Inspection on 26/10/06 for Tudor Rose Rest Home

This inspection was carried out on 26th October 2006.

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 Rose Rest Home 30/11/09

Tudor Rose Rest Home 01/12/08

Tudor Rose Rest Home 19/12/07

Tudor Rose Rest Home 23/05/07

Tudor Rose Rest Home 20/06/06

Tudor Rose Rest Home 03/11/05

Tudor Rose Rest Home 09/08/05

Tudor Rose Rest Home 07/12/04

Tudor Rose Rest Home 13/07/04

Tudor Rose Rest Home 24/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Tudor Rose Rest Home 671 Chester Road Erdington Birmingham West Midlands B23 5TH Lead Inspector Ann Farrell Key Unannounced Inspection 26th October 2006 06:50 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 Rose Rest Home DS0000059825.V317129.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 Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor Rose Rest Home Address 671 Chester Road Erdington Birmingham West Midlands B23 5TH 0121 384 8922 0121 241 3507 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) Careplex Jackie Barrett Care Home 27 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (5), Old age, of places not falling within any other category (27) Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Employ a recognised care management consultancy service for the first 12 months following change of registration That the home can care for up to five service users in need of care for reasons of mental health problems (5 MD(E)). 20th June 2006 Date of last inspection Brief Description of the Service: Tudor Rose is registered to provide residential care for up to 27 persons for reason of old age with a maximum of five who may suffer from mental health illness. The property is a converted and extended domestic residence and the frontage blends well with the adjacent residential properties in the area. The premises are situated on a busy main road close to local shops and amenities. It is very conveniently situated for bus and rail services to Sutton Coldfield and Birmingham city centre. There is sufficient off road parking at the front of the building to accommodate three vehicles and further parking is available in nearby side roads. The majority of the accommodation is located on the ground and first floors; a shared room is situated on the second floor that has its own bathroom adjacent. There is a shaft lift that gives access to all floors and accommodates a maximum of two persons, but is not suitable for wheelchair users. This restriction in conjunction with the narrow corridors prohibits the home from caring for presidents who are wheelchair users. Communal toilets and bathrooms are strategically located throughout the home some of which are small and would not be suitable for residents with mobility problems. There are five double bedrooms and seventeen single bedrooms; all have wash hand basins and a call bell system. Communal rooms are situated on the ground floor and consist of two lounges and two dining rooms. There is a rear garden with out houses and a paved area with seating that residents and visitors can frequent during clement weather. Meals and a laundry service are supplied on site. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted over two days commencing at 6:50 am on the second day. This was the second statutory inspection for 2005/2006 and the manager was available for the duration of the inspection. During the inspection process the inspector toured the home, sampled residents files and other documentation. Case tracking was used to determine care from the time of admission to the home plus direct and indirect observation. During the fieldwork the manager, five members of staff two relatives and a visiting district nurse were spoken to. A number of residents were unable to communicate verbally and their views could not be obtained. Although the proprietor has undertaken some improvements to the environment since the last inspection there are still a number of areas that require attention. In addition, areas in respect of basic aspects of care such as hygiene, continence management and tissue viability needs to be addressed in order to demonstrate that resident’s needs are being adequately met. What the service does well: What has improved since the last inspection? The home has replaced some of the beds, bedding, pillows etc enhancing the environment for residents. There have been some improvements in the standard of cleaning and odour control reducing the risk of infection and enhancing the environment for residents. There have been some improvements in recording of admission documents, which can lead to improved care planning and have as positive impact on meeting resident’s needs. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tudor Rose Rest Home DS0000059825.V317129.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 Rose Rest Home DS0000059825.V317129.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information available for prospective residents and their relative’s about the services and facilities needs developing further to enable them to make an informed decision about moving into the home. The admission documents and risk assessments need further development as without these it cannot be guaranteed that residents needs will be identified and met prior to admission. EVIDENCE: The home accommodates residents on a long term or respite basis. They have updated the statement of purpose and service user guide to provide two separate documents. The service users guide is very brief and does not include the terms and conditions of accommodation or a standard from of contract. It was found that the contract had not been updated since the last inspection so residents are not clear about the terms and conditions of their stay. This will need to be reviewed in light of the amended regulations that came into force in September 2006 and a copy made available with the service Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 9 users guide. When the document is reviewed it is recommended that alternative formats be considered e.g. large print so that it is more accessible to residents. A copy of the statement of purpose was forwarded to the Commission following the last inspection and it was found to be lacking in detail in some areas so that it does not provide adequate details about the facilities and services provided. Three new residents have been admitted to the home since the last inspection. A pre-admission document had been completed, but it had not been consistently signed and dated. There was noted to be some improvements in this area. Further work is required to provide more detail especially in relation to mental health problems so that residents and relatives are able to be confident that their needs will be met prior to admission to the home. Following admission to the home there was evidence of some risk assessments in respect of moving and handling, but none in respect of nutrition to provide staff with adequate information about resident’s dietary needs. It was found that the moving and handling record gave generalised details that were not specific to the resident. It referred to a hoist, but did not give staff information about when to use the hoist, the size sling etc and could put residents at risk if used by staff. The residents recently admitted to the home suffer with mental health problems. The home already has a number of residents with mental health problems or dementia. The registration only allows them to take five residents with mental health problems. The manager will need to review this aspect and formally apply to the Commission for a variation for any residents who are not included within these conditions. They should not admit residents outside their conditions of registration. At the last inspection it was stated that some staff had undertaken some basic training in respect of caring for people with dementia and further comprehensive training was to be undertaken. However, there was no evidence that any staff had undertaken this training. All staff working in the home must undertake training in caring for people with dementia and mental health problems to ensure they have adequate skills and knowledge to care for residents. Tudor Rose Rest Home DS0000059825.V317129.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Medication systems were not satisfactory and it could not be guaranteed that residents received the medication prescribed to them. Resident’s holistic needs were not being met consistently and areas of concern were not adequately dealt with in a timely manner to provide for their health and well being. Residents are not consistently treated in a manner that respects their dignity. EVIDENCE: The senior staff develop a care plan for all residents following admission to the home, which outlines how resident’s needs are to be met by staff. On inspection of a sample of records it was noted that there had been some improvements in the ones completed for the new residents. However, further work is required as there were still some vague statements about meeting resident’s needs. They had not been updated in some instances and on discussion with staff they were not fully aware of the contents of the care plan. The care plans for existing residents were unchanged and were of a poor Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 11 standard. Also there was no evidence that the resident or their representative were involved in the process so it could not be guaranteed that care was being delivered in accordance with their preferences. The staff have already had two training sessions in relation to continence management and at the last inspection a requirement was made to have further training. It was noted that the district nurses were visiting a number of residents and on inspection of their records significant shortfalls were found. When they visited dressing were not in place, staff were not aware of this and in one case staff were not aware that the resident had any dressings performed. Also dressings on some resident’s legs were found to be soiled with urine due to poor continence management. In one case the nurses records indicted the continence adviser did not know the resident and in another they found a resident had two incontinence pads in place. On the second day of inspection it was noted that there was only one size of continence pads available and a member of staff stated they did use two at one time, as they were small and they felt two were needed. This may contribute to tissue damage. During the inspection some residents had draw sheets on their beds, but these are not required if the appropriate size continence pads are used. On discussion with some staff they stated continence management was merely the use of pads. This indicates that the staff in the home are not managing continence problems or making appropriate referrals and it is concerning that such poor practice is in place. On inspection of another residents record it was noted that they had started loosing weight some time ago. The G.P. was called and the dietician visited. The dietician recommended action to be taken, but this was not included in the care plan. Upon review the resident commenced nutritional supplements, which were gradually increased. At the time of inspection a number of investigations had been completed and they were unable to determine the cause of the weight loss, but staff had stopped the nutritional supplements. This was concerning as the resident was below weight and there was no evidence that the staff had consulted health professionals. The issue was discussed with the manager and district nurse and it was recommended that a food chart should be commenced and the dietician was contacted to request a review, as on discussion with staff there was no evidence of any special diet or food boosters in use. At the time of the last inspection it was identified that some residents were not wearing shoes/slippers, one of whom was a diabetic and this puts them at risk. The reason given for not wearing any footwear was because their feet and legs were swollen. At the last inspection it was recommended that staff should Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 12 liaise with the district nurses regarding some footwear that could be ordered, but no action had been taken to address the issue. Records did not indicate that residents received regular personal hygiene. Staff stated residents were washed in the morning by night staff before getting up and in the evening before going to bed and there is a weekly bath rota. However, on some occasions baths had been refused and there was no evidence that staff returned at another time to suit the resident. Other records did not give information about bathing and some residents stated they had not had any baths. Also records from specialist nurses linked pressure area damage with poor hygiene. During inspection residents were poorly presented e.g. hair was not combed, spectacles were not put on, sleep was not removed from eyes, clothing was creased, some were not wearing stockings/socks or slippers/shoes and had been assisted in the morning. The manager will need to review the arrangements for attending to residents hygiene and ensure robust systems are in place for meeting hygiene needs and residents are well presented at all times. A member of staff had assisted one resident with washing and dressing and a dressing was falling off their arm suggesting a lack of attention to detail in respect of personal care. There needs to be more attention to detail with appropriate and effective management of hygiene and continence in order to meet resident’s basic needs. The handover at change of shift is informal and on discussion with staff they were not aware of aspects of care suggesting poor communication in the home. The manager will need to review the communication systems and ensure all staff are aware of residents needs, current interventions and any changes. All residents are registered with a local G.P. and there is input from district nurses, tissue viability nurse specialist, continence adviser and dietician, but advice is not always followed. The district nurses had left specific instructions with the staff in respect of pressure relief for some residents, but this was not included in the care plans and it could not be evidenced that the instructions were being followed so putting residents at risk of developing pressure sores. In one case staff were required to maintain a skin inspection and turn chart. It was noted that the skin inspection chart did not indicate the state of the skin and the turning chart did not indicate that pressure was relieved or the resident was turned regularly so increasing the risk of tissue damage. There ware also visits from the chiropodist and optician, but it could not be confirmed that these were occurring regularly or that residents have opportunity to see a dentist. All residents must have the opportunity to see a chiropodist, optician and dentist on a regular basis. If it is refused it must be recorded. Also there was no evidence available to demonstrate that chronic diseases are monitored regularly e.g. diabetes, asthma, hypertension etc. to ensure residents health and well being. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 13 During the inspection it was noted that one resident was sat in their bedroom and did not have access to a call bell. Systems must be in place for all residents to have access to a call bell when they are in their bedrooms to summon assistance. The home uses a monitored dose medication system and on inspection it was found that the monitored dose system was adequately managed. However, there were discrepancies in respect of the boxed medication. In one instance in could not be audited and it could not be guaranteed that residents received the medication prescribed. In one case a member of staff had given larger doses than prescribed, as the home did not have the correct dose in stock. Other areas that need to be addressed: • • • • • • • The medicine trolley needed cleaning. Creams were in use one month after opening. They should be dated when opened and discarded after one month due to the risk of bacterial infection. The amount of medication administered when variable doses were prescribed was not recorded so it could not be audited. Some medications were not currently prescribed. There was no written consent for flu vaccinations. The drug fridge was not locked plus the minimum, maximum and current temperature were not being recorded to ensure medication is stored at the correct temperature. It was not clear that all staff who administer medication had undertaken the accredited training as required under the National Minimum Standards. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The meals offered are not adequate in respect of amount, timing and choice and will need to be reviewed to ensure residents receive a nutritious diet. There are very limited opportunities for residents to engage in activities despite some development since the last inspection. EVIDENCE: Visiting is flexible enabling people to visit at a time that suits them. Activities and stimulation of residents remains very limited and since the last inspection there has been a visit by a donkey, which residents enjoyed. The manager has also purchased a ball and net, which she stated has been popular with residents. The manager stated there were plans to go to the lights in Walsall and have a pantomime for Christmas. However, there is little evidence to demonstrate that activities are based on individual’s interests or past hobbies etc. This area still needs a considerable amount of work to address the shortfalls and meet individual’s preferences. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 15 Residents were observed to be watching the television and some were in the dining room smoking during the day. At one stage a member of staff was observed talking to residents in one of the lounges, but there was little evidence of any other activities, as many of the residents were falling asleep in chairs when the lounges were entered. On discussion with some residents they stated they did get bored at times. On discussion with staff they stated all residents are up by 8am for breakfast. On the second day the inspector arrived at 6.45am and found 10 residents up. The night staff confirmed that all residents were up in the morning and currently they assist 17 residents getting up, as the remaining 5 are able to manage themselves. They stated they commenced getting residents up and 5.45am. The record for one resident indicated they were assisted up at 5am and they required two members of staff. Also another resident stated they were woken up between 5am and 6am. All residents are washed and in their bedrooms by 8pm when staff go off duty. There was no evidence that residents had any choice in respect of getting up and going to bed and this fitted in with the staff routine. This is not acceptable practice and was discussed with the manager who stated that she always felt the night staff have a hard shift. The manager must review this practice and ensure staff do not wake residents up early in the morning in order to conform with staff routines, as this is institutionalised practice. The home employs a cook who covers breakfast and lunch. There are three meals a day and the manager stated she has reviewed the menu since the last inspection, which provides a cooked breakfast at the weekend and a choice of meals in the evening plus special diets such as diabetic meals. It was stated some fresh vegetables had been introduced at the main meal since the last inspection, but it could not be evidenced that residents were receiving five pieces of fruit or vegetables per day in line with healthy living guidelines. Most residents take their meals in the dining rooms, but may have them in their own rooms if they wish. The dining rooms are situated on the ground floor adjacent to the kitchen. Staff were available and provided assistance as required. Breakfast and lunch were observed and residents were not given a choice. Menus indicated there is a choice of meal at teatime, but records of food did not demonstrate that any residents received an alternative to sandwiches. On discussion with residents some stated they did not get enough to eat; others stated they enjoyed the meals. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures in place and staff knowledge were adequate in respect of protecting residents. EVIDENCE: A copy of the complaints procedure was available on the wall in the main hall on entering the home for information. The manger stated they had received one informal complaint since the last inspection, which had been addressed. The Commission has received some concerns about the cleanliness of the home, staff approach, missing laundry, infection control and aspects of care. During the inspection it became apparent that laundry was mislaid, aspects of care were not adequate, infection control was poor and the deep cleaning needed more attention. Therefore the complaints are upheld. The home has a copy of the Multi-agency Vulnerable Adult Guidelines produced by the Local Authority, so that staff have information available to guide them in the event of an allegation of abuse being made. At the last inspection a requirement was made to update the whistle blowing policy to ensure staff were aware of contact details in the event of an allegation, but it had not been addressed. On discussion with staff they were aware of the action to take in the event of an allegation of abuse. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 17 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of areas need re-decoration and refurbishment to provide a safe and homely environment for residents to live. The standard of cleaning and infection control practices are not adequate to safe guard residents. EVIDENCE: The home is a converted and extended domestic residence over three floors. The corridor space and capacity of the shaft lift prevents the home from accommodating residents who are wheelchair users. The home was found to be warm and lit satisfactorily in some areas, but other areas appeared rather dim. The manager will need to review this aspect with residents and ensure all areas are lit satisfactorily to meet resident’s needs and reduce the risk of accidents. There is a large garden to the rear of the property, which residents use when weather permits. At the last inspection it was noted that the side of the property can be accessed and the ground is uneven and would pose a risk Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 19 to residents if they wandered into this area and this remains outstanding. A more secure gate should be fitted to ensure the safety of residents. On touring the home there was noted to be some improvement in the standard of cleaning, but further improvement is required in respect of deep cleaning to provide a clean environment. There are two lounges and two adjoining dining rooms on the ground floor, one of which is used for smoking when meals are not being served. The carpet in the small dining room is worn across the width and will need replacing as it poses a trip hazard to residents using the area. There are seventeen single bedrooms and five double bedrooms, which have a wash hand basin and call bell facility. The call bell and light were not accessible to the bed in some rooms so residents would not be able to summon assistance. Currently a re-decoration programme of the bedrooms is in progress, carpets are being replaced and over bed lighting fitted to enhance the environment for residents. Bedroom doors have locks to them enabling residents to lock their doors if they wish. However, there were no lockable facilities available for the storage of medication or valuables and rooms only had one double electrical socket for electrical items. During the course of inspection it was noticed that some of the furniture was unstable and of poor quality and will need to be replaced. Some of the bedrooms did not have a comfortable chair for residents to sit. A full audit of all furnishings must be undertaken and action taken to ensure all furnishings are in a good state of repair, rusting commodes must be removed, and residents must be provided with the furnishings outlined in the National Minimum Standards. Since the last inspection some new beds, privacy curtains and bedding have been provided. All areas are individually and naturally ventilated, but some of the restrainers on windows were broken and resident’s safety is compromised. A full audit of windows must be undertaken and any damaged restrainers repaired. Radiators are covered with guards and water from hot water taps is controlled to prevent the risk of scalding. There are a number of toilets strategically placed around the home, but some are rather small and would be difficult for residents to access with walking aids. Some of the toilets did not have toilet roll holders accessible for residents use and the lock on the ground floor toilet was not working. There are three assisted bathing facilities one of which has been upgraded to a walk in shower. Some of the floor tiles in the assisted bathing facility on the ground floor were damaged and the bath seat was not working adequately. The shower on the first floor had been repaired, but the water was cold and the water from the shower unit in the walk in shower was too hot and will need to have a thermostatic valve fitted to restrict the temperature of water to Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 20 reduce the risk of scalding to residents. There is a domestic style bath on the second floor. The bathing facilities do not meet the needs of residents. Since the last inspection liquid soap and paper towels had been fitted in some bedrooms for the purpose of staff hand washing where personal care is provided. However, some aspects in respect of infection control are poorly managed e.g. some staff were walking around the home with vinyl/latex gloves on. These gloves should be removed and hands washed after dealing with infected material or body fluids and staff were not aware of the use of various types of gloves, bar soap was in use, paper towels were not available in some areas for staff hand washing, commode pots were cleaned in the bath and waste bins did not have lids. Also some staff were not aware of the full range of infection control procedures for incidents of infection in the home. The manager stated they were waiting to have sluice facilities fitted at the time of the last inspection. The laundry floor has been patched since the last inspection. The manager stated they are to have a new laundry area with a planned extension. The manager will need to inform the Commission of the date for the new laundry facility. The laundry was found to be dusty and in need of cleaning; a supply of toiletries were found in a cupboard suggesting communal use. All toiletries must be labelled with the residents name to ensure that they are not used communally to reduce the risk of cross infection. Also the lock the laundry door needs to be replaced, as it is not adequate. On discussion with staff about the laundry system and use of the equipment it was found there was not a consistent procedure for using the washing machine, laundry was not separated at source, there were no alginate bags or similar for soiled items, there was only one suitable receptacle for collecting washing from residents bedrooms and staff were taking it to the laundry by hand. It was also noted that there was only three washing bowls in the home and residents who required washing in their bedrooms did not have an individual bowl. These procedures are not appropriate and will need to be reviewed. Soiled items must be washed on a sluice cycle in the washing machine. Where items are heavily soiled or infected they should be placed in alginate bags or similar and put directly in to the washing machine. The kitchen is situated on the ground floor and was found to be clean and orderly with a designated cook. Since the last inspection a second sink has been fitted and they are waiting to have a mesh fitted to the windows. Fridge and freezer temperatures were recorded and were satisfactory, but some sauces had been opened and had not been dated with a use by date. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment procedures need to be developed to demonstrate residents are adequately protected. Induction training is not adequate to ensure staff have the skills they need to meet residents individual needs. EVIDENCE: Currently the home has twenty-two residents and staffing rotas indicate there are three care staff and the manager on duty during the day and two care staff on duty overnight. Rotas also indicated that the manager and deputy manager always work the same shift. This is not good practice in respect of supervising staff and it is strongly recommended that this area be reviewed to provide an appropriate skill mix of staff. Catering, domestic and maintenance staff support care staff. The staffing levels appeared satisfactory for the dependency of residents. A small number of staff files were inspected for staff who had been employed recently. It was noted that an application form and references had been obtained. However, CRB or POVA checks had not been obtained until after the person commenced employment at the home and in one case there was no evidence of eligibility for a member of staff to work in this country. The manager has been sent a letter of serious concern and must ensure a robust Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 22 recruitment procedure in the future or the Commission may take enforcement action to safe guard individuals. Records of newly appointed staff did not demonstrate that the induction training for care staff met the standards of the Social Skills Council. There was no evidence of induction training for other grades of staff. Also night staff did not spend any time on day duty prior to commencing nights to learn about residents, routines, policies and procedures etc. to ensure they have adequate skills to support residents. Induction training for all grades of staff needs to be reviewed and developed and it is strongly recommended that night staff spend some time on day duty to orientate themselves to residents and the home. At the last inspection information provided indicated that 50 of care staff are qualified to NVQ level 2. This is concerning considering the number of shortfalls found in respect of basic care. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management systems need further development to ensure resident’s benefit from living in a well managed home. The provision of training and adequate supervision needs developing further to ensure resident’s health, safety and well-being is protected. EVIDENCE: A Registered Manager is in post and has completed the Registered Managers award. She is in the process of developing a quality assurance process and some staff, residents and relatives have completed questionnaires to provide feedback about the quality of the home. Health professionals have been invited to a meeting, but there has been no feedback from them to date. Some audits had been undertaken in respect of the environment and action taken following the last inspection, but there was no evidence of audits in Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 24 respect of other areas of the home and as can be seen in the report there are shortfalls in a number of areas. The manager was advised that she would need to undertake audits of all aspects of the home and draw up a development plan outlining improvements and indicate the outcomes for residents. The providers visit the home regularly; write a report and a copy is forwarded to the Commission in line with the regulations providing feedback about the conduct of the home. A sample of records were inspected in respect of the money and valuables held on behalf of residents in the home. There had been an improvement since the last inspection with receipts for expenditure and records balanced. There were no receipts for deposits and the record of valuables was not comprehensive to demonstrate robust management of resident’s valuables. Samples of records were inspected in relation to maintenance/servicing of equipment and were found to be up to date with the exception of the following, which will need to be addressed to ensure the safety of residents; • Some issues in respect of the passenger lift were outstanding and it was stated they were waiting for the company to obtain parts. • Some of the water from hot water outlets was above 50 degrees and action will need to be taken to address this to prevent the risk of scalding to residents. • Risk assessments were not viewed at this inspection, but were found to be in need of reviewing at the last inspection and the manager did not state they had been updated. Since the last inspection staff have undertaken training in respect of basic food hygiene and first aid. The manager stated training is due to be given in respect of tissue viability, continence, moving and handling and fire to provide staff with the knowledge required to meet residents needs. On discussion with staff about the fire procedures there was a mixed response and some were not appropriate putting residents at risk in the event of a fire. Training will also be required in respect of infection control in order that staff have the appropriate basic knowledge to work as carers in homes. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 25 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 2 2 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 2 2 1 1 2 1 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 X X 2 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 26 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. 2. Standard OP1 OP1 Regulation 4 5 Requirement The registered person must review and enhance the statement of purpose. The registered person must review the service users guide ensuring it is in line with the regulations providing adequate information for residents and their representatives. It must include a copy of the terms of conditions of residency. When completed copies must be made available to residents. Timescale not reached The registered person must review the contract of residence to ensure it accurately reflects the services and facilities in the home and a copy should be provided in the service user guide. Timescale of 30/7/06 not met. Timescale for action 30/11/06 30/11/06 3. OP2 5(1)(b) 30/11/06 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 27 4. OP3 14 5 OP3 OP7 14 6 OP4 12(1) The registered person must 30/11/06 ensure: • All assessments are comprehensive and fully completed to determine if the home can meet resident’s needs. • All assessment documents must include an assessment of mental health if the residents presents with and mental health problem. They must also be signed and dated by the member of staff undertaking the assessment. • Written confirmation that the home is able to meet needs must be sent to the resident or their representative. Timescale of 30/8/06 not met. The registered person must 30/11/06 ensure full risk assessments are undertaken on admission to the home to include a nutritional risk assessment and manual handling risk assessment. Timescale of 15/7/06 not met. The registered person must 30/03/07 ensure all staff undertaken training in respect of dementia care commensurate with their position in the home. Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 28 7. OP7 15(1)(2) 8 OP7 17(1) 9. OP8 13(1) 12(4) 17(1) 10 OP8 12(1) The Registered Person must: • Ensure a comprehensive care plan is drawn up for all residents outlining in detail the action to be taken by staff to meet resident’s needs. • The residents or their representative should be involved in the process. • Care plans should be reviewed every month and care plans updated to demonstrate any changes in care. Timescale of 30/8/06 not met. The registered person must ensure daily records indicate aspects of resident’s condition, follow up to any areas of concern and are based on fact. Timescale of 30/6/06 not met. The registered person must ensure: • There are systems in place for residents to see a dentist on a regular basis and records are retained in the home. Timescale of 30/7/06 not met. • There are systems in place for all residents to be seen by a chiropodist and optician on a regular basis and records are retained in the home. • All residents with chronic diseases such as diabetes, hypertension etc have regular checks and records are retained in the home. The registered person must ensure there are robust systems in place to meet residents personal hygiene needs and complications are reduced. 30/12/06 15/11/06 30/12/06 30/11/06 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 29 11 12 OP8 OP8 12(1) 13(4) 12(1) 13 OP8 12(1) 14. OP8 12(1) 23(2(n) 15. OP8 18(1) 12(1) 16 OP8 12(1) 17 OP8 12(1)(2) 18 OP8 12(1)(3) (4) The registered person must ensure all residents wear suitable footwear. The registered person must review all residents weight and where they are below average weight e.g. BMI 20 a referral is made to an appropriate health professional. The registered person must undertake a review of communication systems within the home and ensure all staff are fully aware of residents needs, interventions and any changes etc. Timescale of 30/7/06 not met. The registered person must ensure a call bell is accessible to all residents when they are in their room. Timescale of 30/6/06 not met. The Registered Person must ensure all staff undertake training in respect of the management of continence. Timescale of 30/7/06 not met. The registered person must ensure all staff undertaken training in respect of tissue viability. The registered person must ensure a more proactive approach to care with attention to detail. The registered person must review the arrangements for getting residents up in the morning, ensure residents are consulted and implement practices that are not institutionalised. 30/11/06 30/11/06 30/11/06 15/11/06 30/11/06 30/12/06 30/11/06 30/11/06 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 30 19 OP8 13(3) 20. OP9 13(2) 21 OP9 13(2) 18(1) The registered person must : • Review the practices for dealing with infections in the home and ensure all staff are fully aware of the precautions to take. • Ensure vinyl gloves are used by staff for dealing with continence problems and latex gloves are used for blood spills. The registered person must ensure there is a fully auditable and robust medication system to include: • The correct administration and recording of all medication. • All creams must be dated when opened and discarded after one month. • The drug fridge must be kept locked when not in use and the minimum, maximum and current temperature must be recorded on a daily basis. • All medication must be prescribed on a current MAR chart. • The dose of medication administered must be recorded when variable doses are prescribed. • Written consent must be obtained for flu vaccinations. Timescale of 30/6/06 not met. The Registered Person must ensure all staff who administer medication undertake accredited training and a record is retained in the home. Timescale of 308/06 not met. 30/11/06 15/11/06 30/01/07 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 31 22. OP10 12(1) 12(4) 23. OP12 16(2)(m)( n) 24. OP13 12(1) 12(3) 25 26 OP15 OP18 17(2) 13(6) 27 OP19 16(2)(j) 28 OP19 23(2)(b) The registered person must ensure systems are in place to maintain residents privacy and dignity e.g. the use of socks, stockings, and slippers/shoes, hair combed, spectacles in place, clothes neatly pressed etc. Timescale of 30/6/06 not met. The Registered Person must ensure all residents have access to a range of recreational activities to meet their needs, preferences; past lifestyles and cultural backgrounds and records are retained in the home to demonstrate this. Timescale of 30/8/06 not met. The Registered Person must ensure arrangements are in place to provide a person centred approach to care and residents are offered choices in various aspects of day to day living Timescale of 30/7/06 not met. The registered person must ensure a comprehensive record of food is retained in the home. The Registered Person must ensure: All staff have training in relation to adult protection procedures and clearly understand their role. The whistle blowing policy is updated. Timescale of 30/7/06 not met. The registered person must ensure mesh is fitted to windows in the kitchen and all sauces are dated when opened. The Registered Person must forward a plan of re-decoration and refurbishment to the Commission. Timescale of 30/7/06 not met. 30/11/06 30/12/06 30/11/06 30/11/06 30/11/06 30/11/06 20/12/06 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 32 29 OP19 13(4) 30 31 OP20 OP21 13(4) 23(2)(b) (j)(n) 32 OP24 16(2)(c) 12(1) 23(2)(c) 33 OP24 16(2)(c) 17(1) The Registered Person must ensure: • The area to the side of the building is made safe or access is restricted. • All out door store areas are secured. Timescale of 15/7/06 not met. The registered person must ensure the carpet in the small dining room is replaced. The registered person must ensure: • The damaged bathroom floor tiles are replaced. • Toilet roll holders are accessible to residents. • The locks on toilet doors are in working order. The registered person must ensure: • Lockable facilities are provided for all residents in their bedrooms. • Damaged commodes are replaced. • An audit of all furnishing is undertaken and any damaged or unsafe items are replaced or repaired. • Two double sockets are provided in bedrooms. Timescale of 30/7/06 not met. The Registered Person must ensure all residents have the furnishings outlined in the National Minimum Standards in their bedrooms. Where this is not provided records must be maintained to indicate the reasons. 20/12/06 30/12/06 30/12/06 30/03/07 30/11/06 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 33 34 OP25 23(2)(p) 35 OP26 13(3) 36 OP26 13(3)(4) 37 OP26 16(2)(k)2 3(2)(d) The registered person must ensure: • All lighting is satisfactory to meet resident’s needs and a light can be accessed from the bed. Timescale of 30/7/06 not met. • The temperature of water from all hot water outlets accessible to residents is 43 degrees plus or minus 1 degree. • Undertake an audit of all windows and ensure restrainers are fitted and in working order. The registered person must endure adequate infection control procedures: • Ensure all staff are aware of the correct use of the washing machine. • Bar soap should not be used in communal areas. • Toiletries must be labelled, when stored in communal areas. • Staff must remove gloves and wash hands after dealing with clinical waste Timescale of 20/7/06 not met. • Use appropriate receptacles for collecting laundry from bedrooms. • Use alginate or similar for soiled linen. • Residents must have individual washing bowls. The registered person must: • Replace the lock on the laundry door. • Advise the Commission when a new laundry will be provided. The registered person must ensure all areas of the home are kept clean at all times. Timescale of 30/6/06 not met. DS0000059825.V317129.R01.S.doc 30/11/06 30/11/06 20/12/06 30/11/06 Tudor Rose Rest Home Version 5.2 Page 34 38 OP26 13(4) 39 OP29 19 40 OP30 18(1) 17(2) 41 OP33 25 42 OP35 17(2)Sch 4 The registered person must ensure the cupboard used for the storage of cleaning materials is kept locked when not in use. Timescale of 30/6/06 not met. The registered person must ensure there is a robust recruitment procedure in place to include POVA and CRB checks plus work permit and visa is obtained prior to staff commencing employment and evidence is retained in the home. Timescale of 20/7/06 not met. The registered person must ensure all newly employed staff complete induction training that meets the standards of the Social Skills Council and records are retained in the home Timescale of 30/8/06 not met. The registered person must review the quality assurance process and ensure it is comprehensive and an annual development plan drawn up following feedback from stake holders indicating outcomes for residents and addressing any issues raised. Timescale not reached. The registered person must ensure: • All valuables are held in the secure facility and a record is retained in the home. • Receipts are available in the home for all transactions. Timescale of 15/7/06 not met. 30/11/06 30/11/06 30/01/07 30/03/07 30/11/06 Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 35 43 OP38 13 (4)(a) 44 OP38 13(3) 45 OP38 18(1) 17(2) The registered person must 30/12/06 ensure: • Risk assessments are undertaken in respect of cleaning materials etc. • General risk assessments are reviewed and developed. Not assessed and carried forward from 30/8/06. The registered person must 30/12/06 ensure the issues in respect of the passenger lift are addressed. Timescale of 30/7/06 not met. The Registered Person must 30/01/07 ensure all staff undertake mandatory training in respect of manual handling, and infection control and records are retained in the home. The Registered Person must ensure all staff undertake mandatory training in respect of fire prevention and at least two fire drills a year and records are retained in the home. 30/12/06 46 OP38 23(4) 17(2) Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 36 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. 3. Refer to Standard OP3 OP26 OP32 Good Practice Recommendations It is recommended that the home liaise with the social worker for a copy of their assessment. (Carried forward) It is recommended that the Health Protection Unit be contacted regarding the arrangements for cleaning of commode pots etc. (Carried forward) It is recommended that staff meeting are conducted more frequently and consideration given to meetings with residents/relatives. (Carried forward) Tudor Rose Rest Home DS0000059825.V317129.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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