Inspection on 28/11/06 for Tudor Court LA

This inspection was carried out on 28th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Tudor Court LA 11/01/08

Tudor Court LA 08/02/06

Tudor Court LA 13/09/05

Tudor Court LA 19/10/04

Tudor Court LA 27/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Tudor Court LA Tudor Court Seymour Street Heywood Rochdale Lancs OL10 3AJ Lead Inspector Jenny Andrew Unannounced Inspection 28th November 2006 09:30 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 LA DS0000032850.V312511.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 LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor Court LA Address Tudor Court Seymour Street Heywood Rochdale Lancs OL10 3AJ 01706 364427 01706628700 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) Rochdale M.B.C. Vacant post Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (1), Physical disability of places over 65 years of age (3) Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 27 service users to include up to:27 service users in the category of OP (Older people), 1 service user in the category of PD (Physical disability), 3 service users in the category of PD(E)) (Physical disability over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Within the maximum of 27 OP(Older people) there can be up to:12 Intermediate Care Places, and 6 Short Stay/Emergency Placements. 8th February 2006 2. 3. Date of last inspection Brief Description of the Service: Tudor Court is a purpose built residential home owned by Rochdale Council offering accommodation for 27 service users. It currently offers care for 6 permanent service users and can accommodate up to 11 intermediate care clients and has 2 recovery beds. The Intermediate Care Unit offers a shortterm programme of rehabilitation for between two and six weeks for older people leaving hospital or for those in the community who may otherwise need admission to a hospital bed. Over a period of time, the permanent care beds are to be phased out and ultimately the unit will cater solely for those people requiring an intensive rehabilitation programme. No new permanent admissions were being accommodated and day care was also being phased out. All rooms were single and suitable for wheelchair users as they all measured in excess of 12 square metres. There were no en-suite facilities. The home is situated approximately half a mile from the centre of Heywood where there is a wide variety of shops, pubs, cafes etc. Ramped access for wheelchair users is provided to the front and rear of the home. There are safe garden areas, which residents enjoy during the Summer months. Adequate parking is available to the front of the building. Weekly fees varied dependent upon the service. Short stays were £91.85 per week and no charge was made for intermediate care. Permanent residents fees varied dependent upon personal circumstances but did not exceed £404.24 per week. Additional charges were made for private chiropody, hairdressing, papers/magazines, transport for outings, holidays and clothes. The provider made information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which was given to new residents. A copy of the most recent Commission for Social Care (CSCI) Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 5 inspection report was displayed in the entrance hall together with other useful information. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9 hours with one Inspector. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly (care plans), watched how medication was given out and looked at other records the home needed to keep. In order to obtain as much information as possible about how well the home looked after the service users, the manager, 2 team leaders, 2 permanent service users, 4 intermediate care clients, a physiotherapist, social worker, cook, 2 agency care assistants, 3 permanent care assistants and a relative were spoken with. In addition comment cards were sent out before the inspection to relatives, residents and professional visitors to the home. Of these 5 resident, 4 relatives/visitors and 1 G.P. questionnaires were returned. Other information, which had been received about the service, over the last few months, has also been used as evidence in the report. What the service does well: The manager and staff team were giving good care and support to the service users. All 6 of the service users spoken to were really pleased with the care they were receiving and described the staff as “marvellous”, “very pleasant”, “very kind”, “really nice”, “extremely patient” and “kind and thoughtful”. Other comments made on comment cards, which had been returned were “very high standard of care and thoughtfulness”, “all staff are kind, courteous and considerate”, “a dedicated team of workers provide an excellent support service” and, “without exception the staff exhibit a warm and caring attitude to ones requests, often beyond the call of duty”. Residents admitted to the home for intermediate care were aware of the aims of the home in enabling and supporting them to become independent and return home. Residents were of the view that they were being enabled to achieve this objective. One resident said ‘I really feel my mobility has improved during my stay’, another said ‘I can now do much more for myself and am looking forward to returning home”. Before coming in for rehabilitation, the home made sure they had all the right details about them, so that they were clear that the home was the right place for them and that their needs would be met. Each service user needed different help and support and the care plans showed exactly what each person could do for themselves and what they needed support with. The carers and health and social care team staff worked really Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 7 well together, which assisted clients in rebuilding their skills and confidence for when they returned to their own homes. Service users were pleased with the meals they were given and felt the food was varied and well cooked. They were offered choices at each meal and people who had special dietary needs were well catered for. Good training opportunities were provided which enabled staff to strengthen and develop their skills and knowledge so they would be able to give care safely for the service users. What has improved since the last inspection? What they could do better: The home was not always making sure that the intermediate care clients were being given contracts showing what the terms and conditions of their stay were. When service users first came into the home, there was no system in place where staff filled in forms about their weight and diet (nutritional assessments) so that they could look at what needed to be done if people were under or over weight. The recording of medicines and how it was being given out could place service users at risk and one of the staff who gave out medication had not received any training. Fire reports which had been done by the GMC Fire Services in November 2004 and by the local authority’s own fire officer in March 2005, showed that many things needed to be done to make sure the home was safe for service users and staff. These had still not been done. As the home catered for a wide range of people with different needs, the home’s lighting in the corridors needed to be brighter. Also the bedroom main light switches could not all be reached when service users were in bed, nor were bedside lamps provided. The home did not have an effective system in place for checking the quality of the service they offered. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 8 Regular monthly visits by a Council representative were not being made to the home so they could speak to the people living in the home, check around the building and look at records that should be kept. A proper check on when equipment in the home needed to be serviced had not been kept up to date, which meant that the gas appliances in the home had not been serviced for over a year. 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 LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst thorough assessments were taking place before service users were admitted, clients were not always given written contracts so they would know the terms and conditions of their stay. EVIDENCE: Whilst the information contained in the home’s Statement of Purpose and Service User Guide would enable any prospective client to make an informed choice about the home and its suitability for them, both documents were in need of reviewing and updating. They had last been updated on 14 December 2005 and since this time changes in the home had taken place. In addition to these booklets, other useful information describing what intermediate care was about was sent out to potential clients whilst they were in hospital by the health and social care team. Two of the clients spoken to said they had received this information which explained clearly about the service being offered. A copy of the Intermediate Care leaflet was seen. It was very user friendly and clearly set out the unit’s aims, what it could offer, duration of stay (up to 6 weeks), facilities available, how the staff worked and what they would Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 11 need to bring in with them. A copy of the Service User Guide was also in each of the bedrooms and the statement of purpose was displayed on a dresser in the entrance hall. The 6 permanent service users living at Tudor Court had lived there a long time and had been originally assessed and referred through Social Services and had service delivery agreements in place. Two files for the intermediate care clients were checked. One contained a contract setting out the terms and conditions of their stay. The document had not however, been signed, nor was it dated. In the other file there was no contract in place. Feedback from the 5 returned comment cards indicated that only two people had been issued with contracts. All clients must be issued with a contract, which should be part of the admission procedure. The contract did however, clearly set out that there was no charge for the accommodation and support service and recorded what clients had to provide for themselves during their stay such as toiletries and continence products. It also outlined that charges were made for hairdressing, newspapers/magazines etc. The contract had not been changed since the service had been commenced. Clients received a very thorough assessment prior to moving onto the intermediate care unit. This assessment was undertaken by one of the intermediate care professional staff i.e. the Occupational Therapist or Physiotherapist. The assessment detailed the clients’ level of independence prior to their hospital admission and their present level of functioning. Copy assessments were in place on both of the files inspected. Following on from assessment, the health care professionals would then write a care plan, a copy of which would be given to the management team who would include relevant information when writing their own care plans. Since the last inspection, the first floor intermediate care unit had closed and moved to ground floor level. This had meant some changes with the 6 permanent service users but after consultation, it had been agreed they would move into Boleyn unit and the intermediate care beds would use the larger unit. The units were self-contained in respect of services and facilities although dedicated care staff were not provided. The aim was to have staff who worked on either unit, ensuring that a suitable skill mix was available at all times to both intermediate care clients and permanent service users. Staff spoken to felt this worked well. Several had received 3 half days training from the Physiotherapist in respect of client mobility and group and individual exercises. The Physiotherapist said she would be arranging further training for the newer staff and the manager also confirmed this was to happen. She also confirmed that when any new aids or adaptations were used, she instructed staff in their use and ensured they were competent in using any new equipment. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 12 The health and social care team had a range of equipment available to them and kitchen facilities ensured that skills in this area could be promoted. Before discharge, clients had home assessments with the occupational therapist. This process ensured that before discharge, any necessary aids and adaptations could be fitted or given to them to further promote their independence. One client was spoken to who had been on a home visit the day of the inspection. She said she had managed well and was really looking forward to returning home. Clients spoken with said they were fully aware that the unit had a focus to enable them to become independent and return home, and all felt that this aim was being achieved. One service user commented “I’d never have managed to get better so quickly if it hadn’t been for the support I’ve been given”, another person said “I can now get dressed on my own and will be going home soon” and one person commented “I didn’t know such places existed and its been a really good service”. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 13 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. In the main, service users health and personal care needs were being met but some shortfalls in care practices were identified which could place service users at risk. EVIDENCE: Three service user care records, were inspected, two from the intermediate care unit and one from the permanent residents unit. The care plans in place for residents on the intermediate care unit were detailed and covered all relevant areas. They included Physiotherapist and Occupational Therapist input as well as personal/social care needs. They were reviewed on a very regular basis, in some instances daily and clearly showed agreed goals, which were being worked towards. It was evident, from talking to clients on the intermediate care unit that they were fully involved in the care planning and reviewing processes. Their treatment programmes were also kept in their bedrooms and these were seen during the inspection. The staff spoken with, including the agency staff, said they would always read the care plans of any new clients, when coming on duty and that they would sign to say they had read them. This was evidenced on the files inspected. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 14 The care plan inspected for the permanent stay service user, was detailed, addressed all aspects of care and had very recently been updated to include input from a speech therapist. Regular monthly reviews of care plans for the permanent service users were not however, taking place and this shortfall was identified at the last inspection. Signatures to care plans/risk assessments were not always being obtained from service users or their representatives. This should be addressed and where this is not possible, a note should record why. Whilst some risk assessments were in place, nutritional assessments were not being routinely undertaken as part of the admission process. Care plans did however, record nutritional needs and where service users’ were identified as being at risk, the appropriate health care professionals were consulted. This was evident on one of the care plans seen where the staff and cook had been instructed in changes in one persons dietary needs and weight was being monitored. The team leader said the home had not received training about how to implement the Malnutrition Universal Screening Tool, which was to be implemented in all Rochdale and surrounding area care homes. The Community Health Care Dietician had however, notified the Commission for Social Care Inspection on 1 June 2006 of all the Rochdale homes that had received training up until this date. Tudor Court was included on this list. The manager should now ensure that this tool is introduced and if necessary, request further training for the staff team. Residents’ health and personal care needs were being appropriately met on both the intermediate care and permanent units. Service users spoken to stated they were enabled to access health care services and evidence of this was seen on the record of professional visits/interventions maintained in each service users’ care file. The home clearly benefited from having the multidisciplinary team of health care specialists on site to consult and seek advice from as necessary. There was a specific G.P. practice who was responsible for visiting the home twice weekly. Other health care services were accessed as required. Detailed shift handovers took place where written notes and verbal feedback were passed between the staff to ensure continuity of care for the service users. A monitored dosage system for the medicines of permanent service users was in current use. Clients on the intermediate care unit, brought in their own prescribed medication with them, which was routinely reviewed by the visiting G.P. and Pharmacist. Upon discharge, if assessed as required, the pharmacist would arrange for medication to be put into blister packs, so that at home, the client could more easily manage their own medication. Clients on the intermediate care unit were encouraged to self medicate as part of their rehabilitation process. All bedrooms were equipped with lockable space so their medication could be safety stored. Individual risk assessments were in place for the 3 people who were holding their own medication. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 15 A medication round was observed as part of the inspection. It was identified that the team leader was not adhering to the home’s procedure of only signing the medication administration record (MAR) after having given the medication to the client. In two instances, medication was signed for and not immediately given out which is considered an unsafe practice. A controlled drugs book was in place and had been completed appropriately. The inspector was advised that no service users were currently on any controlled drugs but an invoice showed that in the middle of November some liquid medication had been received by the home that had not been signed in on the service user’s MAR sheet; nor had it been commenced. The home is responsible for ensuring that all drugs are checked in so they can be accounted for and the manager must ensure that all staff adhere to the policy. A ‘drug returns’ book was in place, which had been completed appropriately and had been signed by the pharmacist. It was however, identified that in the drugs room, there was medication waiting to be returned which had not been included on the sheet. With the exception of one acting Team Leader, all staff responsible for administering medication had received training. Training must now be arranged for this person. Discussion with clients throughout the home indicated that staff treated them with respect and sought to maintain their dignity and privacy especially when they were being assisted with personal care tasks. Comments from clients included, ‘the staff are always discreet and never make me feel awkward”, “staff knock before coming into my room”, ‘I am able to go to my own room whenever I want” and “when I had an accident the staff didn’t make a fuss but just helped me”. A relative, spoken to, commented on how respectful the staff were with the service users. The staff who were spoken to were able to give good practice examples, such as closing toilet and bathroom doors, keeping service users covered when assisting with personal care tasks and assisting service users to their rooms when they wanted privacy to see their visitors. On the day of inspection, staff were observed to assist residents appropriately, and sensitively and to interact well with them. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 16 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. Residents were encouraged to live a lifestyle in which they retained as much personal freedom as possible, to make their own choices and keep control over their lives. EVIDENCE: An activity board was displayed in the home but only bingo and hairdressing were recorded. An outside entertainer “Active Minds” did however, visit during the inspection and some of the service users enjoyed the activities offered. These visits took place on a monthly basis. Service users were able to choose whether or not to take part and those in their rooms were asked if they wanted to join in. When they declined, staff respected their wishes. Four people felt that more frequent stimulating activities could be offered but they said that these would have to be arranged around their rehabilitation programmes. Those on the intermediate care unit did group exercises twice a day and in the later stages of their rehab programme, would also do individual exercises. The manager said she had already identified the lack of activities as one of the home’s weaknesses and would be addressing this. Some of the permanent service users had enjoyed several trips out during the summer months including shopping in Heywood, trips to Hollingworth Lake and Blackpool illuminations and meals out. The staff team were planning the Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 17 Christmas programme and had included a party, a pantomime trip as well as a Christmas meal out. It was difficult to judge whether people’s religious needs were being met as due to the nature of the service i.e. short-term rehabilitation, the clients felt this was not a problem area. One of the permanent residents enjoyed going out to church on a weekly basis with a staff escort. Due to past problems, when on occasions staff had not been able to take him, the manager had arranged that from December, an additional carer would be put on the rota so that this service user would always be able to go to church. One of the staff said a representative from the Roman Catholic faith regularly visited two service users. All of the service users spoken with said they enjoyed a flexible lifestyle and could make choices about rising and retiring times, food, where to sit and use of their bedroom. Those on the intermediate care unit said they only had set routines in respect of exercises, which they had known about before coming into the unit. One person said that if they really did not feel up to doing exercises, the staff respected their wishes. Relatives and friends were encouraged to visit at any reasonable time but were made aware of the need for the intermediate care clients to be available for group exercises. One relative visiting a permanent service user, who had been in the home for many years, was extremely positive about the level of care given. He said the staff were fantastic, that he couldn’t fault the service and that when there were changes to her care, he was kept fully informed. He also said he was made very welcome and really enjoyed visiting the home. Feedback from the returned questionnaires was all very positive about their dealings with the home. Four weekly menus were in place, which were rotated. The Cook had recently changed the menus to include more winter type food and said that service users were consulted about food at the residents meetings. Minutes of service user meetings were seen and showed that food was usually on the agenda. The menus were varied, nutritious and provided two choices at each meal. The service users spoken with were, with one exception, very positive about the food. Comments included “”we always get a choice”, the food is very good” and, “there’s always something hot at breakfast and a full cooked breakfast on Sundays”. Feedback from returned service user comment cards were also positive stating, “an excellent and varied menu with home made dishes”, “excellent meals” and “we are offered two choices for each meal and everything is fine with the meals”. Only one criticism was made about the potatoes sometimes being hard. However, on the day of the visit the inspector tried the potatoes i.e. those that had been boiled and were to be mashed and those in the meat and potato pie and both were soft. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 18 The inspector sampled the meat and potato pie, which was extremely tasty and the alternative option of roast ham. The ham was moist and tender. Egg custard or ginger pears and cream were the desserts. The cook had worked at the home for many years and was aware of the permanent service users likes/dislikes. Any special dietary needs of new clients coming into the intermediate care unit were passed to her and they were catered for appropriately. Food allergies were also noted. There was always a dessert on the menu that was suitable for those people with diabetes. One service user had recently been visited by the speech therapist who had requested the person be given pureed food on a teaspoon. The cook had a copy of her request in the kitchen and staff were adhering to the instructions. Large bowls of fruit containing bananas, apples and satsumas were situated in each of the units that service users could help themselves to. One of the intermediate care clients commented that she would like more fruit in her daily diet. When the inspector pointed out the fruit bowls she said she felt uneasy taking fruit to her room. It may be that new clients needed to be given assurances about this and that the fruit was there for them to eat. The service users on each unit had their own dining facilities and small kitchens where they could make themselves drinks or snacks. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 19 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. An effective complaints system was in place which service users were familiar with and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: A formal complaints procedure was in place and included information provided to service users. Each bedroom had a copy of the service user guide in place. In addition, leaflets entitled “How to Comment, Compliment and Complain” were clearly displayed in the entrance hall and service users and visitors to the home could help themselves to these. Two returned visitor questionnaires commented they were unclear about the complaints procedure. It may be that the staff needed to be more pro-active in pointing out to new visitors where the leaflets were. Service users spoken to said they had no complaints about the home. Feedback from returned service user comment cards also said they had been extremely satisfied with the service. One person commented, “I’ve had no complaints to make in my 7 years here” and another said, “I know how to complain but I’ve never had to do so”. Service users confirmed they received information on how to complain, and all felt if they had anything to say they would speak to a member of staff first. A complaints logbook was in place where any complaints were recorded together with action taken to address the problem. Since the last inspection, Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 20 no complaints had been logged and the Commission for Social Care Inspection had not received any complaints about the home. The manager had a copy of the Rochdale MBC Inter Agency Protection of Vulnerable Adult policy and had recently been on a Protection of Vulnerable Adult course. Copies of the procedure were in the staff room and staff signed to acknowledge they had read and understood it. Adult protection training had also been done by many of the staff. However, as the training matrix did not include protection training, it was difficult to establish exactly how many staff had undertaken the training. In the 3 staff files that were randomly sampled, two contained copy certificates showing the training had been done. The manager should ensure that as part of supervision, she checks which staff have undertaken the training and arrange for those who have not to do it as soon as possible. The home had a range of policies and procedures in place for staff to follow in respect of service users monies/gifts/wills etc. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 : Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The provider had not taken any steps to address requirements made by fire officers which could place both service users and staff at risk. EVIDENCE: Since the last inspection, one of the rehabilitation units, which was on the first floor unit, had been closed and plans were in place for this area to be used as office accommodation when the home was upgraded. Both the rehabilitation unit and the unit for the permanent service users were now on ground floor level in separate units. Facilities and services, such as bedrooms, bathrooms, toilets, lounge and dining areas were contained on each unit. This change had meant that the permanent service users had had to move into one of the smaller units. However, those spoken to were happy with the move. One of the service users said the unit was cosier and warmer than the larger unit. He also said his bedroom was much bigger and he was pleased with this. Before service users moved, they and/or their relatives Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 22 were consulted. Minutes of a residents meeting, recorded this process had taken place Over the past 2 years, the Commission for Social Care Inspection (CSCI) had been advised that outstanding environmental requirements would be addressed as part of a major refurbishment programme. This programme had been postponed for several years, but at the last inspection in February 2006, the CSCI were advised it was due to be implemented imminently. None of the work had commenced and a further delay was now expected. The operational team manager, who was spoken to by telephone, was not able to state when the refurbishment would take place. Information included on the preinspection questionnaire stated, “refurbishment was likely to take place between April and October, 2007”. As part of the refurbishment programme, the outstanding requirements of the Greater Manchester Council’s Fire Officer’s report dated 3 November 2004 were to have been addressed. Since that date a Fire Risk Assessment dated 1 March 2005, had been undertaken by the Rochdale MBC’s own Fire Advisor. This had identified many shortfalls, with only a minority being addressed. Given the continued delay in implementing the refurbishment programme, this work must now be done as the identified fire hazards could place both service users and staff at risk. In the main, appropriate environmental aids and adaptations were in place throughout the home. Individual resident’s needs for specialist equipment/aids were addressed following assessment by the appropriate health care professional. It was however, noted that the majority of the Occupational Therapist assessments, for intermediate care clients, recommended shower practice before clients’ returned home. From checking bathrooms, it was noted that shower facilities on the ground floor were unsuitable for service users with physical disabilities as they were cramped and difficult to access. Again, this shortfall was to have been addressed as part of the refurbishment programme. An adapted shower had been available on the first floor unit but this unit was no longer in use. Given the continued delays and having regard to the purpose of the unit i.e. short-term rehabilitative care, action should now be taken to provide suitable shower facilities. Corridors around the home were dim and for those people with impaired vision it would be difficult for them to move around safely. The position of electrical sockets also made it difficult in some rooms for service users to have bedside lamps. Whilst service users in some rooms could easily reach the main light switch from their beds, this was not always the case, due to the bed position. One person on the intermediate care unit had brought her own bedside lamp in with her. Given that the home caters largely for intermediate care clients, with diverse needs, all rooms must be equipped with bedside or over-bed lights. Alternatively, switches to the main light must be easily accessible. Where this necessitates fitting additional electrical plug sockets, this must be done. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 23 Bedrooms, bathrooms, lounge and dining areas were all clean and free of malodours and the arrangements in respect of resident’s laundry were satisfactory. All the service users spoken to were complimentary about the cleanliness throughout the home, as was feedback from returned comment cards. The following comments were made: “The home is cleaned scrupulously and all my clothing is laundered and ironed to a high level,” “The home is kept exceptionally clean, particularly the table linen which is changed every meal” and “everywhere is spotless”. The infection control policies/procedures were being followed. Disposable gloves and aprons were in stock and being utilised, liquid soap and paper towels were in place and visitors to the home were being encouraged to use alcohol based hand gel to lessen the risk of the spread of infection. Staff were able to describe good care practices when assisting service users with personal care tasks. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 24 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. A competent, trained team of workers ensured the needs of the service users were being met. EVIDENCE: From checking staff rotas and speaking to service users and staff, it was identified that existing staffing levels of 2 care assistants on each of the units was meeting the service users needs. When service users needed an escort for hospital or other appointments, the manager would rota an additional carer onto the rota. This had been arranged for a service user who attended church every week. There were 4 care assistant vacancies, but these posts had been advertised and the closing date had expired. Central personnel department had the application forms and the manager of the home would be part of the interview process. In order to ensure staffing levels were maintained, agency staff were being utilised. Two agency workers were spoken with. They confirmed they worked at the home on a “permanent basis” and that in total it was usually the same 6 agency staff who were used. One of the workers had been covering the home for approximately 2 years as the Council were contracting with the Agency in order to have continuity for the people living there. On the day of inspection, an agency cook was being shown around the home as there was a cook vacancy. The permanent cook said that the post was Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 25 presently being covered by other cooks doing overtime, from other Local Authority homes. Service users spoken to on both units praised the staff team and all felt they were really well looked after. They said the staff were kind, considerate, patient and caring. Observations made during the inspection, showed good interaction between staff and service users. Staff interviewed felt they worked well together and had good liaison with the health and social work team who also worked at the home. They felt staff morale was good and commented they were pleased that a new manager had been appointed. Rochdale MBC operated stringent recruitment and selection policies and procedures, encompassing equal opportunities. Evidence of this had been checked at past inspections when inspectors had visited the Central Personnel Department where staff recruitment files were held. Some details were held in-house. It had been agreed at previous inspections that copy application forms, references and evidence of Criminal Record Bureau (CRB) checks would be held on site. Three files were randomly sampled and whilst CRB evidence was available, two files did not contain application forms or references. Following feedback, the manager was to audit all the files and obtain the necessary documentation from the Personnel Department. Staff received mandatory training with regard to fire safety, food hygiene, infection control, first aid, and moving and handling and the 3 files randomly sampled contained copy certificates confirming the training had taken place. A staff training matrix was in place which showed the majority of staff had undertaken all the required training. The new manager was in the process of addressing any gaps in training, during staff supervision. Staff attended numerous other training courses, but due to the training not being recorded on a matrix, it was difficult to check exactly what additional training had been done. Certificates in place on the files checked indicated some staff had done dementia, protection of vulnerable adults and equality training. To identify all the training undertaken, or to identify any gaps in training a full audit of the personnel files would need to take place by the manager. As no new permanent staff had been recruited since the last inspection, it could not be determined whether or not Skills for Care Induction training had been introduced in place of the previous TOPSS induction course. One of the files checked showed the person had completed the TOPSS induction training. The manager should now check that Skills for Care training is being implemented for all new staff and that evidence of how competencies have been assessed is recorded. Of the 22 staff employed, 10 had obtained an NVQ level 2 qualification which meant the home had almost achieved the 50 of trained staff. The manager Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 26 was aware of the need for new staff, who were not already qualified, to undertake NVQ training as soon as possible after starting work. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 27 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 adequate. This judgement has been made using available evidence including a visit to this service. Due to no registered manager having been in post for almost a year, several areas were in need of addressing in order to ensure the health and safety of service users and staff. EVIDENCE: There had been no manager in post for over 10 months and during this time, management responsibilities had been shared between the management team at the home. From speaking to the staff, it was evident they had worked hard to ensure that the good care and support to their service users was maintained. During this period, they did not however, receive regular supervision from higher management to ensure they were clear about their management responsibilities. Since the manager had started work, she had addressed this shortfall and a supervision programme was now in place. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 28 The new manager had only been working at Tudor Court for 3 weeks and was completing her induction training. She was in the process of obtaining all the necessary checks so that she could forward an application for registration to the Commission for Social Care Inspection. She had previously worked as a deputy manager in residential care for three and a half years and had obtained her NVQ level 4 qualification in care, as well as the Registered Managers Award. It was evident through speaking to her that she had a good knowledge of the legislation she would be working under and at her previous job had been involved in Commission for Social Care inspections. In the 3 weeks she had been employed she had attended Protection of Vulnerable Adults training and was also on a supervision course, which 2 of the team leaders were also undertaking. The home’s qualitative process was in need of expansion in order to be able to more effectively monitor the service being offered. In order to gather feedback about what people thought about the service, feedback questionnaires were given to all intermediate care clients before they were discharged. The inspector was not however, able to look at their comments as the questionnaires were sent elsewhere and no copies could be found on site. In order to measure satisfaction, the home should retain copies within the home and record what action has been taken to address any comments received. The results of surveys should be published and made available to current and prospective service users. For the permanent residents, meetings were arranged. From the minutes seen, it was evident that these took place on an infrequent basis and the manager should take steps to arrange them more regularly. Since the last inspection in February 2006 3 had taken place in May, August and October 2006. The minutes did however, show that service users were consulted about food, activities and outings and anything else which directly affected them such as their move into the new unit. The views of other visitors to the home were not obtained such as relatives, friends and other professional visitors to the home. The manager should consider implementing a system whereby more feedback about the service can be obtained. Information from the pre-inspection questionnaire recorded that all but one of the permanent service users managed their own financial affairs, with the assistance of family. One person received weekly payments from the home, which were appropriately recorded. The intermediate care clients retained their own money and lockable space was provided for them to keep it in. Regular monthly visits were not taking place by a representative of the organisation (Regulation 26 visits). These must be re-commenced without delay. When checking care plans, it was identified that where an intermediate care client had sustained a fall, this had not been recorded on an accident report sheet. All accidents must be recorded and a copy of the report retained on file. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 29 From the pre-inspection questionnaire, it was identified that the servicing of the gas appliances was overdue, the last service having been done in October 2005. The bath and mobile hoists were also overdue but these were serviced just after the inspection, on 29 November 2006. The manager faxed proof of the servicing to the CSCI office. The pre-inspection questionnaire did not record when the last electrical 5 yearly check had taken place. Following the inspection, proof of this was faxed through and it had been undertaken in April 2003. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 30 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 3 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation 5(3) 5A 5B Requirement Where a Local Authority has made arrangements for the provision of accommodation, nursing or personal care to the service user at the care home, the registered person shall supply to the service user a copy of the agreement specifying the arrangements made. The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users in that nutritional assessments are undertaken upon admission. The registered person shall make arrangements for the recording, handling and safe administration of medicines received into the home. The registered person shall ensure that persons employed to work at the care home receive training appropriate to the work they are to perform i.e. medication training. The registered person shall after DS0000032850.V312511.R01.S.doc Timescale for action 31/01/07 2. OP8 12(1) 31/01/07 3. OP9 13(2) 31/12/06 4. OP9 18(1)(c) (i) 31/01/07 5. OP19 23(4)(a) 31/03/07 Page 32 Tudor Court LA Version 5.2 (c) 6. OP19 23(2)(p) 7. OP33 24(1)(2) (3)(4) 8. OP37 26(1)-(5) 9. OP38 17(2) 10. OP38 23(2)(c) consultation with the fire authority take adequate precautions against the risk of fire. Requirements in the GMC fire officers report of 3/11/04 and the authority’s fire report undertaken in March 2005 must be implemented. (The GMC fire requirement has been outstanding since November 2004). The registered person shall ensure that lighting suitable for service users is provided in all parts of the care home that are used by them. This specifically refers to improved corridor lighting and provision of bedside lighting or easy access to light switches from the service users bed. The registered person shall establish and maintain a system for evaluation the quality of the services provided at the care home. Where the registered provider is an organisation, the care home shall be visited by the responsible individual or an employee of the organisation, who is not directly concerned with the conduct of the home on a monthly basis. The registered person shall maintain in the care home the records specified in Schedule 4. This specifically refers to accident report records. The registered person shall ensure that all equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order. This specifically relates to the servicing of all gas appliances. DS0000032850.V312511.R01.S.doc 28/02/07 31/03/07 31/12/06 31/12/06 31/12/06 Tudor Court LA Version 5.2 Page 33 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. 4. 5. 6. 7. 8. Refer to Standard OP1 OP7 OP12 OP18 OP19 OP29 OP30 OP30 Good Practice Recommendations The service user guide and statement of purpose should be kept updated and revised copies sent to the CSCI. Care plans for the permanent service users should be updated on at least a monthly basis. A more varied activities programme should be formulated which meets both individual and group needs. All staff should undertake protection of vulnerable adult training. Level access showers, suitable for the diverse needs of intermediate care clients should be provided. Staff personnel files should contain all relevant copy documentation e.g. application forms, references etc. The manager should ensure that all new staff receive Skills for Care induction training and that competencies are assessed and clearly recorded. The manager should formulate a training matrix for training done additional to that which is mandatory. Tudor Court LA DS0000032850.V312511.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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