Inspection on 01/02/06 for Tullyboy Homes

This inspection was carried out on 1st February 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tullyboy Homes 05/09/06

Tullyboy Homes 14/09/05

Tullyboy Homes 11/01/05

Tullyboy Homes 19/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Tullyboy Homes 2 Inlands Close Pewsey Wiltshire SN9 5HD Lead Inspector Tim Goadby Unannounced Inspection 1st February 2006 11:10 – Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 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 Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tullyboy Homes Address 2 Inlands Close Pewsey Wiltshire SN9 5HD 01672 562124 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) Tullyboy Homes Mrs Catherine Howie Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2005 Brief Description of the Service: 2 Inlands Close provides personal care and accommodation for five adults who have a learning disability. The home is owned by Tullyboy Homes, a private sector organisation. They run another similar establishment in Wiltshire. Both owners have close involvement in all aspects of service delivery. One of them is also the registered manager for Inlands Close. The house is in a residential area, close to the various amenities available in the large village of Pewsey. The service has been open for over ten years. All five current residents have lived there since it opened. All service users have single bedrooms. Most of these are on the ground floor. There is one bedroom upstairs, which has an en-suite shower. There is a bathroom for general use downstairs. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in January 2006. A total of 3.5 hours was spent in the home. The following inspection methods have been used in the production of this report: indirect observation; pre-inspection questionnaire, completed by the provider; sampling of records; sampling a meal; discussions with service users, staff and management; tour of the premises. The two homes operated by Tullyboy were both inspected on the same day. Findings have been applied to both services, where appropriate. What the service does well: Service users can be confident that the home meets their needs and aspirations. Inlands Close is an established service, which has cared for the same group of people since it was first set up. All five service users were at home for at least part of this inspection. Direct access to their views is difficult, because of the nature of their impairments. But all appear settled and confident in their surroundings. The service has developed a detailed knowledge of individual characters and preferences. Strategies are in place to deliver support around these. The home is particularly strong on caring for people’s health needs. The group of users have a variety of issues requiring support. Specialist input has been accessed, where appropriate. There is effective monitoring and review of care, involving all relevant professionals. For developing needs, and deteriorating conditions, there is clear forward planning about the best ways to respond. Service users benefit from the focus on promoting and maintaining the best health possible, enhancing their quality of life. The organisation has good management systems. The owners have close daily involvement with all aspects of the service, applying their own expertise in relevant areas. There are two registered managers within Tullyboy Homes, both qualified to the appropriate level. Another carer is also taking on additional responsibilities, and is working towards a more senior role. Service users benefit from a well run home. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standards relating to admissions to the home were not applicable at this inspection. Service users have their needs and aspirations met by the home. EVIDENCE: There have been no new admissions to the home since 1993. It is therefore not possible to rate practice under the relevant standards. The organisation has relevant procedures, which have been applied in its other home. Inlands Close has regular input from a range of professionals. They assist the home in meeting the various needs of its residents. A range of support is offered to the user group. There is ongoing assessment and planning in place, to adapt to the developing needs of particular individuals. Reference is made to steps that would be taken if the service ever felt unable to meet someone’s needs. The home’s staff have undertaken various training courses in techniques and principles that are of direct relevance to their daily work with residents. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. The key standards in this section were met at the previous inspection. EVIDENCE: Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 16 & 17 Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Daily lives for service users have an appropriate balance between necessary routines, and individual choice. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: When people are not attending daytime occupation or education, the home ensures that they get one to one input. This enables them to undertake activities. Weekly plans are drawn up. These ensure that all service users get equal access to opportunities, and allocate the staff members who will support them. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 11 Residents at Inlands Close make full use of the range of amenities on offer in Pewsey itself. They also travel further afield to participate in leisure opportunities that reflect their particular interests. The home has its own vehicle. At home, users have access to entertainment equipment in their own rooms. There are also a range of games, puzzles, and books available. Outside the home, users attend some local clubs specifically intended for people with learning disability. They also access a full range of integrated activities. People participate in physical exercise, including swimming and trampolining. All users receive the opportunity of an annual holiday, escorted by staff. These are done in small groups. Some people may only go for short breaks, if they find it difficult to cope with longer periods of absence from familiar surroundings. Holiday destinations have included trips overseas. There is generally unrestricted freedom of movement for residents. They are expected to respect the privacy of each person’s own bedroom. A limited number of areas are kept locked, for particular health and safety reasons. External access is also made secure overnight. Care plans show the reasons for such steps. There are guidelines on the morning routine for each day of the week. These vary, depending on which service users have to go out. The times that people need to get up are specified, where necessary. Inlands Close has always been found to have a pleasant, homely atmosphere. Positive interactions amongst residents and staff are the norm. There is no sense of barriers between the two groups. All meals are prepared by staff of the home, in line with the known needs and preferences of the service users. Staff receive training in food safety, and the home has recently obtained some updated information on this topic. Menus show that a variety of dishes are served. None of the current residents have any particular special dietary needs, but the advice of a dietician has been obtained on occasions. Some people use adapted cutlery and crockery. An occupational therapist has advised on the most suitable items for the relevant individuals. The household usually dine together. There is a separate table in the conservatory which is sometimes used by one person if they prefer to do so. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20 Service users are supported to address their health care needs effectively. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The home has been proactive in ensuring that the health needs of users are identified and addressed. Staff have worked hard to challenge and overcome negative images that may have been associated with people with learning disability in the past. They promote people’s rights to receive necessary treatment. There have been successes in the resolution of some long-term difficulties. A range of professional advice is sought in relation to all the needs of the user group. Some innovative approaches have also been tried. Health needs continue to develop for the group. These may be linked to natural ageing processes, or to the particular conditions that people have. There is ongoing monitoring and review of care. As well as responding to situations as they arise, the home plans ahead for likely future changes. This includes ensuring that staff receive training on any relevant topics. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 13 Since the previous inspection one service user has had operations on both eyes. Due to careful preparation by the home, to get the person ready for this delicate treatment, the operations appear to have been successful. One service user is to be monitored overnight for a short period, via the use of a web cam, to obtain information about a particular health need. Relevant professionals have been involved in drawing up a suitable protocol for this practice, showing that the ethical and legal implications have been taken into account. The observation is being kept to the minimum necessary. None of the present service user group are self-medicating. So staff are involved in storage, administration and recording of any prescribed drugs. They receive training after they have been in post for six months. Concerns about practices in the management of medication arose at recent inspections of Inlands Close, leading to the setting of a number of requirements on this topic. The CSCI’s pharmacist inspector conducted an additional inspection of the home in November 2005. This found that significant improvements had been made. Requirements for clear documented proof of prescribing instructions; and for clear guidance on the criteria for administration of medicine prescribed to be given ‘as required’, had both been met. One remaining requirement relating to medication was for administration record charts to contain all relevant details, to ensure that medicines are administered in accordance with prescribed instructions. This is also now met. At this inspection, all service users’ current medication administration record charts were checked. No problems were identified. There is guidance for staff which instructs them in the need to be clear about key information, such as times and doses. One good practice recommendation remains on this topic, which is for the use of any different administration systems to documented. For one drug, the home is making up a week’s prescribed doses from the packages supplied by the pharmacy. This step has been implemented in response to identified difficulties in spotting the difference between the two strengths of tablet which are prescribed for different times of day. This additional step in the administration process is not being recorded. The practice should be carried out and signed for by two people. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Service users are placed at risk by a failure to notify allegations of staff misconduct to the CSCI. EVIDENCE: A complaints procedure is in place. There is a version with symbols and photographs, intended to be more comprehensible for service users. A complaint was made to the service in January 2006 regarding an allegation of misconduct by a staff member. This was dealt with by the organisation’s internal processes, which upheld the complaint. The matter was not notified to the CSCI, as is required under care standards legislation. At the end of January 2006 the CSCI was contacted directly by another complainant, to raise concern about the organisation’s handling of the above matter; and about a number of other issues relating to the conduct of the home. These complaints have been put to Tullyboy Homes for their response. The organisation has taken appropriate steps to arrange for investigation of the matters raised. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 Service users live in a comfortable, clean and safe environment, suitable to their needs. Service users have suitable adaptations and equipment to promote their independence and quality of life. EVIDENCE: All areas of the home were seen during this inspection. The premises present as well maintained. There is evidence of regular and ongoing redecoration. One of the owners is able to carry out a number of jobs himself, having relevant professional qualifications. Other contractors are engaged as necessary. Records are in place regarding the upkeep of the building. These note problems identified, set timescales for action, and show when they have been resolved. The main desire of the service is to maintain a homely feel. This has been achieved. Periodic audits of the home are carried out. These identify any tasks to be addressed. Over the past year the home has had a new oil tank, and had all electrical wiring renewed. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 16 Each service user has their own bedroom. Four of these are on the ground floor. All rooms are decorated and furnished to reflect the taste of their occupant. The first floor bedroom has an en-suite shower. Downstairs there is a bathroom, and also an additional separate toilet. Areas of communal space are all on the ground floor. There is a main lounge with dining area. A conservatory in the part of the house linking the original building with an extension has also been turned into a seating area. The enclosed rear garden has a patio which is often used during the summer. Inlands Close has a kitchen, which has recently been completely refitted. There is a separate utility room. A staff office and sleep-in room, with en-suite shower and toilet, is on the first floor. Various adaptations and equipment have been provided for service users with sensory and mobility impairments. Relevant professionals have been involved in providing advice on the most suitable options for each individual. The home was seen to be clean and hygienic throughout. The property has also had a recent environmental health officer’s inspection, which identified no concerns. Records are kept of cleaning schedules, and audited as part of the overall quality assurance process. Care staff carry out all cleaning and household tasks. The approach has recently been reviewed so that more of these are carried out during the week, leaving weekends more free to undertake activities with service users. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 34 Service users are supported by suitable numbers of staff. Service users are protected by effective recruitment practices. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 18 EVIDENCE: Inlands Close was registered under previous legislation. So it must not regress from the staffing levels in place as of 31st March 2002. A minimum of two staff per shift is always maintained during daytime cover. Whenever possible, this is increased to three. Additional staff are provided when this is required, to facilitate particular activities. On the day of this inspection three staff were on duty. One person remained in the home whilst others escorted service users on various outings, such as shopping and swimming. Overnight cover consists of one person, who sleeps in. They have access to senior staff, via an on-call rota. There is a mixture of full and part-time staff. Some people work set shift patterns. These vary depending on individual’s circumstances. There is also a pool of relief staff, and agency cover may be used when necessary. There is a checklist for all stages of recruitment, selection, and joining the organisation. This is closely linked to the home’s quality assurance system. Sampled records showed that all required checks are carried out, at the appropriate times. New starters do not commence working until satisfactory clearances have been obtained. Service users have informal involvement in the recruitment and selection of staff, as candidates visit the home. All new starters are subject to an initial probationary period of six months. This may be extended, if it is felt that an employee has not yet demonstrated the necessary competence or conduct. Additional supervision arrangements are then put in place. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 Service users benefit from a well run home, with clear leadership and involvement from senior figures. EVIDENCE: Tullyboy Homes has two registered managers. Both work in both of the homes operated by the organisation. They are each qualified to the required levels in both care and management. In addition, one has a professional background in learning disability nursing. Although not practising in this setting, she has maintained her registration through regularly updating her knowledge. The managers attend a range of courses and conferences. Tullyboy Homes is also a member of organisations concerned with developments in the social care field. Usually these two senior staff will alternate the weeks when they focus on Inlands Close. The other week will be spent in the organisation’s other care home. However, they are available for advice and support when required. The access to two well qualified managerial staff is of advantage to the service. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 20 One carer at this home is now studying towards the NVQ Level 4 award, and taking on additional responsibilities. The intention is that this person will also be able to offer managerial support to both services. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 N/A 3 3 4 N/A 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 4 3 X 4 X X X X X X Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 22 No 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 YA22 Regulation 37-1g Requirement The persons registered must notify the Commission without delay of any allegations of misconduct by any person who works at the care home. Timescale for action 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA41 Good Practice Recommendations The use of a different administration system for one medicine should be documented on the medication administration record. Records should contain objective descriptions of behaviours, and ensure clear cross-referencing when details about significant events are held in more than one place. COMMENT: This recommendation of the previous inspection was not checked on this occasion. Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Tullyboy Homes DS0000028632.V281723.R01.S.doc Version 5.1 Page 24 - 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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