Inspection on 20/12/05 for Tudor House - Pangbourne

This inspection was carried out on 20th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tudor House - Pangbourne 25/07/07

Tudor House - Pangbourne 26/05/06

Tudor House - Pangbourne 19/07/05

Tudor House - Pangbourne 30/11/04

Tudor House - Pangbourne 25/08/04

Tudor House - Pangbourne 27/02/04

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

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

CARE HOME ADULTS 18-65 Tudor House - Pangbourne Farm Lane Maidenhatch Pangbourne Berkshire RG8 8HP Lead Inspector Lucy Martin Unannounced Inspection 20th December 2005 1:00 Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 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 - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 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 Adults 18-65. 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 - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tudor House - Pangbourne Address Farm Lane Maidenhatch Pangbourne Berkshire RG8 8HP 0118 974 5030 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) cynthia@vickery8648.freeserve.co.uk TACT Ms Cynthia Vickery Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Tudor House is a large detached house, surrounded by farmland, situated approximately three miles from Pangbourne village. The nearest bus stop is two miles away and Reading and Newbury, approximately six miles away, provide a comprehensive range of amenities. Tudor House provides accommodation and care for up to six service users, aged between eighteen and sixty-five years of age, who have a learning disability and some of whom also have a physical disability. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection which started at 1pm and finished at 4.30pm. Five of the six service users currently living at the home were seen and greeted, and two were spoken with individually and in private. The inspector spent time with the Manager and spoke to other members of staff on duty. The Divisional Director was spoken with as he was visiting the home. Samples of records, including service user’s files, were seen. What the service does well: What has improved since the last inspection? What they could do better: There is a need to ensure that the service users files contain up to date care plans that accurately reflect the current needs of the service users and that there is evidence that medical appointments have been attended. There was no evidence that the monthly monitoring visits are taking place and that there are effective quality assurance and quality monitoring systems in operation. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home now has an assessment form to complete when a new service user is admitted but no new service users have been admitted since the last inspection. EVIDENCE: At the last inspection it was reported that the last two service users had been admitted at short notice and that the outstanding requirement to develop a referral and admission policy had not been met. On this inspection, a quality of life and service assessment form was seen which when completed would provide a comprehensive assessment of a prospective service users need. This satisfies the requirement which is now met. There were concerns expressed at the last inspection that the last two service users admitted were far more independent that the other service users and that the home was not meeting their needs. It was a made a requirement that there is written evidence that the home meets the needs of prospective service users. This requirement has not been able to be assessed as no new service users have been admitted since the last inspection. The home are aware that they are not meeting the needs of two of the service users and are working with the placing authorities to find more suitable placements. This is taking more time than anticipated although it is hoped that both service users will move in the spring. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 Although the care plans seen had been reviewed on a regular basis, there was no evidence that any of the plans had been changed or updated in any way. There are robust systems in place to safeguard the finances of service users. EVIDENCE: The service users files seen had up to date pen pictures with photographs of the service user. It was generally found that although the care plans had been signed and dated every six months to indicate that they had been reviewed, nothing had been changed or updated in any way. In one service users file, there were ten care plans outlined, eight were introduced in 2002 and the other two in 2003. None of these care plans had been changed or altered in any way since being introduced. It would be difficult to believe that there have been no changes whatsoever in these plans in the last three years. It is a requirement of this report that the reviews of the service users care plans are meaningful and that they genuinely reflect current needs. The care plans in service users files contained details of decisions that should be made by them regarding their day-to-day lives but advice is given that further details regarding decisions and choices could be included in the daily diaries written regarding service users. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 10 One service user manages all his money and another maintains some responsibility but all the others finances are managed by the staff team. The financial records and receipts for one service user were seen and these were up to date and in good order. There was evidence that there is a regular management check maintained but there was no time limit and there were gaps of up to six weeks between checks. Advice was given that the checks take place on a more regular basis, at least monthly, to ensure that any mistakes can be quickly discovered and rectified. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 17 Friends and family are welcomed at the home but there was not much interaction seen with the service users in the lounge. The food menus were varied and balanced. EVIDENCE: The service users visit and are visited by family members. One parent is visiting on Christmas Eve and has been invited to eat a special meal with staff and service users. Another service user confirmed that he had recently been taken to visit family members and had enjoyed the trip. It was evident that there had been parties and meals out enjoyed by service users in the run up to Christmas and those spoken with had enjoyed these events. At the last inspection, it was noted that the staff on duty were not seen spending time in the lounge with the less verbal service users. The Manager said at the time that this was unusual, but this was also found to be the case on this inspection. Three of the service users tend to spend much of their time in the lounge and the staff mostly spend time in the dining room next to the kitchen. No members of staff were seen sitting in the lounge and interacting with these service users. It is acknowledged that staff spent time with service Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 12 users when they go out of the house but it is recommended that this is an area is reviewed. The lounge is large and consideration could be given to having a small table in the lounge where staff could write the records, instead of using the table in the dining room. The food menu was seen for the Christmas fortnight which was varied and full of treats for the festive season such as smoked salmon on Christmas Day. It was positive to see that changes to the menu were recorded and that service users are involved in choosing the menus. One of the service users has a birthday on Christmas Day and it was positive to note that he has not been forgotten and is having a party later on Christmas Day. The lunch was seen which was served at the start of the inspection which was a pasty and tinned spaghetti. This was appropriate on a cold day and all the service users and staff ate together round the dining room table. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 , 20 Although service users health needs are monitored, there was not always evidence that visits to health care professionals are recorded. The medication records were up to date and appropriately completed. EVIDENCE: Service users care plans provided information about how personal support should be provided. All the service users are male except for one female and the staff team has a mixture of male and female workers. There is good consistency of care from a staff team who know the service users well. The staff files seen showed that there are regular trips made to see health care professionals including GP’s, dentists, opticians and psychiatrists. One service user had a dentist appointment on the afternoon of this inspection. There was not always clear information in the service users files that appointments had been attended and the results recorded. For example, one service user had no record of seeing a GP since August 2004 and no annual health check. There was no record that any service users had had flu vaccinations given. It is required that clear records are made of the health care appointments attended by service users and the outcomes are recorded. It is also recommended that service users are offered annual health checks. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 14 The medication administration records were seen which were up to date and appropriately completed. One member of staff administers the medication and a second member of staff signs as a witness. A pharmacist continues to visit the home on a quarterly basis. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are protected from abuse and staff receive training in the protection of vulnerable adults. EVIDENCE: The policy on adult protection was not seen on this inspection. There is a good programme of training in the protection of vulnerable adults and it is recognised as essential training for all staff working at the home. Training records seen showed that most staff have already attended training in this area with two staff attending training in November 2005, and a further three in December 2005. As already stated in this report, there are robust systems in place to ensure the safeguarding of service users finances. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The home is comfortable and clean and some improvements have been made but there are still areas in need of further attention. EVIDENCE: Since the last inspection a new carpet has been fitted in the lounge and work undertaken to improve the appearance of the fireplace. The home was clean and there were Christmas decorations and a large Christmas tree in the dining room. There were no decorations in the lounge, but the inspector was informed that streamers had been put up but had been taken down by one of the service users. There is still some work to be done in the lounge and the existing sofas and chairs are extremely worn. The inspector was informed that new settees will be bought in the New Year and it is a requirement that this is done. The carpet is in need of replacement outside the two downstairs bedrooms and the carpet is fraying outside one bedroom. This will need to be trimmed as it is a tripping hazard at present. The upstairs bathroom was seen and it was noted that there is no blind or curtains at the window. Although this room is not overlooked it would make the room more homely and warm if a blind or curtains were fitted. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 17 Two of the service users bedrooms were seen. Both were well personalised but one room smelt heavily of urine. This service user spend a lot of time in the bedroom and there was no evidence in the file seen that this has been identified as a concern and action taken to identify the cause and how to deal with ensuring that the room is kept as odour free as possible. It is a requirement that this action is taken. The home has a separate laundry room which contains an industrial washing machine and tumble drier. The washing machine does not have a sluice programme but there are high temperature washes available. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 Service users are supported by a consistent staff team in sufficient numbers who receive a variety of training opportunities. EVIDENCE: At the last inspection it was reported that there had been a number of staff changes including the appointment of two new Team Leaders. On this inspection it was noted that there has been more stability within the staff team and there were positive reports from the Manager regarding the two Team Leaders. Staffing was more consistent and there are no staff vacancies. The home has a number of bank workers who know the service users and can cover staff shortages. At the last inspection there were some staff members who were working excessive hours and it was a recommendation that there is management monitoring of the hours staff work at the home to ensure that they are in the service users best interests. This has been done and although some staff still work double shifts, the number of double shifts in a row has significantly reduced. The training records were seen which showed that staff are attending a variety of training. The organisation that owns the home had recently provided training in manual handling, health and safety, food hygiene, first aid and the protection of vulnerable adults. There was evidence that the Manager monitors training to ensure that staff are up to date in key areas. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 There was no evidence that there are effective quality assurance and quality monitoring systems in place. EVIDENCE: The Manager is currently undertaking the Registered Manager’s Award and is nearing completion. This standard cannot be fully met until a qualification at level 4 NVQ in management and care is obtained. The Divisional Director undertakes monthly monitoring visits to the home and was at the home on the afternoon of this inspection. His visit was anticipated and so was not unannounced which the visits should be. There were no reports of the visits kept at the home since August 2005 and it is a requirement of this report that there are copies of the monthly visits held at the home. The Manager informed the inspector that the quality assurance aspect was being remodelled and a member of staff within Tact has been appointed to monitor standards in the residential homes. There should be a more robust Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 20 approach taken to monitoring quality and it is a requirement of this report that quality assurance systems are put in place. Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 2 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tudor House - Pangbourne Score 3 2 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 1 X X X X DS0000011174.V262083.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement There is written evidence that the home meets the needs of prospective service users. (This requirement could not be assessed as no new service users have moved into the home since the last inspection – therefore the timescale is extended) Care plans are maintained up to date and reflect the current needs of the service users. Appointments to see healthcare professionals and the outcomes are recorded in service users files. The existing settees are replaced in the lounge. The carpet outside the two downstairs bedrooms is replaced or is trimmed on one threshold to prevent a tripping hazard. Action is taken to investigate the cause and to ensure that one of the service users bedrooms remains odour free. Regulation 26 visits take place on a monthly basis and a copy of the report is kept in the home. There are effective quality assurance and quality monitoring DS0000011174.V262083.R01.S.doc Timescale for action 20/03/06 2 3 YA6 YA19 15(2) 13 20/03/06 20/02/03 4 5 YA24 YA24 23(2)(b) 13(4)(c) 20/02/06 20/02/06 6 YA30 16(2)(k) 20/02/06 7 8 YA39 YA39 26,17(2) Schedule 4 24 20/02/06 20/03/06 Tudor House - Pangbourne Version 5.0 Page 23 systems in place. 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 YA15 YA19 Good Practice Recommendations There is management monitoring to ensure that staff spend time and interact with service users in the lounge. All service users have annual health checks Tudor House - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 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 - Pangbourne DS0000011174.V262083.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!