CARE HOMES FOR OLDER PEOPLE
Tudor Grange Care Centre 54 Main Street Radcliffe On Trent Nottingham NG12 2BP Lead Inspector
Rajshree Mistry Unannounced Inspection 13th February 2006 9:25 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 Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Tudor Grange Care Centre Address 54 Main Street Radcliffe On Trent Nottingham NG12 2BP 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) 0115 9334404 0115 9332966 the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Natasha Burbidge Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 26th August 2005 Brief Description of the Service: Tudor Grange is an adapted and extended period house situated within the village of Radcliffe-On-Trent, Nottinghamshire. The village provides access to shops, the library, banks, a post office, restaurants, public houses and local bus, rail and road networks. The home is registered to accept up to 33 residents within the category of old age only. The accommodtaion is provided mainly in single rooms, all of the rooms have ensuite facilities. There are ample bathing facilities, two of which have recently been refurbished. There is one main lounge and a dining room for service users plus a small seating area in the main entrance. There is limited outdoor space, confined to a small patio area as the car park takes up most of the available space. However by verbal agreement residents may use the gardens of the flats adjacent. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the service, which took place on the morning of 13th February 2006 and lasted 3 hours. This is the second regulatory inspection of the service addressing the remaining core standards. The focus of the inspection undertaken by the Commission for Social Care Inspection (CSCI) is upon the outcomes for the resident and their views of the service provided. The primary method of inspection used was ‘case tracking’ three residents. The inspection consisted of a group discussion with the residents and members of staff, a tour of the home, review of the residents’ records and observation of care practices. The inspection also reviewed of the requirements and recommendations from the last inspection. What the service does well: What has improved since the last inspection?
The requirements made at the last inspection have been completed. The home has had a new bathroom fitted with a hoist and decorated on the ground floor. Upstairs a shower room has been fitted and decorated to enable residents to use the facility with some assistance. The contracted catering team are in the process of being directly employed and managed by the Registered Manager. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 Page 6 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. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 the following standard(s): 6. EVIDENCE: The home is not registered to provide intermediate care. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 the following standard(s): 8, 10. Residents are well looked after having their choice of lifestyle, health and social care needs met. EVIDENCE: Residents spoken with confirmed they are involved and agreement is sought in what care is provided and how, which is reflected in their care plans that were viewed for the residents tracked. The residents care plans are located in the file in the residents’ bedrooms with additional records from the visiting District Nurse. Observation during the inspection showed that staff have a good awareness of individual residents care needs, social and leisure interests and how these are met. Residents all said that the staff are very polite, treat them with respect and were able to identify their key-workers. One resident was quoted saying, “I do whatever I want but sometimes need some help but the girls do not persuade me otherwise or refuse me”. Residents have access to the local GP and District Nurse, who was visiting one resident during the inspection. The GP holds a ‘Friday Surgery’, when the residents can see the GP in the privacy of their own rooms. Many residents spoken with indicated that although the staff would call the GP if required, they preferred to see the GP on the Friday.
Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 the following standard(s): 14, 15. Residents are supported to make choices around daily living and activities. The home offers a good choice of meals to suit any special dietary needs. EVIDENCE: Residents spoken with described how they are supported by the staff to make choice about the care they receive, how they choose to spend the day, maintaining contacts with family and encouraged to receive visitors or goingout to the village. Several residents indicated that they can choose to retire to their bedrooms at anytime. The Inspector observed a member of staff supporting a resident to meet with their relative in the quiet area of the lounge. The menu on the day of inspection is displayed on the notice boards outside the lounge and in the reception area, showing a choice of nutritionally balanced meals whilst accommodating special diets. Residents spoken with were all satisfied with the variety and selection of meals offered with fresh vegetables. Meals are served in the dining rooms or residents can choose to eat in their own rooms. Comment received from the residents included: “I prefer to have breakfast in the bedroom and then they will fetch me for lunch”, “I always have one toast with marmalade and a pot of tea everyday”; “Gisty-Goomer” as one resident refers to the meal provided, stating that she “enjoys the meals provided and have a good appetite”.
Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 the following standard(s): 16. Arrangements for receiving and responding to complaints are satisfactory, resulting in protection of residents’ rights. EVIDENCE: The residents are provided with the home’s brochure on or prior to admission, which contains the home’s complaints procedure. Residents spoken with were aware of whom to contact and were confident that any concerns and complaints made would be addressed promptly. The majority of the residents spoken with indicated that they could not think of any reason to complain about the home or the staff. Records showed no complaints had been received since the last inspection. The home does not currently have the contact details of the Advocacy Services available to the residents and their relatives. This was discussed with the Registered Manager in relation to expectations of the family, which are often different to the expectations of the residents that can cause some distress, and can benefit the resident. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 the following standard(s): 21, 26. Residents live in a safe, homely and clean home with ample bathrooms and toilet facilities. EVIDENCE: On the day of the inspection the home was clean, pleasantly decorated and rooms benefit from ample natural light. Residents spoken with were very satisfied with the presentation of the home, the décor and furnishing to compliment the layout of the home. Since the last inspection the residents have benefited from having a bath with a hoist and shower room fully equipped fitted and well decorated. The bath and shower rooms were bright and with complimentary fixtures, with ample supply of protective clothing. Several residents bedrooms viewed were personalised, with each room having a different character and feel. All the bedrooms have en-suite facilities. The bedrooms on the first floor can be accessed by the stairs of the passenger lift located at the centre of the home. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30. Residents’ needs are met promptly and safely by sufficient numbers of trained staff. EVIDENCE: On the day of the inspection the carers and ancillary staff on duty was reflective of the staff rota viewed. The staff rota showed there was sufficient staff on duty throughout the day and night to respond to the differing needs of the residents with additional on-call assistance. Residents spoken with stated the staff appeared competent in assisting them with their personal care. The home uses regular agency staff to cover sickness and annual leave. The Registered Manager is in the process of recruiting a night carer. The contracted catering staff are in the process of being directly employed and managed by the Registered Manager. The staff training audit viewed indicated that the carers have received training in First Aid, moving and handling, fire awareness, health and safety and food hygiene. There are thirteen carers registered to complete the NVQ training and the Registered Manager is completing the Registered Managers Award. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33. Residents are consulted about living in the home and the regular internal audit of the home ensures all the residents and the staff are protected. EVIDENCE: The residents spoken with during the inspection all indicated that they are asked whether they are satisfied with the care being provided on a regular basis. Care plans are reviewed on a monthly basis in consultation with the resident and their family, where appropriate. The Registered Manager undertakes a monthly audit of the home which is recorded in a comprehensive format covering the home environment, health and safety, care, staffing levels, cleanliness of the home, quality of the meals, records and feedback of the residents, family and visiting professionals. The ‘Residents Meetings’ are held every three months and minutes of the meeting are displayed on the notice board outside the lounge.
Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X 3 X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 Page 16 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 Refer to Standard OP16 Good Practice Recommendations It is recommended that the Registered Manager considers making available the contact details of Advocacy Agencies to benefit the residents. Tudor Grange Care Centre DS0000008782.V282787.R01.S.doc Version 5.1 Page 17 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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