Inspection on 10/06/05 for Tudor Lodge Nursing Home

This inspection was carried out on 10th June 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 but made no statutory requirements on the home.

Other inspections for this house

Tudor Lodge Nursing Home 12/09/07

Tudor Lodge Nursing Home 24/01/07

Tudor Lodge Nursing Home 11/11/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Tudor Lodge Nursing Home Newgate Lane Fareham Hampshire PO14 1AU Lead Inspector Tim Inkson Unannounced 10th June 2005 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 Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tudor Lodge Nursing Home Address Newgate Lane Fareham Hampshire PO14 1AU 01329 220322 01329 822075 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) Mr and Mrs Mark Colin Palmer Mrs Janet Catherine Broad CRH 24 Category(ies) of TI Terminally ill - 4 registration, with number TI(E) Terminally ill - 24 of places OP Old age - 24 Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users in the category TI, must be at least 55 years of age. Date of last inspection 25th January 2005 Brief Description of the Service: Tudor Lodge is located in a residential area near Fareham, close to local amenities and on a bus route that enables ready access to Fareham town centre. Originally a large family house, the buiding was extended and converted for use as a care home. There is bedroom accommodation for residents on the ground and first floors of the building and a passenger lift provides access to the first floor. The home has fourteen single and five shared rooms. Four bedrooms have en-suite facilities. The communal/shared facilities include two assisted bathrooms, a lounge and a dining room, and a small annexe room that can provide more privacy for visitors. The home is set in extensive gardens that are easily accessible and other facilities include a laundry service and full board. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on 10th June 2005 and it was the first of two visits that must be made to the home during a period of twelve months. It was also the first inspection of the home since new registered providers/owners had taken over the business on 20th April 2005. The inspection started at 08:55 and was completed at 16:45 hours. The home’s registered manager was available throughout the inspection and able to provide information and advice. In addition one of the home’s new owners’ was available for much of the inspection. During the inspection an opportunity was taken to look around the home, examine records and policies and talk to, residents who were able to converse meaningfully (10), visitors (6) and staff (5). In addition staff working practice was observed where this did not compromise residents privacy and dignity. At the time of the inspection there were 21 residents accommodated in the home and of these 3 were male and 18 were female and their ages ranged from 74 to 96 years. What the service does well: The standard of care in the home was good with the staff able to meet the needs of residents and ensure that the fundamental principles that underpin good care were promoted. Residents not only felt safe when being provided with help and care but they also felt valued as individuals and able to exercise choice in their daily lives. There were good relationships between all people living and working in the home and also with visitors and residents who liked the relaxed routines and atmosphere in the home. Visitors appreciated the home’s friendly and welcoming approach. Residents and visitors said that the food was good and had improved and residents were pleased that more activities were being organised in which they could participate. The home’s gardens and surroundings were an aspect that many residents found pleasing. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home must attend to a number of weaknesses that were identified during the inspection, some of which were found on previous occasions. A minimum of 50 of the care staff working in the home should have an appropriate qualification. This should ensure that the home always had staff on duty with the skills and competence to meet residents’ needs. A quality monitoring system must be set up to enable the home to continually improve the service it provides based on the views of residents and visitors and audits of the home’s systems and procedures. Staff must be provided with regular formal individual supervision sessions to among other things enable them to receive support and guidance and identify any training needs they may have. All records that the home is required to keep must be complete and up to date and where these include photographs of individuals these should be in place. Photographs can be used to identify people and promote residents safety. The following health and safety matters need improving to ensure the welfare of both residents and staff; warning signs must be installed in areas where the Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 7 hot water exceeds the recommended safe level; all staff must receive fire safety training with the frequency recommended by the Fire and Rescue Service; and all staff handling food must have appropriate training. 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 Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3, and 5 There were good admission procedures in place that included providing potential service users with information about the home and assessing their care needs before they moved into the home. Potential service users were also able to visit the home before deciding whether to live there permanently EVIDENCE: All residents had a copy of the home’s Statement of Purpose and Service users Guide in their bedrooms and these detailed among other things, the facilities and services that the home provided. Residents and visitors/representatives said that either before they moved into the home or soon afterwards they were given detailed information about the home and that that they were able to visit the home to view it to enable them to decide whether it was suitable. Two of the visitors spoken to during the inspection included one potential resident and her daughter who were looking at the home’s accommodation and facilities. Residents and visitors also said that someone from the home saw them before they moved in to see what help they needed. A resident that had moved into the home since the last inspection visit on 25th January 2005 and his relative said that following the visit by one of the home’s senior staff to see them in hospital they were notified in writing that the home could meet their needs. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 10 This was a practice that was not being followed by the previous registered person when the home was last inspected on 25th January 2005 and was consequently a requirement in the report arising from that inspection. It was apparent that this had since been actioned. • “J visited him in hospital and after that we were given some information about the home” • “She was visited by staff from here when she was in hospital” The records of 4 residents were examined including some of individuals who had moved into the home since tha last inspection on 25th January 2005. They indicated that comprehensive assessments of the needs of potential service users were made before they moved into the home and also included copies of local authority community care assessments and care plans for those individuals referred to the home through care management arrangements. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 10 There were good systems in place to ensure that the social and health care needs of service users were met and their privacy and dignity was promoted EVIDENCE: The care plans and related records of 4 residents were examined. Plans of care were detailed and set out the action staff had to take and any equipment that was necessary to meet the assessed needs of service users. There was documentary evidence that service users and /or representatives were involved in the development of the care plans and that they were reviewed regularly. There were specific plans in place to ensure that the fundamental principles underpinning social and health care were promoted e.g. plan for privacy and dignity that in one case stated, “Ensure screen in place and shut door – ensure he is not exposed when washing”. Another plan stated, “Ensure she is given choice in what she wants to wear”. Residents and visitors said Service users said that the help and care they received was in accordance with their agreed plans and where equipment (e.g. wheelchair, Zimmer frame; pressure relieving mattress) was required this was observed to be in place or being provided. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 12 • • “They give me all the help that I need” “I need a lot of help as I can’t walk. I have a bed bath every day. I feel safe as the staff are very good” Staff spoken to were able to describe the contents of care plans, the needs of residents and how they provided the specific help and support those individuals required. Records kept by the home that were related to care plans included daily notes that detailed the help and care that had been provided to each person. Records, observation and discussion with residents and relatives indicated that the home promoted the health care needs of individuals. Service users and visitors said that the home arranged for doctors to visit if individuals were unwell. Also that the home arranged visits to specialists, clinics etc, when necessary and that other regular health care checks and treatments were arranged for them. Some individuals said that they preferred to make their own arrangements for services such as chiropody. • “I have seen a doctor recently and I have a chiropodist privately. They will arrange an eye test for me” • “I am going with my Aunt next week when she goes for an X-ray. They would send staff if I was unable to go”. • “I am seeing the physiotherapist because I fractured my arm” The home kept records of all visits from health care professionals or to outside clinics for each resident. They indicated that regular health checks were arranged by the home including preventative treatments such as annual influenza injections. A range of recognised methods of assessing service users health needs and for identifying appropriate interventions that may be required included consideration of; skin integrity; continence; mobility and nutrition. Consequently equipment or action plans were in place where necessary e.g. air mattress; hoist; provision of soft diet. On a previous inspection of the home there had not been evidence of the routine assessment of individuals nutritional needs or continence. This was being done at the time of this inspection and all residents’ needs were being reviewed regularly. There were detailed and specific care plans in place for the management of wounds and there was evidence that these were monitored and reviewed appropriately. There was some discussion about the use of photographs or some means of regularly measuring wounds to make monitoring progress more accurate. All residents spoken to said that the staff respected their privacy and dignity. There was screening available in all shared rooms and one resident confirmed that it was used to ensure her privacy. Residents also confirmed that they were able to wear their own clothes and that they were addressed by their preferred terms that were noted in their care plans. One visitor said “the staff seem efficient and kind without being patronising”. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 13 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, 13 and 15 There had been recent improvement in the promotion of social activities ensuring that residents had opportunities for stimulation and interest. Individuals’ choices and preferences were promoted. Good links were maintained with the community and visitors were encouraged and made welcome. The meals in the home were good and special dietary needs were catered for. EVIDENCE: Residents said that that until recently when the new owners took over that there had been very few organised activities but that things had improved with singers and musicians coming to the home in recent weeks. • “There was a singer here yesterday but I did not go” • “We had a lovely man singing yesterday” Staff were observed pushing a number of residents in wheelchairs around the extensive gardens surrounding the home in order to benefit from the warm weather on the day of the inspection. In addition some staff were observed providing individual hand-care/manicures for residents who seemed to be enjoying the experience. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 14 The records of residents that were examined included details of the leisure interests and one individual who continued to pursue an active interest in wildlife and painting said he spent his time “talking, reading, doing sketches and I shall have my artists materials brought in as well”. Residents said that their particular lifestyles were respected. One resident said that when her first arrived at the home he did not want to eat in the dining room but as he had settled down he had changed his mind. Another said that she was not forced to mix with other residents’ as she preferred her own company. “No one says that you have to be in bed, there are only sensible routines here. My breakfast comes to my room at 09:00 which is a bit late I know but it’s what I want”. “I am a bit of a loner” Residents and visitors spoke of the flexibility of the home’s visiting arrangement and the welcoming attitude of the staff and their appreciation of being notified if there were any problems. • “We have been made very welcome” (visitor) • “They keep me informed about my concerns” (visitor) • “There are no restrictions on visiting, except the need to sign in, the staff have been very forthcoming with meals for my visitor, they are very generous” (resident). All residents said the food provided by the home was good and many commented that it had improved considerably since the new owners had employed a new cook. Visitors also commented about the standard of food. Residents also said that the were made aware of what the meals were, that they had three meals a day and could have snack and drinks at other times. Water jugs and fresh fruit were seen in resident’s rooms and in the home’s lounge. Information about the needs of service users with specific dietary requirements was readily available in the kitchen e.g. diabetic, soft, chopped up, etc. Pureed meals were not provided with all their constituents prepared separately. There was some discussion with the cook about doing this to ensure that not only that the appearance of such a diet was attractive but also that all the ingredients could be tasted separately. Some service users chose to eat in their rooms and some in the home’s dining room. Comments about the food provided included the following: “The food is not bad, I can have as much as I want to eat and drink” “The food is very good” “Generally speaking the food is good – there is a board outside the kitchen with the days menu” “Its better now that they have a new cook” “Lots of things have improved since the new owners took over - the food is definitely better now” (visitor) “The food is terrific. I like my food and my appetite is good” “The food is really good” (visitor) Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 15 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) 16 and 18 Arrangements for protecting service users and responding to their concerns were good. EVIDENCE: The home’s complaints procedure was readily accessible to residents with all individuals having their own copy in the Service Users Guides in their bedrooms. In addition a copy of the home’s complaints procedure was prominently displayed near the lounge. Since the last inspection of the home on 25th January 2005 this had been amended to ensure that details about the Commission for Social care Inspection were included. All residents spoken to expressed confidence in their ability to raise matters of concern with the manager. One visitor said that she had raised some matters that she felt needed attending to with the new owners and had been assured by them that that they would be rectified. A record of complaints, including how they were investigated and their outcomes was kept by the home. There had been no complaints made to the home since in the last 12 months and the Commission for Social Care Inspection had received no complaints about the home. The home had a number of written policies and procedures available that were concerned with the protection of vulnerable adults from abuse. Most of the staff had attended training in adult protection and the prevention of abuse within the last 12 months and all staff spoken to were able to describe the Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 16 appropriate action to be taken if they believed or knew that residents had been abused. Where care plans indicated that bed rails were used to prevent residents injuring themselves these had been provided as the result of risk assessments and signed agreements with the individual and /or their representatives for their use had been obtained. Residents and visitors commented about the improved security of the home that had been implemented by the new owners. Access was controlled as a result of the new owners taking simple and expedient action and removing the handle from the outside of the front door. Consequently all visitors now had to ring the doorbell to be admitted to the building by staff. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 17 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) 20, 25, 26 The home provided a comfortable, clean and a generally safe standard of accommodation and suitable facilities to meet the needs of residents and the owners were committed to improving matters concerned with both the safety and comfort of residents. EVIDENCE: The home’s communal areas comprised a lounge with a view of the front garden and with a small enclosed area adjacent to it described as an annexe where residents could be afforded some privacy if they had visitors. In addition there was a dining room that had views over the garden at the back of the home. All residents spoken to expressed satisfaction with the condition of the furniture and décor in the lounge and dining room. One resident said that the lounge was “comfortable but not big”. As a pre-existing home (i.e. registered before 1st April 2002) the communal space is deemed satisfactory for the number of residents accommodated in the home. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 18 Several residents expressed appreciation of the home’s surroundings and gardens that included a large expanse of lawn and many trees and shrubs. Staff were observed taking residents around the grounds in wheelchairs during the afternoon of the inspection. • “The dining room is lovely because of the view of the garden that R keeps in good order. If I need anything fixed R will sort it out”. • “I watch the wildlife here, the squirrels and so on” • “The outlook is good with those trees” The home was centrally heated and there were radiators in residents’ bedrooms. All were covered appropriately to protect residents from the risk of suffering burns from hot surfaces. The temperature of the radiators could be controlled by individuals in their own bedrooms. In one bedroom despite it being a warm afternoon the temperature of the radiator was very hot and the resident concerned said that the control mechanism was not working and that she could not turn the radiator down. In the same room an en-suite shower was not functioning and the temperature of the hot water being delivered to the wash hand basin considerably exceeded the recommended safe temperature as set out in the National Minimum Standards for Care Homes for Older People. The owner stated that the radiator control and shower would be repaired by the end of July 2005 and that warning signs would be put in place on all wash hand basins where the hot water was not regulated to be delivered at the recommended safe temperature. The home was clean and free from offensive odours and all residents spoken to said that the home was kept clean. One visitor commented that the cleanliness had improved since the new owners had taken over and that “it smells nice now”. Staff were observed during the inspection undertaking cleaning tasks and all staff observed during the visit were noted using protective clothing appropriately. There were a range of policies and procedures available that were concerned with infection control these included some that referred to the management of soiled laundry and clinical waste. A member of staff described the procedures for managing laundry items and it was apparent that the homes procedures were adhered to. Staff confirmed that infection control was among the health and safety training topics that they regularly received. There were sluice disinfectors located on both floors of the home. The home’s laundry facilities were appropriately sited and equipped. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 19 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 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, 28, 29, There was a good staff skill mix and they were deployed effectively to meet the needs of service users. The proportion of staff with National Vocational Qualifications was insufficient. Recruitment procedures were appropriate to ensure the protection of residents. EVIDENCE: All residents spoken to said that staff were able to provide the help and care that they needed and they felt safe when staff assisted them and that they knew what they were doing. Residents and visitors also said that there were enough staff on duty in the home at all times and residents said that the nurse call system was responded to quickly. Their comments included the following: • “I have seen plenty of staff” (visitor) • “They give me all the help I need. If I want help I ring and they come quickly” (resident) • “They check on me regularly and I feel very safe when they are helping me” (resident) • “Staff come and go but there are enough of them” (resident) • “Staff are kind and thoughtful, I think they have the necessary skills and the nurse are excellent” (resident) • “I get all the help that I need and I can always ring and ask if I need any. All my requirements are met” (resident) • “The staff know what they are doing” (resident) • “They come quickly when I use the call bell” (resident) Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 20 There were mixed views among staff spoken to about the adequacy of staffing levels and there were references to a turnover of staff, some recent difficulties with shortages but also to more recent and further impending improvements with staffing. The owner said that more staff had been recruited and if there was a shortage of health care assistants then additional registered nurses would be deployed to ensure that there were enough staff on duty. In addition that the shift pattern was being changed to accommodate more flexible working arrangements for staff who could only work certain hours. Comments from staff spoken to included the following: • “It’s lovely when we are fully staffed and when the correct number are on its enough, that is as long as there are 2 upstairs and 2 down”. • “I enjoy having time to get to know the residents” • “We have all been mucking in, which has been tiring but the shifts are being changed” The minimum number of care and nursing staff deployed in the home was as follows: 08:00 to 13:00 1 4 5 13:00 to 20:00 1 3 4 20:00 to 08:00 1 1 2 Registered Nurses Health care assistants Total In addition to nursing and care staff the home employed cleaners, catering staff and a “handyman”. The home should have been adhering to at least the minimum levels of staff required by the agency responsible for regulating the home prior to 1st April 2002 when new legislation was implemented. A copy of a staffing notice that would have been issued to the home by that agency was not available in the home. A copy of general guidance about staffing levels in nursing homes issued prior to 1st April 2002 was left with the owner. At the time of the inspection there were 7 registered nurses employed to work in the home and out of a total of 10 Health Care Assistants 1 had National Vocational Qualification (NVQ) level 2. The owner and manager both said that 4 other staff were working towards the award and that the home had recruited and would be employing 4 new staff and of these 3 were already qualified to at least NVQ level 2. The owner agreed to ensure that at least 50 of the care staff would be qualified to NVQ level 2 by 31st December 2005.. The records of 3 staff were examined including those of 1 employed and working in the home since the last inspection of 25th January 2005. All documents, information and pre-employment checks required to be obtained Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 21 and undertaken before a person worked in the home were in place and had been done. It was recommended that all staff be issued with a copy of the General Social Care Council’s (GSCC) Code of Conduct in accordance with Standard 29.4, as this had not been done. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 22 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, 33, 35, 36, 37 and 38 The home’s management approach was good, ensuring the promotion of an inclusive, relaxed, living and working environment. The home had no quality monitorning system in place to ascertain whether it was satisfying residents expectations but there was evidence of an intention to seek the views of residents. Residents’ financial interests were well safeguarded. Formal staff supervision was inadequate. Record keeping needed some improvement. Systems and procedures for ensuring the health and safety of residents and staff had been enhanced and were mainly satisfactory but some further improvement was needed. EVIDENCE: The majority of residents spoken to were aware that ownership of the home had changed recently and they said that it had made no noticeable difference to their lives and the help and care that they received. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 23 Residents, staff and visitors said many positive things about relationships within the home and spoke highly of the manager’s attitude. Staff expressed enthusiasm about working in the home. Comments included the following: • “The manager is very nice and the staff are all very good” (resident and her visitors) • “Its brilliant, its very nice. The residents and staff and the atmosphere is calm and friendly. The manager is lovely, she is good with residents and staff. We have staff meetings and we talk about problems” (staff member) • “Its quite a happy place, I have never heard any quarrels. The manager is lovely and full of fun” (resident) • “Its pleasant and good here. I like the manager and her sense of humour” (resident) • “I have been here 18 months and I like it here. It has its ups and downs, but I would not stay if I did not like it. The manager has a lot to do but she is good” (staff member) • “It’s a friendly place” (resident) • “It is smashing, a lovely place to be, lovely people, they help to make it” (resident) • “I am very happy heer, it has a good atmosphere, its happy and the staff get on well. I get on with the managers fine and I can see them at any time” (staff member) Regular staff meetings had been taking place in the home since the new registered owners had taken over. Some residents could not recall any organised meetings in which they could participate and express opinions. The new owners had however consulted with residents about setting up a residents committee and had talked to individuals about their interests and matters of concern and had recorded their comments. The home’s commitment to promoting diversity was exemplified by recruitment and employment of staff from ethnic minorities. There was no system in place for monitoring the quality of the service the home provided at the last inspection of the home on 25th January 2005 and a date for implementing a system and producing an annual development plan for the home had been agreed as 31st December 2005. Due to the change in ownership of the home nothing had been put in place. The owner agreed that the original time scale for implanting a quality monitoring system would stand. It was suggested that quality monitoring could include among other things; audits of care plans and other statutorily required records; analysis of accidents; and audits of response times to the call system. Visitors of one resident stated that they dealt with her finances and that the home always provided them with receipts for any purchases or transactions made with money they left at the home to be used on her behalf. The home Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 24 looked after money for several residents and kept accurate records of all transactions. The balances of monies held accorded with the records. It was agreed at the previous inspection on 25th January 2005 that the home would have until 31st December 2005 to set up a suitable structure and programme for formal individual staff supervision sessions. The manager said that little progress had been made with this and it was agreed with the owner that the original timescale would stand and that this would be assessed again at future inspections of the home. At the last inspection of the home some records examined were incomplete or were not being kept. These included reports of visits undertaken by the home’s owner in accordance with Regulation 26(5)(b) of the Care Homes Regulations 2001. The new owners had completed all such required reports since they took over and had also submitted copies to the Commission for Social Care Inspection. Other records examined during the inspection were complete and up to date with the exception of staff and residents records. This was because photographs of the individuals were not available in all cases. This was brought to the attention of the manager at the last inspection and was a requirement in the report of that visit. It is therefore repeated as requirement on this occasion, as photographs are a helpful means of identifying a person in situations where this may be necessary e.g. missing person; administration of medication. It was apparent from discussion with staff and training records that all staff received regular training in most health and safety topics, including moving and handling. The new owners had purchased 7 new height adjustable beds for use in the home. These could reduce the risk of injury to staff from accidents and improve their working conditions as well as ensure that providing care for residents was made easier. Despite regular training in health and safety topics being provided by the home a member of staff preparing the evening meal in the kitchen who had worked in the home for some years said that she had not undertaken training in Basic Food Hygiene. All staff handling food should complete this training in order to reduce the risk of food poisoning occurring. A number of matters concerned with health and safety that had been identified at the last inspection of the home on 25th January 2005 and that required attention had been addressed. These included the installation of magnetic releases on doors leading into the communal rooms and in a corridor on the ground floor. This had improved access and movement for both residents and staff and this improvement was commented on by both residents and visitors. In addition hoists had been serviced and information obtained about hazardous chemicals used in the home. Some matters were however still outstanding and these were as follows; • Risk assessments for safe working practices in the home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 25 Tudor Lodge Nursing Home • Fire safety training and drills at the frequency and intervals recommended by the Fire and Rescue Service. The owner agreed to ensure that these matters were actioned including ensuring that all staff handling food had appropriate training and also the installation of warning notices about hot water on wash hand basins where the temperatures exceeded the recommended level. Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 26 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x 3 x x x x 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 1 x 3 1 2 3 Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 27 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 28 Regulation 18(1) Requirement The registered persons must ensure that a minimum of 50 of care staff working in the home are qualified to at least National Vocational Qualification level 2 The registered persons must implement a quality monitoring system in the home. The registered persons must ensure that all care staff receive at least 6 formal supervison sessions a year. The registered persons must ensure that all statutorily required records are complete and up to date. Specifically that records of staff and residents include a photograph of the individual (Schedule 2 paragraph 1 and Schedule 3 paragraph 2). The registered persons must: (1) Display warning signs on basins where the temperature of the hot water exceeds the recommended safe level: (2) complete risk assessments for safe working practices in the home; (3) arrange for all staff handling food to undrtake appropriate training in basic food hygiene. Timescale for action 31/12/05 2. 3. 33 36 24 18(2)(a) 31/12/05 31/12/05 4. 37 17 30/09/05 5. 38 13(4)(b) & (c) 30/09/05 Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 28 6. 38 23(4)(d) The registered person must ensure that all staff receive fire safety training at the frequency and intervals recommended by the Fire and Rescue Service. 30/09/05 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 29 Good Practice Recommendations It is recommended that the registered persons provide all staff with copies of the General Social care Councils Code of Conduct Tudor Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 29 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hampshire, SO15 1GW 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 Lodge Nursing Home H54 S63543 Tudor Lodge NH V231800 100605.doc Version 1.30 Page 30 - 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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