CARE HOMES FOR OLDER PEOPLE
Tudor Court Tudor Court 18-20 Midvale Road Paignton Devon TQ4 5BD Lead Inspector
Peter Wood Unannounced Inspection 22 May 2007 14:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Tudor Court Address Tudor Court 18-20 Midvale Road Paignton Devon TQ4 5BD 01803 558374 01803 528132 jean.entwistle@btconnect.com 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) 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 disability or 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 DS0000018444.V334780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Date of last inspection 20 June 2006 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. The fees range from £321.18 to £436, increasing in line with the dependency of the resident. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one afternoon and the following day in May 2007. The focus of this inspection was to inspect all key standards and to seek the views of residents, staff, relatives and professional visitors to the home, the latter using survey forms. Six residents completed the “Have your say about Tudor Court” survey forms. Five staff returned the “Care Workers Survey” form. No doctors or other health and social care professionals in contact with the care home returned any forms. One form was returned by a relative. This return rate contrasts quite sharply with the exceptionally high return rate at the last inspection which provided considerable external references for the home. Considerable time was spent with the registered manager examining documentation and developments within the home. A full tour of the building was undertaken. Most residents were consulted to the extent of their ability during the inspection. The “case tracking” methodology was partially used whereby four residents were selected to be consulted, along with their key worker, relatives and professional visitors such a district nurses. Care planning and other documentation, particularly relating to the “case tracked” residents were examined. What the service does well:
Quality in all seven outcome areas is good. This judgement has been made using available evidence including a visit to this service. The systems for admission are thorough and comprehensive and allow residents and their relatives to be confident that their needs can be met. Residents’ health, personal and social care needs are properly assessed and met and residents are treated respectfully. The home’s practices relating to medication administration protect the residents from risk. Social activities provide daily interest for the residents. Contact is maintained with friends and families. Residents are encouraged to exercise choice and meals are varied. 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. Residents live in a pleasant, reasonably well-maintained home that is comfortable and which provides sufficient facilities to meet their needs.
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 6 Residents are cared for by staff in sufficient numbers to meet their needs. Staff are competent by experience and training. Recruitment processes protect vulnerable residents. Residents live in a well-managed home run in their interests. The owners, manager and staff provide a safe environment that respects and protects residents’ rights. What has improved since the last inspection? What they could do better: 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 Court DS0000018444.V334780.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for admission are thorough and comprehensive and allow residents and their relatives to be confident that their needs can be met. EVIDENCE: Tudor Court produces a brochure, Statement of Purpose, Services Users’ Guide and other documentation which accurately describes the aims, objectives, values and facilities offered at the home. The registered manager undertakes a pre-assessment 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. The home does not offer Intermediate Care. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are properly assessed and met and residents are treated respectfully. The home’s practices relating to medication administration protect the residents from risk. EVIDENCE: Detailed Care Plans were seen which were 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. Residents can self medicate subject to a satisfactory risk assessment. The medication administration practice at teatime and lunchtime was observed. The home has good policies, procedures and practices for the proper administration of medication. Residents were observed to be, and
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 10 reported that they were, treated with respect by staff. Residents consulted reported that staff were “good”, “caring” and “always listen to me”. A relative who was consulted reported that the “manager and staff are nice and friendly and do care for the residents there.” Staff took pride in the work they do. Several said that above everything else, the home “cares” for the residents. However, a relative who was consulted felt that relatives should be more involved in residents’ care plans. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities provide daily interest for the residents. Contact is maintained with friends and families. Residents are encouraged to exercise choice and meals are varied. EVIDENCE: Residents are encouraged and enabled to do as much for themselves as possible. They have a range of activities from which to choose whether or not to partake. Residents told us 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. The teatime and lunchtime meals observed in the pleasant conservatory dining room were attractive. Several choices were offered, and a record kept of what was on the menu and what each resident actually chose. Menu plans accompanied the Pre-Inspection Questionnaire. Some musicians visit the home on a regular basis during which the residents enjoy a song-song. At the time of the inspection visit music was playing in the lounge, chosen by residents. Residents enjoy being taken out by
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 12 their relatives and occasionally by staff. Some residents said they would like more activities, while a relative who was consulted thought the home could improve by “having more activities for able bodied residents and dementia residents, as I feel they need stimulation, also to be taken out for short walks and trips out.” Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: The home has a complaints procedure, and follows the good practice promoted in the National Minimum Standards that issues are resolved before they escalate to become complaints. The home received one complaint since the last inspection. This was responded to within 28 days. A detailed and up to date policy on 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. Residents consulted reported that they were listened to and expressed confidence that appropriate action would be taken if they were to make a complaint. Staff interviewed knew how to respond appropriately should there be a suggestion of abuse.
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a pleasant, reasonably well-maintained home that is comfortable and which provides sufficient facilities to meet their needs. EVIDENCE: Tudor Court is a large mid terraced property close to all local facilities near the town centre of Paignton. The home used to be two houses so benefits from two staircases, though both of these do not extend through all floors as the lower part of one staircase has been removed to provide space for the passenger lift, which does access all four level floors. The lift is nearing the end of its lifetime. A new lift is likely to be installed shortly. The manager is actively engaged in verifying that her identified choice of lift will in fact be the most appropriate. The home provides aids and adaptations as required including grab rails, raised
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 15 toilet seats, a disabled toilet facility, mobile hoists and an accessible bath. A new wet room is planned, subject to the home being awarded a grant. Some of the rooms are large and airy, well furnished and decorated. Twenty-one of the twenty-nine single rooms have ensuite facilities. Both of the double rooms have ensuite facilities. Rooms tend to mirror the personalities of the incumbent resident. A downside of this is that some residents come into the home without bringing with them such items as their own furniture or personal items such as pictures or family photographs. Items like these can make all the difference to help residents feel “at home”. Some bedrooms and communal areas including the main lounge have vinyl flooring rather than carpet to minimise the effects of incontinence. The manager will, however, now purchase carpets or rugs as appropriate to make some bedrooms more homely. Similarly, some of the corridors are quite dark. The manager intends to paint in white the dark stained doors to brighten these communal areas. There is a large lounge with various alcoves, comfy chairs and a relaxing atmosphere. The conservatory dining room is bright and looks out on to the patio with seating. The home’s grounds are safe and pleasant. The garden gate can be opened by means of a keypad, thereby allowing residents unrestricted access to the rear garden and patio. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by staff in sufficient numbers to meet their needs. Staff are competent by experience and training. Recruitment processes protect vulnerable residents. EVIDENCE: Staff are carefully recruited, inducted and trained, as evidenced by the documentation in the individual staff folders. Numbers and competence of staff, by reason of experience and training, is good at this home. A staffing calculator indicates that the home requires 528 staff hours to meet the care needs of the seven residents with high needs, ten residents with medium needs and thirteen residents with low needs. The home actually provides 673 hours. The home uses a proper application form with a declaration of no convictions, undertakes CRB (Criminal Record Bureau) checks and undertakes proper references. Like many care homes, Tudor Court is finding it difficult to recruit quality staff locally but has recently successfully recruited workers from overseas, principally the Philippines. The home provides training in health and safety topics as required, and enables and encourages staff to undertake National Vocational Qualifications. At the present time twelve of the twentyone (57 ) care staff have NVQ 2 or above.
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-managed home run in their interests. The owners, manager and staff provide a safe environment that respects and protects residents’ rights. EVIDENCE: The owners live away in Bristol and visit the home monthly, delegating the overall responsibility to the exceptionally well-qualified and experienced registered manager. She is a nurse, has the Registered Manager’s Award, NVQ 4 in care, and NVQ Assessor’s Award. Residents’ financial affairs are administered by their family or solicitors. All records inspected were in order,
Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 18 though it is recommended that the manager studies all the National Minimum Standards and Schedules and satisfies herself that the home fully complies with them all, not just those examined during this inspection. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 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 3 X 3 X 3 X X 3 Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 2 3 Refer to Standard OP7 OP12 OP19 Good Practice Recommendations The home should enable relatives to be more involved in residents’ care plans as appropriate. The home should enable individual residents to undertake appropriate activities including trips outside the home. The home should be made more homely by the use of carpet rather than vinyl flooring, bright paint rather than dark stained doors and brighter electric lights. The manager should study all the National Minimum Standards and Schedules and satisfy herself that the home fully complies with them all, not just those examined during this inspection. The registered provider should make available a business and financial plan for the establishment which is open to
DS0000018444.V334780.R01.S.doc Version 5.2 Page 21 4 OP33 5 OP34 Tudor Court inspection and reviewed annually. Tudor Court DS0000018444.V334780.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Devon Office Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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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