Inspection on 24/05/05 for Tudor Beech Place

This inspection was carried out on 24th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tudor Beech Place 19/04/07

Tudor Beech Place 16/11/05

Tudor Beech Place 15/11/04

Tudor Beech Place 07/07/04

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

CARE HOME ADULTS 18-65 Tudor Beech Place Horley Lodge Lane Salfords Surrey RH1 5EA Lead Inspector Graham Cheney Announced 24 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tudor Beech Place Address Horley Lodge Lane, Salfords, Surrey, RH1 5EA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01293 824339 Surrey Oaklands NHS Trust Mrs Tracey Sakhmani CRH Care Home 6 Category(ies) of LD Learning Disability, 6 registration, with number of places Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of the persons to be accommodated will be: 30 - 45 years. 2. Of the six (6) beds registered for learning disability (LD), one (1) may have an additional physical disability. 3. Of the six (6) beds registered for learning disability (LD), one (1) may have a sensory impairment. Date of last inspection 7 July 2004 Brief Description of the Service: The home is comprised of a detached bungalow set in extensive grounds in a private road. All accommodation is at ground floor level, with equipment present to assist some service users with a physical disability. Residents’ bedrooms are attractive and have many personal items present. The home is owned by Metropolitan Housing Association, but run and managed by Surrey Oaklands NHS Trust and has 6 beds. Residents have severe learning disabilities and some also have physical problems. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was the home’s first inspection for the CSCI year 2005/2006. It was an announced visit, which meant that staff and residents knew that it was due to happen. The inspection started at 10.00 a.m. and although some were going out as the inspector arrived he met and spent time with most of the residents. This was the first time the inspector had been to Tudor Beech Place and the first part of the visit was taken up with an introduction to the residents and staff and a tour of the building. The inspector was invited to join the residents for lunch and spend time with them. Despite having limited verbal skills each of the residents was able to express themselves in various ways and generally seemed happy in the home. The rest of the time was spent looking at records and reports and talking to the manager and staff about how the home was run. It is recognised that this report will have limited direct value to the current residents. However it should provide a view of how the home was operating on the day of the inspection for relatives, staff, care managers and others supporting the residents. What the service does well: The manager and some of the staff have known most of the residents since, and even before, the home opened in 1996. Staff appeared to understand the residents well and responded to meet their needs appropriately. The relationship between residents and staff was observed to be relaxed and friendly, creating a warm and homely feel in the home. Residents were encouraged and supported to be as independent as they were able, for example being encouraged to help with domestic tasks such as tidying and cooking (mainly watching) where they could. Guidelines have been set up to ensure that residents have as much choice in their day to day life as possible, for example choosing what they would like to wear each day and trying different meals. The staff, helped by day services staff and the ‘Us in a Bus’ team, provide a range of activities such as music sessions, horse riding and reflexology. Residents also go into the local community on a regular basis, which included attending church, leisure activities, shopping and having meals out. The home has its own transport for residents. All of the residents have the opportunity of a holiday, ranging from a weekend away to a trip to Euro-Disney. Currently the residents pay for their own holiday and the Trust pays for the staff to go to support them. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Although the home was generally operating to a good standard, there were some areas that needed maintenance or to be redecorated. At the last inspection in November 2004 the inspector felt that the bathroom and toilet needed attention, neither of these jobs have been done. The manager said that there were plans in hand to do the work. The inspector requested that the work must be done within two months of the inspection. There have been problems in the home with arrangements for staff on sleeping in duties for sometime, with staff finding it difficult to get a proper rest. Following the last inspection the manager was asked to look at ways to overcome the problems, which has been done. The options were being presented to the trust to decide what action to take. The inspector required that this be resolved within the next three months. The home is currently registered for residents between 30 and 45 years of age, however one of the residents had reached 45 and an application to vary the age range needed to be submitted. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 7 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. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 The home meets both of the assessed standards. A statement of purpose and service user guide were in place. However neither of these would have a direct value to the current residents but would provide information about the home for their relatives, supporters and care manager to help make an informed choice about whether the home was suitable and could meet the resident’s needs. Sampling of care plans provided evidence that the home has established a sound process of assessing residents’ needs and aspirations, with a user focussed approach. EVIDENCE: The home’s statement of purpose, service user guide and complaints procedure were all readily available but of limited value to residents who would not be able to understand them. Residents were very dependent on staff to keep them safe and meet their needs and the manager demonstrated that residents’ needs were regularly reviewed to ensure that this was the case. Care plans provided evidence that a sound assessment process was in place, based on a model developed by the Trust of Essential Lifestyle Planning, which ensures a focus on the individual. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 10 The home is currently registered for residents between 30 and 45 years of age, however one of the residents had reached 45 and an application to vary the age range needed to be submitted. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 Given the dependency of the current residents it is not expected that they would know, for example, what information is kept on them and how it is handled, but it is even more important that there is firm evidence to confirm compliance with these standards to give confidence to their relatives, care managers and staff that each individual’s needs and aspirations were being recognised and met. On the evidence gathered each of the assessed standards was considered to be met on this basis. EVIDENCE: Residents were encouraged and supported to be as independent as they were able, being encouraged to help with domestic tasks such as tidying, washing and cooking (mainly watching) where they could. Guidelines have been set up to ensure that residents have as much choice in their day to day life as possible, for example choosing what they would like to wear each day and trying different meals. Care plans were in place and included a person centred plan for each resident, based on a model developed by the Trust of: Essential Lifestyle Planning, Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 12 which provides details about who they are, which people were important in their lives and what they like and dislike etc. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 13, 14, 17 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. This meant that the home was able to demonstrate that residents were encouraged and supported to lead as independent and fulfilling life as they were able. EVIDENCE: The staff, helped by day services staff and the ‘Us in a Bus’ team, provide a range of activities such as music sessions, horse riding and reflexology for example. Residents also go into the local community on a regular basis, which included attending church, leisure activities, shopping and having meals out. The home has its own transport for residents. All of the residents have the opportunity of a holiday, ranging from a weekend away to a trip to Euro-Disney. Currently the residents pay for their own holiday and the Trust pays for the staff to support them. The manager stated that arrangements for the payment of holidays was under discussion. The inspector was invited to join the residents for lunch and spend time with them. Despite having limited verbal skills each of the residents was able to Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 14 express themselves in various ways and generally seemed happy with their meal. The manager said that although they have known the residents for a long time and were aware of many of their likes and dislikes they continue to introduce different meals for residents to try. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 On the evidence gathered Standard 19 was being met with staff supporting residents well with their health care needs. Standard 20 was assessed on this occasion and the practice for administering medication complied with the Royal Pharmaceutical Society’s guidance. On the evidence presented the home was therefore obtaining, storing, administering and recording medication appropriately. EVIDENCE: The procedure for giving medication to residents was not observed on this occasion but the storage and recording systems were in line with the Royal Pharmaceutical Society’s guidance. Health action plans were in place in the service user plans sampled and had been recently reviewed. Each resident also had a ‘My Health book’ in place to record all of his or her health care needs, at the time of the inspection these had not all been completed, but were receiving attention. One of the residents had been recently reassessed, the outcome of which indicated that more specialist care may be appropriate to meeting the person’s assessed needs. The manager was asked to keep the inspector informed of developments. The evidence presented demonstrated that the home’s Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 16 procedure in this respect was sound and well co-ordinated, i.e. specialist health care assessments had been undertaken and all parties kept informed of developments. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Given that the current residents were highly dependent upon staff to ensure their safety and well being this was particularly important. On the evidence gathered on this occasion the home was able to demonstrate that residents were being appropriately protected and that their views, as expressed through their behaviour, were important, recognised and acted upon. EVIDENCE: Evidence was presented to confirm that all staff have completed vulnerable adults protection procedures training, either the multi-agency or the Trust’s and were thereby aware of the action to take should they have a concern or if an allegation of abuse was made. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 28, 30 Tudor Beech Place was a pre-existing, (before 2002) registered care home. Given this the evidence gathered during this inspection confirmed that, with the exceptions below, the home meets each of the assessed standards and provides a reasonable level of accommodation appropriate to the needs of the current residents. Unmet requirements from the last inspection for redecoration of the bathroom and toilet and deficiencies with office/sleep in facilities meant that premises standards were not fully met. Ongoing requirements have been made to address these issues. EVIDENCE: Although the home was generally operating to a good standard, some areas needed to be redecorated. At the last inspection in November 2004 the inspector identified the bathroom and toilet as needing attention, neither of these jobs have been done. The manager said that there were plans to do the work. The inspector requested that the work must be done within two months of the inspection. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 19 There have been problems in the home with arrangements for staff on sleeping in duties for sometime, with staff finding it difficult to get a proper rest. Following the last inspection the manager was asked to look at ways to overcome the problems, which has been done. The options were being presented to the trust to decide what action to take. The inspector required that this be resolved as soon as possible, but given that this may involve building work it must be actioned within the next three months. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards. Staff appeared to be enthusiastic and committed to supporting residents, with training and development given a high priority. EVIDENCE: The service was in the process of finding new staff to work in the home, this should reduce any need for them to use agency staff and therefore provide a consistent level of care. Training and development of staff has been given a high priority with staff doing the NVQ and a range of other training to help them care for and support the residents. This was well evidenced in individual training profiles and a well presented training programme prominently displayed. The manager and some of the staff have known most of the residents since, and even before, the home opened in 1996. Staff appeared to understand the residents well and responded to meet their needs appropriately. The relationship between residents and staff was observed to be relaxed and friendly, creating a homely feel. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 42, 43 Evidence gathered during this inspection confirmed that the home meets each of the assessed standards and was seen to be well run with sound and accountable management support. EVIDENCE: The manager holds NVQ level IV and RNMH qualifications and said that her Registered Manager’s Award has been submitted Records of residents’ personal finances were sampled and found to be well maintained. The Trust has a person who acts as appointee for all of the residents, who provides a cheque for their personal allowances. Statements were in place confirming all income and expenditure for each resident. The manager described how each resident had a keyworker who supported them to choose what they liked to buy for themselves or for their families, for Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 22 example staff try to support residents to remember family birthdays etc and send a card and gift where appropriate. Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 2 3 x 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tudor Beech Place Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 3 H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard YA24 YA24 YA28 Regulation 23(2d) 23(2d) 23(3) Requirement The bathroom must be re decorated, to include the rusting radiator. The toilet must be redecorated. Timescale for action 9th July 2005 4. YA1 4.1 9th July 2005 The issue of adequate sleeping in 24th August arrangements for staff must be 2005 addressed, to prevent fatigue as a result of poor rest. An application must be 9th July submitted to request that the 2005 age range of residents be extended. 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 Good Practice Recommendations Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Tudor Beech Place H58_s13815_Tudor Beech Place_v214760_240505 stage 4.doc Version 1.30 Page 26 - 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. 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