CARE HOMES FOR OLDER PEOPLE
Tudor Court 18-20 Midvale Road Paignton Devon TQ4 5BD Lead Inspector
Peter Wood Announced 21 July 2005 9:30 am
st 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 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. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tudor Court Address 18-20 Midvale Road Paignton Devon TQ4 5BD 01803 558374 01803 528132 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) Mr Royston Terry Lock Mrs Jean Entwistle Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Mental registration, with number Disorder, excluding learning disabilityor of places dementia - over 65 years of age (31), Old age not falling within any other category (31), Physical Disability over 65 years of age (31) Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: To allow one service user, 55 years of age, to have respite care (as this client no longer has respite care at this home, this condition can now be removed). Date of last inspection 15/02/05 Brief Description of the Service: Tudor Court is a large four storey mid terraced property, close to all local facilities in Paignton. The home provides care to service users over the age of 65 who may also have some form of physical and/or mental frailty. There is a shaft lift. The home has undergone a major refurbishment programme which has resulted in the creation of a large well appointed conservatory area at the rear of the home, refurbishment of the home’s communal areas, the home’s kitchen, the home’s corridors and upgrading of service user’s bedrooms throughout the home. The home now provides accommodation for service users in twenty-seven single rooms and two double rooms. Twenty-one of the bedrooms have a toilet and washbasin en-suite facility. The conservatory looks on to a pleasant level patio area. Its gate, and external doors of the home, can be opened with a keypad. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place two days in July 2005. A pre inspection questionnaire had been completed by the registered manager of the home. A complete tour of the home was undertaken during the inspection and a sample of care and other records were examined. Twelve residents were asked for their views of their experience of living at this home, and three care staff were also consulted. In addition a few comment cards were received from relatives. The registered manager of the home assisted throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
The registered manger and her staff team have met all the National Minimum Standards. There are no requirements. The only recommendation is that the registered provider should make available a business and financial plan for the establishment which is open to inspection and reviewed annually to ensure that service users are safeguarded by the accounting and financial procedures of the home. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 6 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 Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5 Thorough and comprehensive systems for admission allow service users and their relatives to be confident that their needs can be met. The Registered Manager meets Service Users’ needs flexibly within the resources of the Home. EVIDENCE: Tudor Court has produced a Service Users’ Guide and a Statement of Purpose, and welcomes visitors to the Home. The registered manager undertakes a preassessment prior to a resident’s admission, followed by detailed assessments that generate comprehensive care plans. These care plans record the detail of care given by way of codes, obviating staff spending much time on writing. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11 Service users’ health, personal and social care needs are being met and service users are treated respectfully. The home’s practices relating to medication administration protect the service users from risk. EVIDENCE: Detailed Care Plans are drawn up for all residents, generated from comprehensive assessments. The recording of the implementation of the care plans is by way of codes rather than longhand, releasing staff time to actual hands-on care rather than writing about it. The Registered Manager reviews each care plan monthly. Risk assessments were seen with respect to moving and handling. Night care needs, continence aids, and diabetes care were documented. Residents can self medicate subject to a satisfactory risk assessment. Residents were observed to be, and reported that they were, treated with respect by staff. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities are managed well and provide daily interest for the service users. Meals are nutritious and varied. EVIDENCE: Residents’ rooms reflected their personality. Some residents proudly showed me their rooms, some of which contained items of their own furniture as well as smaller personal items. Residents told me that they were able to get up and go to bed at whatever time they wished. Those with relatives who lived locally enjoyed being visited and taken out by them, while some others said they would like to be taken out by staff more often than they were. Some musicians visit the home on a regular basis during which the residents enjoy a songsong. Some residents said they would like more activities. The lunchtime meal taken in the very pleasant conservatory dining room was attractive, with choice offered, and said by the chef to be nutritious. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 Complaints and suggestions from service users, relatives or other visitors to the home, are treated seriously. Service users are listened to and issues resolved promptly. EVIDENCE: A detailed and up to date policy an adult protection was available for staff, and each Service Users’ file contained a form inviting staff to record any concerns they might have about any sort of abuse. Information is made available in the Service Users’ Guide about agencies that might be useful, including solicitors’ contact numbers. The home maintains a suggestion box into which residents, staff, or visitors may post anonymous ideas, though this is infrequently used. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The service users live in a very pleasant, well-maintained home that is comfortable and warm and which provides sufficient facilities to meet their needs. EVIDENCE: Tudor Court is a large mid terraced property close to all local facilities in Paignton. The home benefits from a passenger lift, which accesses all four level floors. The home provides aids and adaptations as required including grab rails, raised toilet seats, a disabled toilet facility, mobile hoists and an accessible bath. The home’s grounds were also safe, tidy and easily accessible. External doors and the garden gate can be opened by means of a keypad. There is a large lounge with various alcoves, comfy chairs and a relaxing atmosphere. There are attractive mirrors and up-lighters. The conservatory dining room is bright and looks out on to the courtyard. There are 27 bedrooms 20 of which have ensuites, and those seen were attractively decorated, though several had lino flooring rather than carpet in an attempt to manage the incontinence of many if its residents with its consequent odour.
Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Service users are cared for by well-trained and motivated staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment processes protect vulnerable service users. EVIDENCE: Numbers and competence of staff, by reason of experience and training, is good at this home. The home uses a proper application form with a declaration of no convictions, undertakes CRB checks (which now include a check of the POVA list) and undertakes proper references. Tudor Court provides training in health and safety topics as required, and enables and encourages staff to undertake NVQs. At the present time 8 of the 21 staff (38 ) have NVQ 2 or above. However, an additional 2 are about to complete, raising the level to 10, equating to 48 , very close to the target to be reached by (the end of?) 2005. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 and 38 Service users live in a well managed home. The owners and their staff team strive to provide a stimulating, safe environment that respects and protects service users’ rights. EVIDENCE: The owner and his wife live away in Bristol and visit the Home monthly. He delegates the responsibility of running the home to the very capable Registered Manager who has been in post for 14 years. She had completed the Registered Manager’s Award, NVQ 4 in care, and achieved her NVQ Assessors’ award in 2004. She has also attended training in the prevention of falls, and up-dated her First Aid at Work qualification. All records inspected were in order. Care was being delivered in a dependable way, and safe systems of work were in place. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 3 Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 16 NO 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. 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 34 Good Practice Recommendations The registered provider should make available a business and financial plan for the establishment which is open to inspection and reviewed annually. Tudor Court D54-D07 18444 Tudor Court V227365 210705 Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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