment checks required such as Criminal Records [CRB] and Protection of Vulnerable Adults [POVA] checks so that residents can be protected. The manager has drawn up training plans for all staff and these were reviewed with the inspector. Staff spoken to described some of the training undertaken and felt that it both prepared them for and complimented the work that they did. NVQ training is ongoing in the home and currently there are over 80 of staff trained to this level evidencing that staff are competent and trained to do their work. Mary Paget has managed Tudor bank for the past 6/7 years. She has been a consistent figure over the transfer of ownership 3 years ago and has maintained good standards in the home over a period of change and development in the home. She has a good record of continual update of skills and attends outside forums on a regular basis especially around the promotion of good practice issues in dementia care. Feedback from the staff, residents, relatives and professionals interviewed on this inspection was very positive as in previous inspections. Resident and relative feedback is canvassed as part of a yearly external audit but the management also carry out their own internal satisfaction survey and the results of this are displayed in the home. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 8 The management of resident’s finances was discussed with residents and it was noted that entries are made on all care plans so that residents are aware of any individual needs in this area. What has improved since the last inspection? What they could do better:
Some care plans were not signed by staff [mentioned in last inspection report] and the manager should pick this up in the care plan audits conducted and feed back to the staff concerned. Care plans can be rather medical in terminology. For example one care plan reviewed stated ‘paranoid schizophrenia and verbal and physical aggression’ as a care need. The use of language [diagnosis] can fail to identify how the disability affects the person’s daily life and therefore make it more difficult to plan specific care interventions. Medication management was good and safe practice was observed. There are some recommendations around the need to develop more specific risk assessments for residents who may self medicate and there should be policy guidance on the covert administration of medicines. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 9 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. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. Residents are assessed prior to admission so that an effective care plan can be drawn up. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files were seen for 4 residents. These included various assessments carried out by staff so that care needs can be identified. The assessment process starts before residents are admitted and care files contained
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 12 preadmission assessments from a senior nurse in the home as well as copies of further assessments from care professionals such as social workers and health care professionals. The social worker interviewed was pleased with the way the home had communicated and assessed any care needs prior to admission of a resident. Elderly residents have ongoing assessments of more physical needs such as moving and handling, nutrition and pressure sore risk. The assessments are thorough and include attention to any risk factors so that residents can exercise some choice and live their daily lives safely. One resident for example had risk factors associated with smoking assessed and a plan agreed that this behaviour would be confined to certain areas of the home. There was also some concerns around a resident leaving the home with out informing staff and again the care plan both alerted staff to this and also agreed a plan so that the residents awareness was raised. Self-medication is also assessed in terms of any risk factors and the need to develop a better assessment is discussed under ‘health care’. Residents spoken to where able to recall how they had been admitted to the home and generally felt that this had been a positive experience in that staff had taken the time to support and answer any questions. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 14 All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are drawn up with the resident’s involvement and reflect changing needs and ongoing review so that interventions are well planned. Health care needs are well addressed and personal care is carried out effectively so that residents well being is maintained. Medication is monitored well but their needs to be some review of risk assessments and one area of policy so that this area of care is more formalised. Residents are given the opportunity to live chosen lifestyles subject to a measurement of risk so that activities can be carried out safely. EVIDENCE: All residents spoken with had a copy of the care plan and were able to explain, to varying degrees, the main aim of the care. The care plans are quite comprehensive and cover all assessed care needs. There is also reference to management of finance so that residents are clear about any agreements in this area. Health needs are addressed in some detail both psychiatric care and general health. For example management of diabetes for one resident includes reference to weight loss and healthy diet. Monitoring is through blood sugar levels conducted regularly and through referral to diabetic support from health care professional as needed. Details of care for residents who have pressure sores are also good with supporting documentation including wound charts. Resident spoken to stated that they could access medical support when needed and were reviewed by psychiatric services on an ongoing basis. Some care plans were not signed by staff [mentioned in last inspection report] and the manager should pick this up in the care plan audits conducted and feed back to the staff concerned. Care plans can be rather medical in terminology. For example one care plan reviewed stated ‘paranoid schizophrenia and verbal and physical aggression’ as a care need. This was discussed with the manager around need to develop care plans using a more social model, which removes barriers to disability that
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 15 medical diagnosis may perpetuate. The use of language [diagnosis] can fail to identify how the disability affects the person’s daily life and therefore make it more difficult to plan specific care interventions. Residents spoken with were very happy with the approach of the care home in helping make decisions. The care home has regular resident meetings weekly to provide information and seek residents’ views on relevant matters. The home also has relative support meetings held on a 2 monthly basis, which tend to attract the relatives of the more elderly care group. Residents were aware of the various house rules and accepted the need for such guidelines. Residents are encouraged to make decisions within the context of risk assessments so that they can develop social skills and abilities generally [see comments under previous section – assessments]. Residents are, for example, encouraged to self medicate within their abilities although this is very limited in the home. The social worker spoken to was pleased with the way one resident was being supported generally and are encouraged to be as active as possible but within the confines of their ability to adapt to responsibilities. Staff in the elderly care areas were seen to be carrying out personal care sensitively and with patience. Observations were conducted and carers assisting with moving and handling, feeding and toileting and residents dignity was given a high priority. Staff were observed to be warm and supportative when carrying out care so that the residents feeing of identity and inclusion was evident in their appearance of well being. Comments from relatives regarding the care received by relatives included: ‘Anything at all the nurses always contact us. All are very efficient’. ‘Excellent care. [Resident] has a quality of life. ‘Staff never raise their voice’. He is always clean and tidy and looks well’. ‘This nursing home is by far the best in Southport. Having had to search for a home for my dad none of the others was good enough’. The medication procedure was reviewed and discussed with staff. There are policies and procedures available so that staff can refer to them. The receiving and returning of medicines in the home was reviewed and is satisfactory with weekly disposal evident so that here is no build up of stock. The medicine storage room has been moved and is more appropriate in size [recommended last inspection]. The supplying pharmacist completes audits on a regular basis. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 16 The medication administration records were seen and these were clear and accurate [ improved from previous inspection]. Some issues were discussed and some recommendations made for good practice: • Covert administration of medicines discussed regarding one resident. Medication policy available but no policy on covert administration. This was discussed with one of the nursing staff and although the practice in this instance follows accepted guidelines there are gaps in knowledge in this area and the inspector recommended the NMC [ nurses professional body] guidelines in this area. Self-medication was looked at with respect to one resident in the home. The risk assessment that needs to be carried out prior to selfadministration was generalised and could be improved in terms of an assessment of capability. The manager and senior nurse was advised to develop a more specific assessment based on set of questions aimed at measuring ability. The resident’s ability and compliance is monitored through the care plan and reviewed weekly. • Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 18 All key standards. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home is able to demonstrate an understanding of need for residents with dementia as well as those younger adults with mental health needs to exercise some control over their lives so that their rights are respected. Activities are provided and encouraged so that residents can experience a good quality of life. Dietary needs are assessed and the meal times are active social occasions that are enjoyed by residents. EVIDENCE: The personal exercise of choice and control over resident’s daily life in the home is a difficult balance to achieve given the lack of mental capacity of the elderly resident group. There were examples however of how the home were trying to achieve a good balance. For example staff interviewed were aware of individual residents likes and dislikes in terms of dress and food preference. A relative explained how her husband was always dressed appropriate in clothing that he favoured evidencing that staff had taken the time to research preferences in this area. The activities coordinator completes a full social assessment which includes preferences with respect to activities and she is therefore able to programme activity with this in mind. Staff are aware of the importance of advocacy and understand its use. An advocate represents one resident and there is literature explaining the use of advocacy on the notice board. The introduction of the activities coordinator is new since the previous inspection. The input for the elderly residents in terms of stimulation and activity, particularly when working one to one, was very apparent. Each resident receiving input was much more engaged and responsive to their environment generally. The activities chosen were well planned and individualised. There was some discussion around the need to promote this further in terms of quality of life for this group of residents. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 19 The home is very relaxed and there is a positive atmosphere. Staff were seen consistently interacting and supporting residents. The younger age group are encouraged to use local facilities for recreation and residents were seen constantly coming and going to town, shopping or visiting. One resident spoke about frequent trips out with her daughter and also going swimming occasionally. Another resident visits a friend locally and makes use of public transport. Residents also spoke about group trips out which are frequent and well appreciated. There could be some difficulties with the mix of residents in the home [both younger and older residents]. For example one resident has to access his bedroom via the older persons lounge area. This did not cause any great issues however and both groups seem well integrated with each other evidencing the homes ability to meet a variety of diverse needs. The food in the home was generally highly praised. There is a choice daily and diets are accounted for. For example one resident has vegetarian diet. Another spoke about her ‘healthy eating’ diet and how she had lost weight and felt more active. Residents can also ‘brew up’ if they wish by either using the kitchen on the lower ground floor or in their own room with the provision of individual tea making facilities. The meal time for the elderly residents in the lower lounge was observed. These are very dependant residents and staff were observed to be very patient and supported residents in facilitating a positive experience so that elderly residents enjoyed their meal. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 20 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and provides a protective and caring environment and there is an awareness of the local adult protection procedures so that residents are protected from abuse. EVIDENCE: Each of the resident lounges has folders with policies, procedures and information for staff and relatives to look at and these include information on, for example, elder abuse and concepts such as confidentiality. The notice boards display a copy of the complaints procedure and also access to advocacy. There are contact numbers for statutory bodies such as Social services and the Commission for Social care inspection [CSCI]. Staff spoken to had received some training in the awareness and understanding of abuse and were able to give examples of how they would
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 21 recognise abuse and what the principal’s of good care where in terms of the need for dignity and privacy for example. One member of staff talked about the induction programme and how this had been covered and awareness raised. Staff were able to give an account of how an allegation of abuse might be dealt with but did not have an understanding of the role of the statutory bodies such as the police, social services or the Commission for Social Care Inspection [CSCI] although were confident that senior staff and management would refer allegations appropriately. Following requirement on the last inspection report the manager has accessed current local policies and procedures and is aware of the process of reporting allegations. At the time of the inspection the home are investigating a complaint and allegations by a residents family over the way the home have dealt with an acute episode involving a younger resident who became disturbed. The complaint has also been dealt with under the local adult protection procedures and the home have been open in their response to date although the findings of the internal investigation still need to be reported. One of the outcomes of the discussion around the complaint is the possible need for staff to update themselves on management of aggression and de-escalation skills. Relatives interviewed on the day felt that the staff approach to the care of vulnerable residents who were elderly was supportative and respectful. One relative gave an account of how staff deal with some difficult behaviours and manage this appropriately with due regard for the dignity of the residents concerned. Residents and relatives felt that management where very approachable and would listen to any concerns and act on them accordingly. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 22 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home shows evidence of ongoing maintenance and upgrading and was found to be safe, clean and hygienic so that residents can live in a pleasant environment. EVIDENCE:
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 23 All day areas were seen as well as 3 bedrooms of residents. All areas were very clean and tidy. Residents and relatives report high standards in this area. Toilets and bathrooms also seen and are well appointed. There has been general upgrading of the furnishings over the past year. For example wardrobes and furniture in bedrooms and soft furnishings in all day areas. There were a good variety of soft chairs in main lounges to accommodate different needs. The smoking room has been re floored with tiles and looks much improved from the previous inspection and is more practical for this area and was commented on favourably by residents. The general maintenance very good with regular daily checks made of all areas. Externally there is access to gardens and residents were seen enjoying the sunny weather on the second day of the inspection. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good. The numbers and skill mix of staff is appropriate for the resident group in the home so that care needs can be met. There is a staff-training programme ongoing which has met the standard for over 50 of care staff to be trained to NVQ level so that care is delivered safely and references good practice. Residents are protected by the homes recruitment processes, which include appropriate checks for all staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE:
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 25 For 43 residents in the home there was the manager, one/two trained nurses and 8/9 care staff on duty. Observations made confirmed that all day areas are constantly staffed so that care needs can be both monitored and addressed. The comments from residents and relatives were very supportive of the staff and felt that they worked hard to achieve a very good standard of care. A majority of care staff are overseas workers and the overall mix does not reflect the cultural background of the residents but this was not an issue on the inspection. Two staff files were inspected. These were staff that had more latterly commenced work in the home. The records were comprehensive and contained evidence of all of the recruitment checks required such as Criminal Records [CRB] and Protection of Vulnerable Adults [POVA] checks. There were also appropriate references on file. The staff were from overseas and the necessary paperwork with respect to immigration status and identity were also in place. The manager has drawn up training plans for all staff and these were reviewed with the inspector. One of the trained nurses has been delegated responsibility for the monitoring of training in the home and was able to provide a list of training for all staff. The home is registered with an external body that assists with training needs of staff particularly around the induction process. Staff spoken to described some of the training undertaken and felt that it both prepared them for and complimented the work that they did. One staff described completing manual handling, fire awareness updates and abuse awareness. NVQ training is ongoing in the home and currently there are over 80 of staff trained to this level evidencing that staff are competent and trained to do their work. There is a recommendation to consider the provision of training in management of aggression [see ‘complaints and protection’]. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 27 Quality in this outcome area is excellent The manager of the home has the experience and qualifications to ensure that Tudor Bank is run satisfactorily and that residents best interests are maintained. The quality systems in place ensure good monitoring and ongoing improvements take place so that resident care can be progressed and procedures are appropriately managed to ensure smooth running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mary Paget has managed Tudor bank for the past 6/7 years. She has been a consistent figure over the transfer of ownership 3 years ago and has maintained good standards in the home over a period of change and development in the home. She is a qualified nurse and has previous management experience running a charity organisation. She has a good record of continual update of skills and attends outside forums on a regular basis especially around the promotion of good practice issues in dementia care. Feedback from the staff, residents, relatives and professionals interviewed on this inspection was very positive as in previous inspections. Relatives in particular were appreciative of her communication skills and found her approach to be caring and supportative. The home undergoes an external audit on a yearly basis in order to monitor and improve quality. Resident and relative feedback is canvassed as part of this audit but the management also carry out their own internal satisfaction survey and the results of this are displayed in the home. There are meetings organised on a regular basis with the younger adult group and any issues raised are followed upon. The older residents have a family forum which relatives can attend and air any views. The home has a good track record of responding to and meeting any requirements and recommendations made on inspections and this was further evidenced this time with all issues from the last visit addressed. The various policies and procedures for the home are reviewed on a regular basis and staff reported that the manager communicates any change in policy on a regular basis. The manager carries out a series of audits, which look at different areas of the care standards in the home. The management of resident’s finances was discussed with residents and it was noted that entries are made on all care plans so that residents are aware
Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 28 of any individual needs in this area. There is a policy and procedure for reference purposes. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 29 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 X 2 X 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 X 33 3 34 X 35 3 36 X 37 X 38 4 Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 OP7 Good Practice Recommendations Consideration should be given around the need to develop care plans reflecting a more social model in the use of language, which removes barriers to disability that psychiatric diagnosis may perpetuate. Some care plans were not signed by staff [mentioned in last inspection report] and the manager should pick this up in the care plan audits conducted and feed back to the staff concerned. 2 3 OP9 OP12 The home should develop a policy / procedure on the covert administration of medicines with reference to NMC guidelines. The activities chosen were well planned and individualised. There was some discussion around the need to promote this further [more hours] in terms of quality of life for the elderly group of residents.
DS0000057949.V330569.R01.S.doc Version 5.2 Page 31 Tudor Bank Ltd 4 5 YA20 YA35 The manager and senior nurse was advised to develop a more specific risk assessment for self medication based on set of questions aimed at measuring ability. One of the outcomes of the discussion around the recent complaint is the possible need for staff to update themselves on management of aggression and de escalation skills. Tudor Bank Ltd DS0000057949.V330569.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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