CARE HOMES FOR OLDER PEOPLE
Tudor House Residential Home Tudor House 6 Park Crescent West Park Wolverhampton West Midlands WV1 4PY Lead Inspector
Pat Scott Key Unannounced Inspection 3rd August 2006 10:00 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 Residential Home DS0000029962.V295451.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 Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Tudor House Residential Home Address Tudor House 6 Park Crescent West Park Wolverhampton West Midlands WV1 4PY 01902 429008 01902 832709 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) Mrs Aurora McGarrigle Juliet Courine Douglas Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Maximum number of residents - 9 persons (OP) category, females over 60 years and males over 65 years of age. 12th December 2005 Date of last inspection Brief Description of the Service: Tudor House is a nine-bedded care home currently registered for older people. The home is a three storey Victorian building with parking facilities to the front of the building and a small paved patio to the rear. It is located near the centre of Wolverhampton, close to shops, West park and bus routes. The three-storey building currently has a lounge, dining room, kitchen, two toilets, two bedrooms and a bathroom on the ground floor, with the remaining bedrooms on the first floor along with a toilet and bathroom. The second floor has a small flat that is now being used as office space. Tudor House make their services known to prospective service users in: the Statement of Purpose and service user guide. The inspection report is mentioned in these documents and is available in the home. Tudor House’s rates are reviewed annually on 1st April each year and service users are notified one month in advance. The only additional charges to service users are for hairdressing, newspapers and private chiropody appointments. This is clearly laid out in the terms and conditions. Fees for care as of 1st April 2006 are: £323 per week. All service users pay monthly by standing order or by cheque. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? What they could do better:
The home needs to provide storage and a record book for controlled drugs. No service users currently have this type of medication, but the facility should be in place for when any is prescribed.
Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 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 Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: The statement of purpose and service users guide have been reviewed and present as very well written, professional documents for people to read. The statement of purpose and service user guide detail the assessment process. Care plans viewed contained assessments of need carried out by the home and those of the funding authorities. Service users spoken with said they had local knowledge of the home but also had access to written information.
Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 9 Current contracts will not meet the amended Care Homes Regulations that come into force September 1st 2006. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system is in a format that provides staff with the information they need to satisfactorily meet service users needs. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. Personal support in this home is offered in such a way as to promote and protect service users privacy, dignity and independence. EVIDENCE: All service users have a robust care plan and four were examined as part of ‘case tracking’. These were very well written and up to date and had been regularly reviewed. The quality of the care plan recording is such that people who are not familiar with its content could use it in an emergency. Care plans demonstrated that staff actively promote the service users’ right of access to the health service both within the home and the community.
Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 11 Appointments are planned or arrangements are made for professionals to visit frail service users. Systems to receive, store, administer and dispose of medication in the home are in place and followed according to the home’s policies. The home does not have a facility in which to store controlled drugs. Staff were seen and heard to respect service users’ privacy and dignity. They were allowed to go about their usual routines and sit where they liked. The staff were seen to interact well with service users and it was evident that relationships are close but still professional. Service users spoken with looked well groomed and they confirmed that staff were helpful and usually came quite quickly when they wanted attention. A returned survey form from a relative stated that “ staff are highly professional at all times but have also become an extension of our family”. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in social activity and keep in contact with family and friends. Residents receive a healthy, varied diet according to their assessed requirement EVIDENCE: The way in which activities are provided places an emphasis on more meaningful pastimes tailored to individual needs. A weekly activity log is completed for each individual. Details are displayed in the foyer and include community outings as well as visiting entertainers. Photographs are taken of events and shared with service users and visitors. Religious observance is assisted. Service users spoken with stated that they may receive visitors at any reasonable time of the day and that they are always made very welcome by the staff. The menus detail a choice of meal and staff routinely ask service users their preference each day and are offered something else if they didn’t fancy the main options. There were no special diets being provided. Service users commented that the quality of meals was very good.
Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 13 All requirements from the Environmental Health Officer’s visit have been met. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 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 the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to a robust, effective complaints procedure that enables them or their supporter’s views to be listened to and acted upon. Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: The CSCI has not received any complaints about the home nor have there been any adult protection issues. Service users are provided with a copy of the complaint procedure in addition to that contained within the service user guide. Service users were seen to speak easily to staff and were comfortable in their company. Staff are skilled in communicating with elderly persons to ascertain their well-being. The care plan reviews that take place give a forum for concerns to be aired. Multi-agency policies are available so that staff are aware of procedures to follow in case of any allegation or suspicion of abuse. Staff training is being updated in this topic.
Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 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 the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tudor House is comfortable and homely and service users live in a safe, wellmaintained environment. EVIDENCE: Rooms entered into were personalised according to individual wishes and tastes. Communal areas were clean and comfortable. Service users commented that they were very pleased with the attention given to making the place comfortable and homely. A relative survey stated that the standard of cleanliness and hygiene could not be faulted. Service users have access to a courtyard garden which the manager stated would be improved. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 16 The laundry is well organised with appropriate equipment in place to deal with the laundry requirements of the service users admitted. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of residents. EVIDENCE: The file of the last recruited member of staff was seen which showed that good recruitment practices had been carried out. Evidence of induction and initial mandatory training was seen. Staff confirmed that training is provided and there are many equal opportunities to improve themselves for the benefit of service user care. All care staff have completed the mandatory training courses of fire safety, risk assessment, health and safety, first aid, moving and handling and basic food hygiene. The home allocates staff to kitchen duties but does not employ separate cleaning/laundry staff. The meal provision and kitchen duties are organised on a day to day basis between 10-1 by a supernumerary staff member. All have received food hygiene training. The availability, quality and presentation of food ensures that service users receive a wholesome, appealing and nutritious diet. Service users spoken with could not fault the food provided.
Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 18 Staff manage the cleaning duties without detriment to service user care. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32.33.35.38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ethos of the home is based on openness and respect with effective quality assurance systems being implemented by qualified, competent manager to achieve good outcomes for service users in all areas of care. EVIDENCE: The registered manager has the required qualification and experience to meet the standards and aims and objectives of the home. Through discussion she demonstrated that she manages the service efficiently, providing quality care to service users. She seeks to develop the service, encouraging staff to improve their skills to create a confident staff team. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 20 Quality assurance surveys take place every three months to ascertain the views of service users, relatives and staff. The manager speaks informally to all service users each day and ascertains their well-being. Meetings, audits, day to day contact all provide records to show that service user satisfaction is at the heart of the service. The home does not manage any monies on behalf of service users. The home keeps records to show that the health and safety of service users is promoted and protected. The fire records and hot water temperature testing were seen as an example of this. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered provider must provide the correct storage for controlled drugs. Timescale for action 04/09/06 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 OP2 Good Practice Recommendations The registered provider should review the contracts to comply with the amended statutory instrument 2006 No. 1493. Tudor House Residential Home DS0000029962.V295451.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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