Inspection on 28/07/09 for Tudor House Nursing Home

This inspection was carried out on 28th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tudor House Nursing Home 31/07/08

Tudor House Nursing Home 22/08/07

Tudor House Nursing Home 11/09/06

Tudor House Nursing Home 11/01/06

Tudor House Nursing Home 08/07/05

Tudor House Nursing Home 25/11/04

Tudor House Nursing Home 01/06/04

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Abbey The

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Tudor House Nursing Home 12 Leeds Road Selby North Yorkshire YO8 4HX Lead Inspector Jean Dobbin Key Unannounced Inspection 28th July 2009 09:15a DS0000027990.V376674.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor House Nursing Home Address 12 Leeds Road Selby North Yorkshire YO8 4HX 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) 01757 701922 01757 701922 tudor@rochehealthcare.com Roche Healthcare Limited Mrs Karen Newsome Care Home 34 Category(ies) of Dementia (34), Old age, not falling within any registration, with number other category (34), Physical disability (34) of places Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE, Physical disability - Code PD. The maximum number of service users who can be accommodated is: 34 31st July 2008 2. Date of last inspection Brief Description of the Service: Tudor House, which is owned by Roche Healthcare Limited, is a care home providing personal and nursing care for up to 34 older people, some of whom may have dementia. The home is situated on a main road, and within walking distance of the centre of the market town of Selby, which has a variety of local amenities. Tudor House is an old detached house, built on two floors. Incorporated into the house is a small separate dementia care unit, which has a keypad access and its own safe garden. The house has a well-tended garden and a small car park at the back of the house. The first floor is accessed by passenger lift. Twenty-six of the bedrooms are single, and four are shared. Fees charged on the day of the site visit are from £375 to £675 per week. Additional charges are made for chiropody and hairdressing services. The Statement of Purpose and most recent Commission for Social Care Inspection report, which was the predecessor of the Care Quality Commission, are displayed in the reception area for people to look at. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes This is what was used to write this report. • • • Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at Tudor House, to staff and to other professional people who visit the home. 10 were sent to people at the home, and 5 were returned. 6 were sent to healthcare and social care professionals and 4 were completed and returned. 5 were sent to staff at the home and 2 were returned A visit to the home by one inspector, which lasted about 8 hours. This visit included talking to people who live there and their visitors and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Tudor House. • • Information about what was found during the inspection was given to the registered manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People needs are assessed by a senior person at the home before a decision is made as to whether they can move to the home. This helps to ensure their need are recognised and understood and that the home is able to meet those needs, should they move there. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 6 People’s health care needs are well met. Staff identify when advice is needed and act promptly so that the right guidance is sought. One health care professional commented. ‘This is one of the best care homes locally’. People like the meals provided by the home. And the cook and dietary assistants know people’s likes and dislikes very well. One person said the home bought their favourite biscuits especially for them after they commented that they really liked that sort. The manager is very approachable and encourages people to speak with her about anything that may be bothering them. She knows people’s needs well and makes herself available for people living there, visitors and staff. People live in a warm, comfortable, traditional home. Several people spoken with described it as ‘homely’. One person said in their survey that Tudor House ‘ensures you feel at home in a friendly environment’. People say they receive good care from the staff. Comments include ‘staff are polite and respectful to residents’. And ‘Overall they provide a good service. I am able to feel very comfortable that my relative is well looked after on a daily basis’. What has improved since the last inspection? What they could do better: There could be more individualised care plans, particularly in relation to washing and dressing, describing what the person can still do for themselves and what they need help with. These need to be kept up to date as people’s needs and preferences change. This would help to ensure they get the right support when they need it. There could be guidelines in the home’s medicine’s policy describing what needs to be done if fridge temperature monitoring identifies abnormal Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 7 temperatures. Similarly the treatment room temperature could also be monitored with a plan of action recorded for if the room is too hot. This would ensure that all staff manage this in a consistent manner, so that drugs can be safely stored at temperatures recommended by the pharmacist or manufacturer. The activities person’s hours could be increased so that she has more time and opportunity to make a difference to people’s day to day lives. This would help people to have more interesting lives so that one day is different to the next. Whilst a handrail has been fitted to the ramp leading to the garden from the dementia unit, there are no guards beneath the rail, so people could still fall through the gap to the garden below. The home is still not doing all it could be doing to keep people safe. Nurses could attend extra training to make sure their professional skills and knowledge are kept up to date. More carers could achieve a Level 2 National Vocational Qualification in Care. All this would help to ensure a well trained workforce. There could be a much more robust system of ensuring bedrails remain correctly positioned on the bed, in line with the assessed risk of potential harm to the individual. This will help to keep people safe. Management systems at the home could still be improved. • Staff meetings and supervision sessions are not carried out regularly. • The manager is not carrying out her own spot checks to satisfy herself that the home is running well. • People are not regularly consulted about how the home operates and what changes they’d like to see. • The company is not always keeping records of the monitoring visits it completes each month. • Some records not available to look at. All these systems are needed to help to demonstrate that the home is running well. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 8 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 House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. The pre admission assessment ensures that individual care needs can be met at the home and the prospective resident and their family receives information and help to enable them to choose whether Tudor House is the right place for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Three people’s care records were looked at as part of the inspection. New preadmission assessment documentation has been introduced since the last visit to the home, but none of these records were seen in people’s care plans. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 10 The manager explained that this information is kept in the care plan for a period of time after admission, for staff to refer to and until the detailed care plans are written, and then they are stored separately. This process was confirmed by a care worker. Those pre-admission assessments looked at contained detailed information about people’s health and personal care needs, as well as information about their interests and social history. This helps to create a picture about an individual, and how they can be supported if they decide to move to the home. The manager generally carries out these assessments. Although people spoken with could not remember that process a visitor spoken with confirmed that the manager had visited their relative in hospital to find out about the help they would need after leaving hospital. The visitor continued that they had visited the home for themselves and been shown around. They were given a brochure and information about the services that the home provides. This helped to reassure them that Tudor House would be the right place for their relative. Both care staff and catering staff spoken with said that they are given information about a new person before they arrive. They can then make sure that the right specialist equipment is in place if the pre-admission assessment has identified a need for this. Knowing about the person means staff can provide the right care and support as soon as they arrive at the home. All the survey responses state that people were given enough information to help them make an informed choice about moving to the home. They also all say that they have a written contract, which was given to them when they moved to the home. Tudor House does not provide Intermediate care. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. The quality of care that people get is good, although this is not always reflected in their records. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Three people’s care plans were looked at as part of the inspection. These are in place to describe the care and support people need to stay in charge of their lives as much as possible. The plans looked at contained a lot of information but this was not always written in the right place. Some assessments were very detailed. For example they described people’s very specific dietary likes and dislikes including things Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 12 like whether they would prefer a big or little spoon, a cup or mug, to use a straw, or to wear something to protect their clothes when eating. This is good practice as it helps to ensure people receive a consistent level of support, according to what they have chosen. Other care plans were not so detailed. Comments like ‘assist with all hygiene needs’ does not describe what the person can do for themselves and what they are unable to manage. People need to be supported in maintaining the skills they have learnt and individualised care plans are needed so that staff don’t ‘take over’ and carry out tasks that the person can still do themselves. The need for more individualised detailed care plans was commented on in the last report a year ago. One carer spoken with though was able to describe exactly what this individual could do for themselves. This must be written down, so that all carers, who may not know the individual so well, have up to date information to refer to. Other records describe people’s preferences, such as ‘likes to have a low light on in their room through the night’, and ‘likes to sleep with four pillows’. This is good practice and identifies what makes one person different to another. These need to be reviewed regularly to make sure they are still current. For example one record stated that an individual likes a soft toy with them at all times, but they hadn’t got it with them. When questioned, the carer said they no longer wanted this. The care record should be updated to reflect this. People’s healthcare needs are generally well met, with one healthcare professional commenting in their survey that ‘this is one of the best care homes locally’. The care plans provide good evidence to show that advice is sought appropriately from professionals like the family doctor, dietician, and community nurse and specialist doctor. People are seen by the chiropodist, dentist and optician. Assessments are in place to assess the risk of an individual coming to harm from falling, developing a pressure sore, or becoming malnourished, because of a poor appetite or a health-related problem. These are generally reviewed monthly to make sure they are still current. Whilst people identified as ‘at risk’ generally have a care plan saying how that risk is to be minimised, this plan also needs to state why the management of that risk does not follow the expected guidelines. For example one person was assessed as at risk of harm from developing a pressure sore, however the use of specialist equipment had been assessed as posing an even greater risk of harm to the individual, so was not being used. This type of information needs to be recorded to show that this is a planned decision and not an omission. Care plans should also clearly state how often healthcare interventions should be completed. For example ‘blood sugars to be monitored’ does not ensure a consistent approach to managing an individual’s wellbeing. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 13 Medicines at the home are generally well managed. A senior nurse is responsible for ordering medicines and ensuring the records are well maintained. Regular checks are in place to confirm that people are receiving their medicines according to their prescription. The manager told us that a recent medicines audit by a community pharmacist identified no significant shortfalls. The home now records the medication fridge temperature each day, to ensure medicines are stored at the right temperature. However on the day of the visit the fridge was recorded as a little too warm, with the senior person saying they would ‘see what its temperature is tomorrow’. Staff must act if the recorded temperature is outside recommended parameters, otherwise the effectiveness of the drugs needing to be stored there may be affected. At the last inspection a year ago a comment was made about the treatment room and whether the temperature there was sometimes too hot. The temperature of this room is not being monitored and the manager must address this. Guidance about what needs to be done should any monitoring identify abnormal temperatures needs to be in the home’s medicine’s policy so that all staff respond in the same way. One drug was stored in the fridge, which should be kept at room temperature once opened. The manager said that she would sort it. One person has their pulse checked each day, before a specific drug is given. This needs to be discussed with the individual’s family doctor. If they want this recorded, then this should be in their care plan with guidelines to ensure that changes in their pulse rate are managed in a consistent way. People seen looked well cared for and were tidily dressed. The survey responses tell us that people are happy with the care received. All the surveys say ‘always’ or ‘usually’ to questions like ‘do the staff listen and act on what you say’, ‘do you receive the care and support you need’ and do you get the medical support you need’. One social care professional commented that ‘families have stated how satisfactory the care of their relative is, at Tudor House’. And one visitor commented ‘my relative is well looked after. They get excellent care’. Care staff were observed speaking with people in a respectful manner and listening to what people had to say to them. Staff were asked about how they ensured people’s dignity and privacy was respected. They talked about always knocking on people’s doors before entering their room and always asking permission before carrying out any tasks, even if the person could not communicate very easily. People were addressed by the name they preferred and carers said that several of the people living there said they preferred to receive personal care from specifically a male or female care worker. This was respected as much as possible, when work was allocated. It would be good Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 14 practice for these preferences to be recorded in the care plan to ensure that all staff are aware of them. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. People enjoy a nourishing and varied diet and whilst their lives are becoming more fulfilled, more activities would enhance them further. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection a year ago the home has appointed an activities person. Although they only work eight hours a week, this appears to have made some difference to people’s day to day lives. The manager tells us that she would like to increase their weekly hours, but there are no plans in place for this to happen. A number of people living at Tudor House stay in bed because of their frailty, however they could still benefit from one to one time with an activities, or social organiser. More hours would enable them to spend more one to one time with all the people living there. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 16 Residents and relatives meetings are now organised. Although there were no minutes from the meetings displayed, one person said that the activities person ‘types up what was talked about, and passes it round’. They added that they chose not to attend but the activities person spoke with them to see if there was anything they wanted bringing up at the meeting. Records looked at suggested a variety of activities are now organised. Some of these could be planned and advertised in advance, so that people can look forward to events that might interest them. Recent activities have included planting out hanging baskets as well as a recent trip to the Church Fayre for coffee. People in the dementia unit have been involved in games and puzzles and some gardening activities. These activities need to be organised and delivered on a more regular basis, so that people can live more interesting lives, where one day varies from the next. One person said in their survey ‘I would like to take part in more activities and get out more’. People are helped to have some control of their lives. One person explained that they stayed in bed three days a week because of their health. Although they had a routine for the other days, they were confident that if they wanted to change that routine, then staff would be only too happy to support them. And one person is supported to stay in charge of their personal finances. They are taken to the bank by two members of staff when they need more money, so that they can withdraw cash themselves. This promotes independence and a feeling of self worth. A religious service is held at the home though one person spoken with said they didn’t know they happened. These events need to be advertised so that people can choose whether to attend. Although a hairdresser visits each week one person spoken with chooses not to use that service. The manager needs to be doing her own checks to make sure people are happy with the facilities provided or seeing if alternatives are needed in order to make sure people’s needs are being met. Visitors are welcomed at any time, and the visitor’s book confirmed that. Two visitors came to the home over the lunchtime period to help their relative with their meal. The home employs dietary assistants, who help with the delivery of food, at the time that people want it. This means that people can have breakfast at a time that suits them and can be helped by staff that are not being taken away from caring duties. Most people don’t have a cooked breakfast, although the cook said that this option was available. This option should be advertised so that people can be reminded of this choice. Having dietary assistants means that people’s preferences are known and supported. One person said they really liked a particular type of biscuit and the home bought them in so that they could have them with their coffee. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 17 People can choose where to eat their meals and one person had their lunch in the entrance area, so that they could continue to watch the comings and goings outside. A choice of main meal is offered although extra meals are prepared so that people can change their mind on the day if necessary. There is a four week menu cycle. The dining room is a bright, airy room and the tables are nicely set out, but it is currently used by only a few people. The meal that day was either sausage and mash, or cheesy poached haddock, with cherry pie for dessert. The meals were presented in an appetising way. People in their survey responses said that they liked the food and people spoken with on the day agreed. Lunchtime on the dementia unit was a relaxed, social occasion. People, including the carer, sat at the dining table and there was a lot of conversation and laughter. People were offered sauces and salt and pepper and were encouraged to put their own on their meal. They were asked if they wanted something to keep their clothes clean and were asked what they wanted to drink. Various aids were used to promote people’s independence. People were helped in a discreet and informal manner and the event was a very positive experience. The cook had a good knowledge of how to provide for special diets and can refer to a list of people’s dietary likes and dislikes, kept in the kitchen. There was a variety of attractively displayed home baking prepared for later in the day. Foods were stored and labelled appropriately so it was clear when they would need to be discarded so that they weren’t kept for too long. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. People’s concerns and welfare are taken seriously, and the right action is taken where necessary to keep them safe from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The complaint’s policy is displayed in the entrance area and people spoken with said that they would complain to the manager if they had any concerns. They were confident that complaints would be taken seriously and sorted. All the survey responses from people living at Tudor House said there was someone they could speak with informally if they were unhappy about something and five of the six said they knew how to make a more formal complaint. The manager needs to keep reminding people of the need to complain if concerned about something, so that the home has the opportunity to put things right and learn from the incident. All the surveys completed by relatives state that they know about the complaint’s process. Neither the home nor the commission have received any complaints in the past year. The manager tells us that in the past small ‘niggles’ raised have been Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 19 recorded in people’s individual care records. She plans to keep these comments together in the complaints log, so that trends can be more easily identified and remedied. This process has not started yet though. All staff at the home have attended safeguarding adults training this year. Two members of staff confirmed this. When spoken with both said they would report to the manager or nurse in charge anything that they witnessed or heard about, that may suggest someone had been mistreated. One, when questioned, knew that they mustn’t keep secrets and must report any incident, even if someone living there asked them not to. However they didn’t know the role of the local authority and that they can report any incident directly to them, if they feel unable to tell a senior person from the home or parent company. This would be good practice so that staff know they can report incidents themselves. One person living at Tudor House, who was spoken with said ‘I would tell Karen (the manager) if someone was horrid to me. She would sort it. I would tell them off too’. Recruitment processes at the home, looked at, were robust with all checks completed before the new person started working at the home. Good recruitment processes contribute to keeping people safe. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. The home is warm and comfortable and generally adapted to meet people’s needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Tudor House is a mature detached building, with attractive gardens, including a fishpond. There is a keypad entry to both the house and the small dementia unit, which is reached through the house. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 21 In the last year the old flagstones around the house, and to the front door, which were uneven and sometimes cracked, have been replaced. This makes the home look more cared for as well as improving disabled access. One person living there, who uses a wheelchair, said it was now much easier for them to get out of the building and around the gardens independently. The long ramped access to the garden from the dementia unit has also had a handrail fitted in the last year, to provide some protection from people coming to harm when walking down it. The rail though has no guard beneath it, so that if someone slipped or fell, then they could still fall under the rail. The company needs to re-look at this to see if what they have put in place is sufficient to keep people safe. The house is clean, warm and comfortable with period features in keeping with the age of the building. There are two lounge areas and a dining room, though many people stay in their rooms, sometimes because of their frailty. Some of the corridors have been repainted in the last year, following a comment from a healthcare professional that they thought parts of the home were ‘gloomy’. Pendant call bells are used, so that people can summon help wherever they may be, without having to reach for a bell attached to the wall. This makes it easier for people who are less mobile. There are four bedrooms, which can accommodate two people however only one is shared, by two people who are related. Screens are used to provide some privacy for the individuals. Rooms looked at were personalised with photographs, and ornaments and some had electrical goods. They were clean and there were no unpleasant smells. The survey comments confirm this. The dementia unit has been painted in bright colours, with pictorial signs to help people to maintain some independence. Photographs are also displayed on people’s doors, to help them in recognising their own room. The unit has a lounge/dining room, which is decorated and furnished in a homely style. A fire safety officer hasn’t visited the home for some time, but a detailed fire risk assessment is in place and reviewed six monthly. The Environmental Health Officer visited in autumn 2008 and reported ‘a well managed home, with a good standard of cleaning’. Two requirements made following their visit were seen to promptly. A maintenance person shares their time between Tudor House and a sister home. Routine maintenance is addressed promptly and a communications book is used to request work to be completed. At the last inspection dirty laundry was seen in different piles on the laundry room floor, in preparation for going in the washing machines. Since then the home has bought more laundry baskets so that this practice has stopped. One person working in the laundry explained that these baskets are washed properly at the end of their shift, to minimise the risk of a spread of infection. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 22 Heavily soiled laundry is managed in a different way and this goes straight into the machines without being handled. The manager makes sure that appropriate aids are available and used to make sure that people living and working in the home are protected against infection. Carers spoken with were able to say how the way they work minimise the risk of a spread of infection, in order to keep people safe from harm. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. Whilst people receive good quality care from competent and well recruited staff there may not always be enough of them to provide this support in a timely way. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Currently there are 24 people living at Tudor House. The company is looking at the staffing levels and restructuring some of the shift patterns to try to provide higher staffing at times when more help is needed. So at this time five staff work both the early and late shift and three people work through the night. One person works a ‘twilight shift’ in the evening to help with people going to bed. A trained nurse is on duty at all times. There is less reliance on agency staff, compared with one year ago. There are also catering and housekeeping staff employed. Care staff did appear very busy on the day of the visit and because quite a number of people are cared for in bed, they are often busy away from the Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 24 communal areas. There is only one carer working on the dementia unit, so if they are helping someone to get washed or dressed then there is no one else supervising the remaining people on the unit. The manager tells us that she keeps the staffing levels under review and she must continue to do this to make sure there are sufficient care staff working to be able to provide care for people when they need that support. Despite these comments the surveys completed by people living there all responded ‘always’ or usually’ to the question ‘are the staff available when you need them’. One person spoken with said the staff were very good and they trusted them but added that they didn’t think there were enough of them. Other comments include ‘I am happy and comfortable here and I appreciate all that is done for me by a well trained, friendly but discreet staff team’ A relative said ‘the staff always manage to go that extra mile’. And a healthcare professional added that ‘Staff are polite and respectful to residents and they and their families appear content’. The home has a document called a ‘skill matrix’ (to show which staff have the required skills in areas like moving and handling, fire safety and health and safety). We were not provided with information to show the dates that staff attend training so it has not been possible to assess whether this training is provided in a timely way. This document states that staff are up to date with annual refresher training. Less than half the care staff have achieved a minimum Level 2 National Vocational Qualification in Care but the manager tells us this is because of staffing changes, where experienced staff have left to start nurse training. Promoting and supporting care staff to complete this recognised award will help to ensure a well trained workforce, who understand what good care is and how to provide it. Whilst the AQAA tells us that the home has introduced palliative care training so that staff can provide the right care for people at the end of their life, this is not included in the skill matrix. Training records need to be kept up to date to show that people are given training appropriate to the work they do. And there is no evidence that nurses are attending training to ensure their professional skills and knowledge are being kept up to date. Two recruitment files were looked at. These showed that all the required checks had been completed before the individuals started working at the home. Good recruitment systems help to keep people safe. People starting work complete a two day induction period which is in line with Skills for Care Standards. This is led by a training officer employed by the parent organisation and is followed by three days observing the practise of other more experienced staff. This consistent approach ensures all new staff Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 25 learn about the policies and procedures which they are expected to follow in their work. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People using the service experience adequate quality outcomes in this area. Whilst the home provides good care, the monitoring systems to show that people’s well being and safety are being protected and that their views are being sought and listened to needs to be more established and better maintained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 27 The registered manager is an experienced nurse who has worked in social care for a number of years. She promotes an open door policy and people spoken with knew who she was and said they saw her regularly around the home. One person who lives there commented ‘Karen is in charge. She’s very friendly. Karen will sort anything out’. Staff spoken with thought she was a good manager and very approachable. The manager tells us that in the last three months she has had more hours each week when she hasn’t had to work ‘on the floor’ but can concentrate on fulfilling her management responsibilities. She says she is happy to work some hours providing care as this helps her to check on people’s needs and whether they are being met. Rotas provided to us since the inspection show that she has these supernumerary hours. Those provided to us on the day of the visit though, which covered the period 20 July to 2 August 2009 did not clearly demonstrate that this was happening. Nor was this improvement made clear on the AQAA, submitted by the manager before the site visit. The AQAA submitted by the manager a year ago and repeated in this year’s AQAA states that ‘a quality assurance management system is to be introduced’. The manager says this hasn’t happened yet though the need to introduce this is included in the home’s Business Plan. The home has been working this year to achieve the Investor’s in People Award, and this has taken up a lot of management time. This is a nationally recognised award, which recognises when organisations have good business plans in place in order to improve performance. The home now has more robust policies and processes in place to enable the home to improve in a more consistent and measurable way. Monthly checks are completed by other staff, such as falls audits and medicines audits, and monthly health and safety checks. However the manager needs to be carrying out her own ‘spot checks’ too so that she can be satisfied the home is running well. The parent company is required to carry out unannounced visits each month so that they can monitor how the home is operating, however only three visits have taken place this year. One of these reports isn’t dated, so it is unclear when that visit took place. We were told that these visits do take place but written records are not always kept. One person living there wrote in their survey that ‘the hot water system is unreliable’. The manager knew of this, and said that the unreliability was due to the age of the system in use. She needs to be telling people what the home is going to do about it. This would reassure people that their views and comments are being listened to. Residents and relatives meetings take place, though these are not regular events. A newsletter is produced which was displayed in the entrance area. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 28 And although staff meetings are held, and minutes are kept these are not held regularly. However one carer said they were happening more than they used to. A carer said that they had had personal supervision recently, and there was evidence in one recruitment file of supervision six weeks after the individual started working at the home. However the manager says that the timings of supervision meetings could be improved. Having these discussions and keeping good records to refer to helps to focus on the individual’s training needs, every day practice, and where improvements could be made. People’s finances are safeguarded with good records and receipts to evidence each transaction. Although only the manager has access to people’s personal monies, the home keeps a small amount of petty cash to which senior staff can access at any time, so that people can have some of their money whenever they want it. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. The organisation has health and safety systems in place and a maintenance person is responsible for carrying out weekly and monthly checks according to the company’s schedule. However new documentation was introduced at the beginning of July and none of the records relating to earlier in the year were available to look at. This is despite the company and manager knowing that a visit to the home was due in July. Some of this information was faxed to the commission in the days following the visit. A satisfactory electrical safety certificate is still awaited. Other safety certificates seen were current. Hazardous products are stored appropriately and monitoring arrangements are in place to ensure the delivery of safe hot water. Some beds looked at had bedrails fitted in such a way that people could be at risk of getting their head trapped between the rail and the head of the bed. The home has the guidance about bedrails displayed; however no staff had raised this concern to the manager. Health and safety checks are carried out each month to make sure the rails work properly. Staff need to check at other times that they are correctly positioned. And the manager needs to be satisfied that this is being done and staff understand what they are checking for. The position of all the bedrails were checked on the day of the visit. A senior manager employed by the company said that the type of beds used by the home prevented the rails being fitted very close to the bed-head, so were fitted much further away. This was to comply with recommended health and safety guidelines, to prevent entrapment. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 29 Comprehensive risk assessments need to be carried out to identify those people who can move their upper body when in bed. Where this is the case, then the beds currently used at the home may not be suitable. Tudor House Nursing Home DS0000027990.V376674.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 31 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. 1. Standard OP19 Regulation 13(4) Requirement The handrail fitted on the ramp leading to the garden from the dementia unit needs to include more guards under the railing to prevent people falling under the rail, to the garden below. This will help to keep people safe from harm. The registered person must send a copy of the electrical safety certificate to the commission to show that all the required remedial work has been completed. The manager must ensure that people risk assessed as being able to move their upper body when in bed must have bedrails fitted less than 60mm from the headboard. This is to prevent the person coming to harm. Timescale for action 31/12/09 2. OP38 12(1) 30/09/09 3. OP38 13(4) 31/08/09 Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 32 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 OP7 Good Practice Recommendations The care planning records should clearly identify people’s strengths, abilities and preferences so that staff can support people in maintaining some control of their lives. These must be kept up to date as people’s needs change and reviewed regularly to ensure the information is correct. There needs to be clear guidelines in the home’s medicine’s policy as to what needs to be done if temperature checks identify that the medicine’s fridge is recording too hot or too cold. This will ensure prompt and consistent action is taken so that drugs needing to be kept at specific temperatures are safely stored. The treatment room temperature should be monitored to ensure that the room does not get too hot. If this problem is identified then the home has to have a plan as to how this is to be managed to ensure medicines are safely stored. There should be some consideration to increasing the activities person’s weekly hours so that they can provide a better service and help to improve people’s lives by making their days more interesting and varied. Care staff should be encouraged to complete a Level 2 National Vocational Qualification in Care as this would increase their knowledge of good care and how this is to be given. Nurses should be supported to attend training events so that their professional skills and knowledge is kept up to date. The home needs to look at how more systems can be put in place, both to ‘capture’ the views of the people interested in how the service runs, and also for in-house checks to be completed so that the manager can be satisfied that standards are being maintained. Staff should have at least six supervision sessions each year where their work and progress can be discussed. This helps to ensure a well supported workforce. A senior manager from the company should carry out an unannounced visit to the home each month, and should keep written records of these visits so they can check that DS0000027990.V376674.R01.S.doc Version 5.2 Page 33 2. OP9 3. OP9 4. OP12 5. OP28 6. 7. OP30 OP33 8. 9. OP36 OP37 Tudor House Nursing Home 10. OP37 issues previously identified have been addressed properly’. Records which are needed to be kept at the home to show it is running well need to be kept there, so authorised people can satisfy themselves that good monitoring systems are in place. Tudor House Nursing Home DS0000027990.V376674.R01.S.doc Version 5.2 Page 34 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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