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Inspection on 31/07/08 for Tudor House Nursing Home

Also see our care home review for Tudor House Nursing Home for more information

This inspection was carried out on 31st July 2008.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People interested in moving to the home are assessed properly by a senior person from the home to make sure staff at the home have the skills and knowledge to provide the right support, should that person choose to move there. People say the meals provided by the home are always very tasty and the cook tries to provide what people want. One person said `I am very picky with my food, so they were ask me what I want each day then the cook makes it for me. The manager encourages an open door policy, where she makes herself available for people to speak with her about anything that may be bothering them. This means she has good knowledge of the people living there, and what matters to them. There are good links with healthcare professionals, where advice and guidance is sought appropriately, and then followed. One professional said `they deal with medical problems well`. People are cared for and spoken with in a respectful manner. Staff listen to what they have to say. One person said `the carers are very good to me` and `they`re very obliging`. Staff make sure people`s privacy and dignity are always respected.

What has improved since the last inspection?

Care planning records and risk assessments are now written in more detail, so it is clearer, when reading them, what sort of support is needed. This should make sure people receive consistent care and staff can be reassured that they are providing the right care. A menu is now displayed so that people can look forward to favourite meals. People needing puree meals now have the same foods, on the same day, as the people having a normal meal. This means people can refer to the same menu and cooked foods are not routinely being kept until the following day. The identified toilet door now has a fire safety device fitted, so that it doesn`t need wedging open, which would have increased risk in the event of a fire. People`s written records now contain information about their past lives and social interests, so that staff have a greater understanding of what is important for that person. A member of staff is now assigned to work on the dementia unit through the night, so that they can respond more quickly if people need help.

What the care home could do better:

Care planning documentation could be improved further, to clearly identify what people`s strengths and abilities are, so that staff can support them in keeping those skills so that they can maintain some independence and control of their lives. There could be a written risk assessment for people who may need bedrails to keep them safe whilst in bed. If all staff assessed this need in the same way it would make sure that people have the same assessment regardless of who is doing it.There could be some small changes to medication practices to minimise the risk of people receiving the wrong drugs. The positioning of the drug`s fridge needs to be looked at to make sure that drugs needing to be stored at a cold temperature are being stored correctly. There could be more urgency placed on recruiting an activities person, who could then work with people to make their lives more interesting. One person said `there`s nothing going on` and another said `I don`t do anything except watch television`. People could be encouraged to make choices for themselves, like choosing their own biscuits, or keeping the different parts of their puree meals separate on the plate so that they can still enjoy the different flavours. There could be a review of the staffing levels in the dementia unit so that people have more stimulating lives there. This could also make sure that people are prompted and supervised at mealtimes and meals could be a proper social occasion, where people are able to sit at the table, like in the main house. There could be a review of the way laundry is managed at the home, to make sure the risk of a spread of infection is minimised. The disabled access to the home and in the gardens could be looked at to make sure risks to people coming to harm are minimised. Staffing levels in the home could be under constant review to make sure that the numbers of care staff on each shift are enough to meet the total care needs of people living there. There could be a more robust way of keeping records about how the home operates. This includes knowing, and recording when staff need training, having clear records to show that checks are being done in timely way and keeping written evidence that management processes are being completed properly. These would all help to show that the home is being well run.

CARE HOMES FOR OLDER PEOPLE Tudor House Nursing Home 12 Leeds Road Selby North Yorkshire YO8 4HX Lead Inspector Jean Dobbin Key Unannounced Inspection 31st July 2008 09:00 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 House Nursing Home DS0000027990.V369024.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 House Nursing Home DS0000027990.V369024.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 F/P01757 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.V369024.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 22nd August 2007 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 £341 to £655 per week. Additional charges are made for chiropody and hairdressing services. The Statement of Purpose and most recent Commission for Social Care Inspection report are displayed in the reception area for people to look at. Tudor House Nursing Home DS0000027990.V369024.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 Commission for Social Care Inspection. Information asked for, from the manager before the inspection. This is called an Annual Quality Assurance Assessment (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 7 were returned. 6 were sent to healthcare and to social care professionals and 1 was completed and returned. 10 were sent to staff at the home and 3 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. • Information about what was found during the inspection was given to the registered manager at the end of the visit. What the service does well: People interested in moving to the home are assessed properly by a senior person from the home to make sure staff at the home have the skills and knowledge to provide the right support, should that person choose to move there. People say the meals provided by the home are always very tasty and the cook tries to provide what people want. One person said ‘I am very picky with my food, so they were ask me what I want each day then the cook makes it for me. The manager encourages an open door policy, where she makes herself available for people to speak with her about anything that may be bothering Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 6 them. This means she has good knowledge of the people living there, and what matters to them. There are good links with healthcare professionals, where advice and guidance is sought appropriately, and then followed. One professional said ‘they deal with medical problems well’. People are cared for and spoken with in a respectful manner. Staff listen to what they have to say. One person said ‘the carers are very good to me’ and ‘they’re very obliging’. Staff make sure people’s privacy and dignity are always respected. What has improved since the last inspection? What they could do better: Care planning documentation could be improved further, to clearly identify what people’s strengths and abilities are, so that staff can support them in keeping those skills so that they can maintain some independence and control of their lives. There could be a written risk assessment for people who may need bedrails to keep them safe whilst in bed. If all staff assessed this need in the same way it would make sure that people have the same assessment regardless of who is doing it. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 7 There could be some small changes to medication practices to minimise the risk of people receiving the wrong drugs. The positioning of the drug’s fridge needs to be looked at to make sure that drugs needing to be stored at a cold temperature are being stored correctly. There could be more urgency placed on recruiting an activities person, who could then work with people to make their lives more interesting. One person said ‘there’s nothing going on’ and another said ‘I don’t do anything except watch television’. People could be encouraged to make choices for themselves, like choosing their own biscuits, or keeping the different parts of their puree meals separate on the plate so that they can still enjoy the different flavours. There could be a review of the staffing levels in the dementia unit so that people have more stimulating lives there. This could also make sure that people are prompted and supervised at mealtimes and meals could be a proper social occasion, where people are able to sit at the table, like in the main house. There could be a review of the way laundry is managed at the home, to make sure the risk of a spread of infection is minimised. The disabled access to the home and in the gardens could be looked at to make sure risks to people coming to harm are minimised. Staffing levels in the home could be under constant review to make sure that the numbers of care staff on each shift are enough to meet the total care needs of people living there. There could be a more robust way of keeping records about how the home operates. This includes knowing, and recording when staff need training, having clear records to show that checks are being done in timely way and keeping written evidence that management processes are being completed properly. These would all help to show that the home is being well run. 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 House Nursing Home DS0000027990.V369024.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.V369024.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use this service experience good quality outcomes in this area. People are assessed before they move to the home and get enough information to help them make an informed choice to help them decide whether to move to the home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The care records looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. One file contained a comprehensive care plan completed by a care manager. A staff member said that they are told all Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 10 about a new person, before they arrive, so that they have a good understanding of their needs. One person said that they had been visited at home by one of the senior nurses who had asked questions about what they could and couldn’t do and discussed what sort of help they would need. They did not visit the home, but said that a family member came to look around for them. Another person said that they had been in hospital and their relatives had also looked round on their behalf. It would be good practice for the manager to obtain the person’s, or their relative’s signature to show that they agree with what has been discussed and decided. All the surveys completed by people living there report that people are given enough information about the service and what it provides. This means they can make an informed choice about whether to move there or not. Trial visits are recommended by the home as a way of experiencing a little of what its like to live there. Intermediate care is not provided at Tudor House. Tudor House Nursing Home DS0000027990.V369024.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. People’s health and personal care needs are well met, and whilst care planning records to underpin this care have improved these can be added to, to promote a person centred approach. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. People’s written consent is now obtained when bed rails, a type of restraint are used. Whilst bedrails were fitted correctly there was no formal risk assessment in the care plan, explaining why the decision to use restraint had been used. An assessment would ensure that all staff are using the same Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 12 criteria to make sure there is a consistent approach by all staff. This would also make sure that a review to ensure the bedrails were still required could also be completed in a systematic way. This was discussed with the manager. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as ‘at risk’ had a care plan in place describing how that risk was to be managed. One person needs a hoist for getting out of bed, and the care plan gave detailed information about how the procedure was to be carried out. Another person had an assessment of the crockery and cutlery that would be required for the person to be able to manage their meals with a minimum of help. These assessments were reviewed regularly to make sure the information in them was still accurate and relevant. Care plans had been written about promoting and maintaining people’s independence, however these need more development now, to make sure they are really person-centred, recognising even small things that people are able to do to maintain some control of their day to day lives. For example one care plan said ‘encourage x to do as much as they are able to’. This statement needs building on to say what x is able to do, so that all the staff can support them in a positive and consistent manner. Records show that the manager and her staff refer appropriately for guidance and advice from other healthcare professionals, like the local doctor, chiropodist and optician. One healthcare professional commented in their survey that there were ‘high quality nursing staff’ and ‘referrals are sensible and appropriate’. There were clear detailed records in one file about how emergency treatment was to be carried out to one person, should a specific life-threatening event happen to them. One person confirmed that their doctor always saw them in private in their own bedroom. Medication systems in the home are generally well managed, although one tablet, which had to be sucked was seen on a person’s table. The nurses must make sure that people take their prescribed drugs before the drug chart is signed, which will also make sure that the drug is only taken by the person for whom it is prescribed. The medication record charts were filled in appropriately and the home counts boxed tablets each week, to make sure the expected number is the same as the actual number as a way of checking people are receiving their drugs according to their prescription. One drug was checked though, and these two numbers did not tally. The manager must be satisfied that these checks are being carried out accurately and any anomalies investigated properly as a way of checking that drugs are being dispensed appropriately. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 13 The treatment room where drugs are stored has no window, and the temperature of the medication fridge, which is recorded daily, is frequently too high. The drugs stored there may not work as well, if they are not being stored at the required temperature. This was discussed with the manager who agreed that the room did sometimes get very hot. This issue needs to be addressed so that drugs can be stored at their recommended temperature. The way controlled drugs were managed was not inspected, as there had been a recent visit by a pharmacist inspector, employed by the commission, who looked at these systems. This is because there has been a recent incident at the home where a number of tablets with controlled drug status, had ‘gone missing’. The manager had reported this to the police and her senior managers as well as taking statements from her staff. The specialist inspector was generally satisfied with the way controlled drugs were managed within the home, however the manager has implemented further measures, as recommended by the inspector, to make sure the nurses are more accountable and that security systems for the storage of these drugs are even greater. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 14 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 and 15 People who use this service experience adequate quality outcomes in this area. People do not have much variety in their day-to-day lives. Whilst people speak highly of the meals the dining experience in the dementia unit does not match the experience of people living in the main house. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People living at the home appeared generally contented and able to choose how they spend their time. One person said they liked to get up early and go to bed early, and staff supported them with that. They said the staff were very pleasant if they needed anything and their clothes were well laundered and cared for. There is currently no activities person working at the home, though the manager says the post is advertised. This means any events have to be organised by the care staff, who are already very busy providing care. A Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 15 photographic display of an event held twenty-four hours earlier was displayed in the entrance area, but there was no evidence of any other activities. One person said in their survey. ‘I would like to take part in something. It doesn’t have to be much, just something to take an hour of my time’. One person whose care was looked at had several photographs of dogs in their room. A member of staff said that they had brought their dog in recently for some of the people to meet. Particularly whilst there is no activities person, the manager needs to be proactive in developing links with the local community so that people’s days can be varied. A programme needs to be displayed, so that people can look forward to favourite events. Those care records looked at all contained information about people’s past lives and interests. Social activities need to be developed, which relate to those interests, such as the person who has always kept dogs being able to maintain some contact with them. The small dementia unit has a very well equipped sensory room, though it wasn’t used on the day of the visit. People were sat watching television, although one person said they did sometimes sit outside. Staff observed during the visit were either providing care, or writing in the care plans. There was little evidence of staff sitting and talking with the people on the unit. There was an orientation whiteboard, but this was dated 28th July, although it was updated during the day. A religious service is held at the home each month, and the hairdresser visits regularly. Visitors are welcome at any time and the visitor’s book confirmed this. One visitor said staff were always very friendly and helpful. Four out of the six people said in the surveys that the meals are very good. One person said that they were usually asked what they wanted as they were ‘a bit picky’, then the cook would provide an individual dish. One person has a fridge in their room, so that their family can bring items in for them. The home employs dietary assistants who help with serving food and provide breakfast for people when they are ready for them. At coffee time the assistant was observed handing biscuits from the tin, directly to people instead of letting individuals choose their own. This does not recognise people’s rights to have choice. The meal that day was roast beef, or quiche, with cherry sponge for dessert. People spoken with said it was very tasty. One person had a puree meal though and the constituents had been all mixed together. The cook said that puree meals are always served as separate foods, so that the person can enjoy the different tastes. The way the food is presented needs to be encouraged by staff, unless the person prefers their food all mixed together, in which case this should be recorded in their care plan. The way puree meals Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 16 are managed has improved since the last inspection a year ago, so that people needing a puree diet have the same menus the other people living there. On the dementia unit two people needed assistance in their rooms to have their meals. This meant that staff were with them, and nobody was available to oversee and prompt the rest. Although there is a dining table in the dementia unit people just sat in the same chairs in front of the television. One person had their dessert dish lifted up, so that their table could be wiped at the same time as the others, who had already finished eating. The dining experience for people in the dementia unit should be the same as that in the main house, and this was discussed with the manager. The cook had a good understanding of people’s likes and dislikes and said she spoke with people regularly to find out their views about the meals. She was also aware of special diets and the importance of making sure people with a poor appetite received enough calories. The kitchen records were well maintained. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 17 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 and 18 People who use this service experience good quality outcomes in this area. People can be reassured that their concerns will be listened to and acted on and staff are alert to the need to protect people from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A complaints policy is displayed in the entrance hall and the home operates an open door policy, where people can speak with the manager any time to discuss anything about the home. There has been one complaint in the last year, where a written complaint about an individual’s care was responded to by the manager’s own manager. The record though does not contain copies of correspondence, so it is unclear whether this complaint was dealt with appropriately, nor whether the complainant was satisfied with the way the complaint was managed. It would be good practice to keep copies of all the letters to show that it was managed properly. Five out of the six surveys completed by people living there said that they would tell someone if they were unhappy about something at the home. One person said ‘I feel I can tell any of the staff if I’m not happy. I would probably tell a carer’. A carer spoken with said that she would tell the manager if anyone spoke about concerns to them. They also said that they would speak Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 18 with the manager, even if the person told them not to. This is good practice as it shows the care staff understand the importance of passing all information on. Information about local advocacy services are displayed in the hall. These services can help people, who may fell unable to speak out, to make sure their rights are always respected. A training session had been held the previous day about protecting people from abuse. One person spoken with said they felt very safe living at Tudor House. Staff spoken with knew about abuse and how they must immediately report any incident that causes them concern, to the manager. The manager was also clear about her need to report incidents promptly to the Local Authority, as required by the North Yorkshire policy. Awareness by all staff about safeguarding adults helps to keep people safe. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 19 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 and 26 People who use this service experience adequate quality outcomes in this area. People live in a clean warm and well-maintained house, however some health and safety issues need addressing to keep people safe. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home 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. Disabled access is via a wooden ramp to the front door, but this needs either replacing or refurbishing, to make a more welcoming entrance. An anonymous phone call was made to the Commission earlier this year, commenting that they were disappointed that Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 20 the ramp had not yet been replaced. The path from the entrance leading into the garden is made of old flagstones, some of which are very uneven. This would present a considerable trip hazard to some people and if the home wants to encourage people to use the outside space, then this needs to be looked at. The dementia unit has a secure garden and the manager says that people from the main house also use this space. At the last inspection the home was required to fit a handrail to the low wall next to the ramp leading into this garden. This has not yet been done. Whilst waiting for this work to be completed the manager should have completed a risk assessment for this area to make sure people were being kept safe, whilst using this ramp. Since this visit the organisation have contacted us to tell us that this work will be completed within three months. 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 prefer to stay in their rooms. One healthcare professional, whilst overall very complimentary about how the home runs, said they felt some rooms and the corridors, with the dark panelling, were ‘gloomy’. This was discussed with the manager. There are four shared bedrooms, however only two people, who are related, currently use one. A screen is in this room to provide some privacy for the individuals. Rooms looked at were personalised with photographs, ornaments and some had electrical goods. They were clean and there were no unpleasant smells. 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 and a well-equipped sensory room. The manager could consider the use of older furniture and other items in this unit, as these may be more familiar for the people living. 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. Staff were observed wearing protective clothing when this was necessary, to help minimise the risk of the spread of infection. The laundry area was spacious and well equipped, with soiled linen put in water-soluble bags so that it didn’t need to be handled. Wet, and otherwise unsoiled linen however had been sorted into piles on the floor, waiting to be washed. This is not good practice and dirty washing should be kept in the linen bags until they are put in the machine. This was discussed with the manager. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 21 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 and 30 People who use this service experience adequate quality outcomes in this area. People are supported by committed and well-supported staff however there may not always be enough staff to meet the needs of the people living there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The staffing levels for the home are 2 nurses and 4 carers in the morning, 1 nurse and 4 carers in the evening, and 1 nurse and 3 care staff at night. Whilst the rota generally confirmed these numbers it also showed that in the two-week period when the site visit took place there were eighteen outstanding shifts that needed covering, primarily by unqualified care staff. Information provided by the manager suggested that staff work most of these extra hours, with agency staff having worked about 20 shifts in the previous 3 months. The rota also doesn’t clearly identify when the manager has supernumerary hours, when she is carrying out management duties. There are also domestics and laundry staff and dietary assistants and cooks employed at the home. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 22 Since the last inspection a carer now stays on the dementia unit through the night, so that she can respond quickly if people need help. There is however, generally only one carer assigned to the dementia unit on each shift. This though means that if that person is providing any care to an individual there is no one else to supervise or even talk with the people there. On the day of the site visit there were two staff working there, as one was a new carer who was working extra to the numbers so that she could observe experienced staff carrying out their work. This level of staff is insufficient to meet people’s needs there, particularly when there is nobody working there as an activities person. Staff spoken with felt that a high proportion of people living there at this time are quite frail and need a lot of support. Many people choose to stay in their room. Staff did seem busy, but were patient and cheerful in their work. Comments from people living there included ‘the carers are very good to me’ and ‘all the staff are very nice to me. Very obliging’. However a number of people said that the staff were very busy and there weren’t enough of them. These comment s include ‘there’s not enough of them at times’ and ‘never enough staff if you want to go out a little bit’. The call bell was activated and it took seven minutes for a care worker to respond. The person spoken with thought that was ‘about average’. The manager needs to keep staffing levels under review at all times to make sure that there are always enough staff to meet varying levels of need. More than half the staff have completed a National Vocational Qualification Level 2 in Care. People are more likely to receive safe, consistent care from people who have a good understanding of their role. There is a training officer who provides training to staff at Tudor House and other homes within the organisation. Abuse awareness is the only training ‘bought in’ from an outside trainer. One staff member is also a National Vocational Qualification assessor, who also has two supernumerary days each week to provide health and safety training. The manager does not have an up to date record to show that people are attending training annually to make sure their knowledge is up to date. This means people may be being supported by staff who do not have the right skills for the work they do. Two recruitment files were looked at. These were disorganised, and whilst police checks were in place it was difficult to be certain that all the checks had been completed properly before people started working there. Although two references were obtained, in one case a different person provided the reference to the named person on the application form. The manager explained that the first person had been on holiday so a second person had been approached. These ‘incidents’ need to be written down and explained so that there is a very clear record, to show that a person has not started work before all the checks are seen to be satisfactory. This would demonstrate the manager’s commitment to keeping people safe. A more organised way of Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 23 storing this information would help the manager to carry out her own checks, as well as making it easier for authorised people to check the records. One staff member was spoken with who had recently started work at the home. They had worked supernumerary for two days but was due to work nights. Although they had had a PoVAfirst check, to make sure they weren’t barred from working in a care setting because of a previous offence, their police check (Criminal Records Bureau check) had not yet been returned. The manager was aware of the need for the individual’s work to be totally supervised by a named person and said she had planned for this person to work with the trained nurse. This person confirmed that they had been started on an induction programme, where they could learn about their role and how the home operates. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 24 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 and 38 People who use this service experience adequate quality outcomes in this area. Whilst the home is generally run in the best interests of the people living there some of the management systems required to show people are always being kept safe, are not well maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is an experienced nurse, who has worked in social care for a number of years. Staff are very complimentary about her support and availability. One person said ‘my manager talks on a daily basis and supports Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 25 me 100 ’. The manager operates an open door policy and prides herself on her availability. This means that concerns can often be addressed before they become bigger issues. The manager works twenty-four hours a week ‘on the floor’ with the remaining time supernumerary. This means she knows people’s needs very well however she also has limited time to complete management duties to make sure that the home runs smoothly. The visit demonstrated that some of these management records are not being maintained properly. Staff training records are incomplete and not available to look at. If these records are not up to date it is impossible for training to be provided in a timely way and staff may not be caring for people in the best or safest way. Whilst recruitment documents were available to look at they were not stored in an organised way, so things were very difficult to check. Similarly there were records and receipts for how people’s monies were handled, but checking that things had been done properly was very difficult. Whilst care staff received supervision, the nurses do not have the opportunity to meet and discuss their work. Although the manager said she knew that a nurse had updated her professional registration, the last evidence of registration was in 2006. All these systems need to be made more robust so that checks can easily be made, both by her, and by other people who may want to check that things are being done properly. The company have a quality assurance system, whereby people interested in how the home operates are consulted so that improvements can be made. This needs to be developed more, and an action plan written and displayed in the home to show what changes the home is going to make as a result of this consultation The manager has started carrying out her own checks to make sure things are being done properly and has also delegated some of this responsibility to senior nurses. Residents and relatives meetings are held, but are poorly supported. A lot of information is gathered informally in conversation. The home produces a newsletter and this could be expanded to include more information about the home and what is happening there. There are a range of health and safety policies and procedures in place. The manager says that safe working practices are generally in place and staff are provided with training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. However she couldn’t demonstrate that people had received annual training to make sure their knowledge was up to date. Staff needed updating in fire safety practices and the fire risk assessment had not been reviewed in the past year. Hazardous products are stored appropriately and monitoring arrangements are in place to ensure the delivery of safe hot water. Some temperature records though suggested that the water was too cold for an immersion bath. The person carrying out these checks needs to be clear what they are checking for, and those abnormally low readings need addressing, then monitoring to make sure the higher temperature is maintained. Bedrail checks were completed on Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 26 the day of the visit, but hadn’t been checked for several months prior to that. Bedrails need to be checked according to the timescale in the home’s policy. No bedrails were noted to be in the wrong position during the day, and posters were displayed to remind staff how these need to be positioned on the bed. Health and safety checks were all in date. The visit from the Environmental health Officer identified no concerns. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 27 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 28 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. 1 OP9 13(2) The home must have a medication fridge, which can be maintained at a temperature of between 2 and 8°C so that drugs needing refrigeration can be stored safely An assessment must be completed to determine how people are to be kept safe, whilst using the ramp from the dementia unit into the garden, to demonstrate that people’s health and safety is being protected. Laundry systems must be reviewed so that laundry waiting to be washed is kept in the laundry bags until it is put into the washing machine. This will promote good hygiene practices and minimise the risk of the spread of infection. Staffing levels must be kept under constant review to make sure there are enough staff on each shift to meet the changing needs of the people living there. There must be enough staff assigned to the dementia unit so that the people living there can be supervised and supported at all times. DS0000027990.V369024.R01.S.doc 31/10/08 2 OP19 OP38 12, 23(o) 31/10/08 3 OP26 13(3) 30/09/08 4 OP27 18(1) 30/09/08 Tudor House Nursing Home Version 5.2 Page 29 5 OP38 12 There must be a more robust 30/09/08 system of ensuring that health and safety checks are being carried out in a timely way. These include • Fire risk assessment • Fire safety training for staff • Written assessments for the need for bedrails • Bedrail routine maintenance checks. This would show that the home is being run well. 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 Refer to Standard OP7 OP9 Good Practice Recommendations The care planning records could clearly identify people’s strengths, abilities and preferences so that staff can support people in maintaining some control of their lives. Where nurses have to write individual prescriptions on the medication chart, these records should be signed and dated by the person writing them, and a second person should also sign as a witness that the information is correct. This would minimise the risk of the information being written down wrong. There should be greater emphasis on providing a more interesting and varied life for the people living there. Some aspects of the meal provision could be improved. • The dining experience on the dementia unit should match that in the main home, where people can sit at the table and make a meal into a social occasion • People should be able to choose their own biscuits from the biscuit tin. • Puree meals should be presented as separate foods, so that the different flavours can be enjoyed. If a person wants this food all mixed up together, then this should be recorded in their care plan. There could be consideration as to whether the disabled DS0000027990.V369024.R01.S.doc Version 5.2 Page 30 3 4 OP12 OP15 5 OP19 Tudor House Nursing Home 6 OP30 7 OP33 8 OP35 access ramp to the front door needs replacing to provide a better ‘first impression’ of the home. Some paving slabs leading into the garden from the front door are very uneven and present a trip hazard. The staff-training records should be kept up to date so that staff can receive up dating training in a timely way. Supervision and appraisals for all staff should be undertaken and recorded. 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 senior staff can be satisfied that standards are being maintained. The way records relating to how people’s finances are kept safe could be reviewed so that there is a more robust way of recording and storing receipts. This will make it easier for staff to show that they are managing people’s monies properly. Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Extracts may not be used or reproduced without the express permission of CSCI Tudor House Nursing Home DS0000027990.V369024.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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