CARE HOMES FOR OLDER PEOPLE
Tudor House Nursing Home 12 Leeds Road Selby North Yorkshire YO8 4HX Lead Inspector
Wendy Dixon Unannounced 8 July 2005 10:30 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 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 J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tudor House Nursing Home Address 12 Leeds Road Selby North Yorkshire YO8 4HX 01757 701922 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Roche Healthcare Ltd Mrs Karen Newsome Care Home with Nursing 34 Category(ies) of Old Age - not falling within any other category registration, with number (OP) 34 of places Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 25/11/04 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.The home is situated on a main road, and within walking distance from the centre of the market town of Selby, which benefits from a variety of local amenities.The premises consist of a two storey building. The first floor is accessed by passenger lift.Twenty six of the bedrooms are single, and four are shared. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Friday 8th July 2005.The inspection lasted 4.0 hours (10.30am to 2.30pm). There were 30 service users resident in the home, all requiring nursing care. The inspection focused on a number of key standards and on the areas of concern identified at the last inspection. An inspection of the premises took place, including a number of bedrooms, the homes bathrooms and lounges. The care records of five service users were examined in detail and these service users were spoken with about the care they receive. There were also discussions with members of staff and visitors to the home What the service does well:
Tudor House provides a good standard of care. Good assessments and plans of care are in place and this helps ensure that all the service users health and social care needs are identified and met. Service users said they enjoyed living in the home and that they found staff to be helpful and courteous. Service users said they enjoy the food provided and there was a range of meals available. Service users’ rights to privacy were well understood by staff; also staff spoken to had an excellent knowledge of the service users needs. Service users spoken to during the inspection were very positive about the care and services provided at the home, the kindness, professionalism and helpfulness of staff. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
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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 Standards Statutory Requirements Identified During the Inspection Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and3 The service user’s needs are well assessed and are met in a well-structured and considered way. EVIDENCE: There is clear information available to service users and their families telling them about the services provided in the home before they are admitted. There is an individual plastic folder for each service user within which all information in relation in relation to them is kept and includes admission details assessment; care plans daily statements, pressure area assessments, nutrition assessments and weight charts. The assessment documentation inspected of five service users was of good quality and in sufficient deal of detail so as to make it possible for their care needs to be identified and then comprehensive care plans developed. The service user spoken to were able to confirm that these documented details about them was accurate and appropriate. There was also evidence that the
Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 9 service user their families and other professionals such as care mangers were involved in the assessment process. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8and 9 The health needs of service users are well met, but some improvement in the monitoring of medication is needed EVIDENCE: The care plans of five service users were inspected and found to be of good quality. These contained detailed information about how service users needed to be cared for. These were up dated on a regular basis. Where these service users were spoken to they confirmed that the information recorded was correct and up to date. Care plans were signed by the service users or where more appropriate their relatives showing they were aware of the contents. Staff support all the service users in the home with the administration of their medication.
Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 11 The five service users case tracked medication was inspected. These were well managed and service users received their medication as prescribed by the doctor ensuring health problems are properly managed. Controlled drugs were stored appropriately in a separate locked cabinet, and record is kept in the controlled drugs register. Those records seen could be reconciled with stock remaining. The controlled drugs register is signed by only one member of trained staff, as there is not always a second trained member of staff to witness the administration procedure. Discussions haven taken place with the manager at the previous inspection with regard to the need for a witness to sign the register. One member of care staff has now completed the necessary training to take on this additional responsibility but further staff need to be trained if this safety precaution is to be carried out On each time this type of medication is administered. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Service users can choose to spend their days as they wish, and there is a range of activities service users can participate in if they wish. EVIDENCE: The home had a relaxed friendly atmosphere with staff and service users chatting about recent and coming events. Service users were spending their morning where and how they wished, some watching television others reading the morning papers. The home has an activities organiser who coordinates trips out or events in the home. All the service users spoken said they were very happy with the care they received and how accommodating staff were. Service users were either eating in their rooms or the homes dining room, which is, spacious and pleasant. It was fish and chips for lunch this was served in a number of ways to suit service users, poached for those requiring a soft or low fat diet for example. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 13 Service users stated the food was good at the home and service users records showed service users unless they had an underlying health problems were maintaining a healthy weight. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 People are protected against the risk ok of abuse. EVIDENCE: The registered provider has updated the homes policy and procedure about the prevention and reporting of abuse. Staff were aware of the policy and the majority have now received appropriate training. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is a clean comfortable and safe place for service users to live. EVIDENCE: Tudor House is a well-maintained home providing a safe and comfortable environment. Corridors in the home have been re-carpeted and the homes lounges are just about to be redecorated and re-carpeted. Bedrooms reflected the individual taste of service users and service users confirmed that they could bring their favourite possessions. This helps service users cope with the move from home to a care home. The home was generally clean and fresh smelling however one service users room discussed during the inspection smelt of urine, this needs to be addressed to provide service users and staff a safe place free from the risk of infection to live and work.
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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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home provides enough suitably qualified and trained staff to meet service users needs. EVIDENCE: There were 30 service users in the home on the day of inspection. The minimum number of qualified nurse hours needed to care for these service users is 254hours per week the home provided 306 week commencing 04/07/05 and the minimum number of care assistant hours needed is 432 the home provided 532 week commencing 04/07/05. Staff have the necessary qualification and skills to care for the service users at Tudor House. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 37 The home is well managed EVIDENCE: The home had a relaxed and friendly atmosphere A member of the management team are available in the home on a daily basis to deal with any problems arise. The deputy manager was on duty at the time of the inspection and was very well informed about the service users and staff management issues. Records and documentation were well organised and up to date. Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 1 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x 3 x x x x 3 x Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 2 Requirement In accordance with the Royal Pharmaceutical Society of Great Britain, the administration of controlled drugs by authorised staff should be witnessed by another designated appropriately trained member of staff The smell of urine in the room identified during inspection must be eliminated Timescale for action 01/09/05 and maintained thereafter 2. OP26 16 2 On receipt of this report and maintained thereafter 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 Good Practice Recommendations Tudor House Nursing Home J53 J04 S27990 Tudor House V238498 080705.stage4doc.doc Version 1.40 Page 21 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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