CARE HOMES FOR OLDER PEOPLE
Tunstall Hall Market Drayton Shropshire TF9 4AA Lead Inspector
Pat Scott Unannounced Inspection 1st November 2005 11:20 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 Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tunstall Hall Address Market Drayton Shropshire TF9 4AA 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) 01630 652774 01630 658270 Guardian Care Homes (UK) Ltd Care Home 34 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24) of places Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate 34 service users of which a maximum of 22 beds may accommodate service users requiring nursing care. Of the total 34 service users, the home may accommodate 10 clients suffering from dementia. Care staffing levels must be maintained as: Up to and including 22 service users: 7am-2pm - 1 RN, 1 SNR and 2 CAs 2pm-9pm - 1 RN, 1 SNR and 2 CAs 9pm-7am - 1 RN and 1 CA Up to and including 30 service users: 7am-2 pm - 1 RN, 1 SNR and 3 CAs 2pm-9pm - 1 RN, 1 SNR and 3 CAs 9pm-7am - 1 RN and 2 CAs Up to and including 33 service users: 7am-2pm - 1 RN, 1 SNR and 4 Cas 2pm-9pm - 1 RN, 1 SNR and 4 CAs 9pm-7am - 1 RN and 2 Cas The Manager will be supernumerary as follows Up to and including 15 service users - 15 hours Up to and including 25 service users - 20 hours Over 25 service users - totally supernumerary An additional 15 hours per week will be included for an Activities Coordinator. 13th June 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Tunstall Hall is a large 19th Century building set in impressive grounds, which are surrounded by open countryside. The town of Market Drayton in North Shropshire is nearby and there are good road links to the larger towns of Shrewsbury and Telford and to the Potteries.The home is owned by Guardian Care Homes (UK) Ltd, a national organisation, which already operates a care home near Bridgnorth, Shropshire. Tunstall Hall is currently registered to provide accommodation and care, including nursing care, to 34 older people. Accommodation is in single or double bedrooms and there are large communal rooms including an imposing library. The home is without a registered manager at present although steps are being taken by Guardian Care to recruit one. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 1st November 2005 commencing at 11.20am. An announced inspection on 13.6.05 identified major shortfalls in the management and conduct of the home. Due to a lack of progress in meeting the requirements from that inspection, a meeting was held with Guardian Care on 20th September to give them opportunity to demonstrate its intentions to improve the service at Tunstall Hall. A revised action plan was received on 5.10.05. This unannounced inspection measured the adherence of Guardian Care to the timescales within the action plan. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records The risk assessment made following the outcomes from the last inspection which also took into account a complaint and adult protection issue determined the core standards focused on and depth of inspection on this occasion. This inspection also focused on a recent complaint received at the CSCI on 26.10.05 relating to care provision of a service user on respite stay. What the service does well: What has improved since the last inspection?
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 6 The objective to improve the standard of the environment for service users has commenced but has not been fully achieved. The action to be taken as detailed in the plan regarding maintenance and refurbishment has been partially achieved. Quotes have been obtained for refurbishment and overall redecoration of the building. The maintenance person for Tunstall Hall stated that this is planned to be carried out in the next 2-3 weeks. The action plan stated by 30.10.05. The action plan expects the redecoration to be completed by January 2006. Staffing within the home has been consistent with the legal requirement with the exception of two occasions both of which have been notified to the CSCI. The deputy manager is sending information to the regional office of Guardian Care regarding ‘residents at risk’. Accident/incidents and complaints. Incident reporting is improving in line with the requirements of legislation. The lack of a Regulation 26 report for October does not provide the CSCI with information as to how Guardian Care are dealing with this information. What they could do better:
The statement of purpose/service users guide is on display in the foyer of the home, which needs to contain copies of the most recent inspection report. The key must be the choice and the opportunity to exercise choice and this can only be achieved if full information is provided. What is found at the assessment process should be put into the service user’s plan. Details found in the plans were not in the initial assessment process and therefore this area needs to improve. The action plan detailed that full assessments will be completed for each service user utilizing new documentation by 30/10/05 but this had not been achieved. Although a new care plan format is in place the inconsistency in its completion shows that staff have not adhered to the action plan. The Commission will expect see evidence of compliance in all aspects of care planning following the audit of the system by the regional manager/support manager of Guardian Care due 30.11.05 as stated in the action plan. Service users regard the food they are given as one of the most important factors in determining their quality of life. It is important in maintaining their health and well being. Service users must be given a choice of food and care staff should assist individuals to eat in as sensitive and tactful a way as possible. Tunstall Hall need to improve training in aspects of food provision and nutritional needs of the elderly. The action plan has not been adhered to with regards to menu provision, chef training and kitchen cover. Complainants may make their complaints directly to the CSCI but they are not informed that they can do this in the statement of purpose.
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 7 An audit by the deputy manager has identified that staff training in many areas is lacking. None of the priorities for training have been organised or actioned by Guardian care as they stated would be done by 30.10.05. Nor is the home able to achieve the minimum requirements for NVQ 2 accreditation within 2005. This does not ensure that all staff are suitably trained to carry out the care and tasks to meet the needs of service users. This judgement is verified by a recently recruited member of staff stating that they had not had any training. Recruitment folders are still lacking in certain elements to demonstrate that good employment practice has been carried out. Robust recruitment is imperative to ensure that only suitable people are employed to work with vulnerable service users. Supervision of staff has not been maintained. Staff need to be adequately trained in order to carry out the care to meet services users needs. They need to be able to assess, plan, provide and monitor the outcomes of care for service users. Supervision is an important element which brings together all these practices and ensures that staff are competent to do their job and that competency is maintained. The report relating to the overview of the home’s conduct by Guardian care has been received for September2005 but not October 2005. This inspection identified that maintenance of aspects such as fire systems, electrical equipment, hot water temperature checks are in place. The lack of overall training and specific risk assessments for potentially dangerous areas (stairwell) shows that safe working practices are not owned for all members of staff. The outcomes of the complaint investigation have been included in the main body of the report. The overall failures of the home from recruitment of suitable people to their induction, training and supervision have resulted in the complaint being upheld. Staffing numbers were adequate but without the above in place, consistent and competent care was not provided for the service user on respite stay at Tunstall Hall. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 8 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. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 9 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 Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 The homes statement of purpose does not contain up to date details of the homes last statutory inspection report which does not enable potential and current service users to be informed about the regulatory conduct of the home. Omissions in admission assessments carried out by the home do not ensure that service users who move into the home have been thoroughly assessed which could result in needs not being met. EVIDENCE: The statement of purpose was in the foyer but did not contain the inspection report of 13.6.05. The deputy manager stated that it had been around in another folder which may have been moved by a service user. Pre-admission assessments carried out by the placing authority were seen on care files.
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 11 The home has been in the process of updating and improving the care documentation. Three assessments carried out on admission to the home were read of which one was a service user who had been in the home since 16.4.03, another since 19.8.05 and the third a respite client admitted on 5.9.05. The baseline observation of all three were incomplete regarding the initial weight of the service user, even though one was assessed in the nutritional risk assessment as having a poor nutritional intake. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The new care plan system in place does not consistently provide staff with the information they need to satisfactorily meet service users needs. Thus the health care needs of a service user have been compromised resulting inadequate care. EVIDENCE: At stated the care plan system is being overhauled with 30 out of 34 care plans now appearing in the new format. These are of a standard format with room to address service users personal needs and wishes. Individual risk assessments are conducted and recorded, for example, nutritional risk assessment and later weight monitoring in the plan of care, but the lack of initial record of weight on admission lets this care process down. A service user admitted on 19.8.05 had no baseline observations on admission and the first monitoring of weight was 29.10.05. Although the format is an improvement, it is not consistently completed (see standard 3 above) and there was no evidence of having consulted with service user relatives or supporters. It is acknowledged that this may be due to the attempt to get them quickly into place. Photographs had not been inserted in all care files.
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 13 Staff have not received care plan training. An element of the complaint received 26.10.05 included concern about the service user admitted for respite on 5.9.05 being discharged with three pressure sores on 19.9.05. The pre-admission assessment from the placing authority determined that the skin of this individual was intact but that they required pressure relieving aids to be used such as cushion and mattress and to be positioned properly whilst sitting in a chair. A letter from this persons supporter also gave information about the skin integrity and treatment used when at home. The daily records written regarding this person detailed the occurrence of two skin breaks and the treatment provided including nursing on alternate sides when in bed. The home failed to record an assessment of skin integrity. Knowing that the skin was fragile from the pre-admission information provided the home failed to record a plan of care for this individual on how they would manage the pressure area care. The home also failed to provide adequate detail regarding the wound status when breaks occurred and a plan of care as to how these problems would be address. This gave no direction to staff in the wound care to be carried out, the frequency of it and evaluation. Nor was there an initial pressure score risk assessment or one as the breakdown in the skin developed. Nor was there a record of pressure relieving equipment used for this person. Wound care was identified as a priority subject for training in May 2005 but has not been carried out. These are serious omissions which lead to the conclusion that this element of the complaint to be partially upheld. The service user went home with two pressure sores in place. Although some nursing intervention is recorded as having taken place, the lack of risk assessments and care plans showed that inadequate care was delivered to this individual service user. An element of the complaint was also that the service user became ‘withdrawn’. An entry in the daily notes reported that on 15.9.05 the service user was a ‘bit down’. No further reference was made or any detail provided as to how the staff should address this change in mood. This criticism that staff mishandled this problem is upheld. On a positive note, as from 7.10.05 staff now send a ‘resident at risk’ form to regional office that includes information regarding pressure damage to individual service users. A care file of a permanent service user receiving wound care had improved documentation regarding this care need. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 There is little evidence of service user choice with regard to meals, and the lack of appropriate training raises concerns as to how food hygiene is being promoted and whether the special dietary and nutritional needs of service users are being met EVIDENCE: Service users are provided with three main meals, plus supper, based on a four week menu. At present there is a choice at breakfast and tea and it was stated by kitchen staff that alternatives are offered at lunchtime (the main meal) if someone doesn’t like the planned meal. A service user asked about this, however, said that if one didn’t like the meal “it was tough”. The home needs to ensure that service users are aware of the choices available to them. It is intended that this will be promoted through introduction of new menus where choice is available at all three main meals which is planned for the very near future. People will be asked the day before what they would like to eat. None of the current service user group requires pureed meals but meat was minced for some people. Some people require assistance with eating and inappropriate practice was observed during the inspection which the manager stated was not usual conduct. Menu boards in the hall and dining room had not been completed but the very new cook said that was probably her responsibility and had been missed. As mentioned elsewhere, staffing
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 15 arrangements at present do not provide kitchen cover at all mealtimes. Staff who are working in the kitchen have not received food hygiene training, or training relating to nutrition needs of elderly people. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The complaint procedure is incomplete thus providing service users of inadequate information as to whom they can express their concerns other than the home. Staff have not been provided with induction and on-going training regarding adult protection. This does not provide staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: The home has a complaints procedure that omits to inform service users of the option to contact the Commission for Social Care Inspection. Complaint monitoring forms are sent on a weekly basis to the regional office of guardian care. One complaint has been received at the CSCI which was addressed during this inspection. A copy of the complaint was left with the deputy manager for their response to the Commission. No complaints had been received in the home. There is an adult protection issue in progress at present. The elements relating to the complaint of 26.10.05 that have been addressed during this inspection include: • Admission assessment of the home
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 17 • • • Service user being discharged with three pressure sores on 19.9.05. Lack of provision, monitoring and training for pressure area care. Neglected skin care. Service user became ‘withdrawn’ which should not have happened. Shortage of staff Other elements were contained within the complaint that are outside the remit of the Commission. A copy of the complaint was left with the deputy manager for investigation and reporting back to the CSCI within 21 days. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26 The intended investment will significantly improve the appearance of this home to create a comfortable environment for those living there and visiting. Equipment to ensure the health and safety of staff and service users is in place but could be improved further. EVIDENCE: The maintenance person is very aware of his role and keeps records of all remedial works carried out in the home. He stated that quotes for refurbishment and redecoration have been obtained and that an audit has been carried out on windows and furniture. The action plan timescale for complete redecoration is 5.1.06. A tour of the premises showed that the environment was clean, odour free and equipment to deal with the needs of dependent service users e.g. hoists,
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 19 handrails, and assisted bathrooms (one of which was in the process of being refurbished). Recommendations from the Shropshire Fire Service are in the process of being addressed. The Fire Authority are allowing a further 3 months for the home to address serious issues and will meet with the home in January 2006. The home does not have thermostatic sluice disinfectors on any floor and has stainless steel slop-hoppers in place. In order to fully meet the requirement that any necessary sluicing facilities are provided, the Proprietors must give an undertaking to upgrade all sluices to thermostatic ones. Soap dispensers are in place but the disposable towel holders are yet to be put up. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 The home has made little investment in staff development and the staff group are largely untrained or have not attended recent training The home’s procedures provide a safe framework for the recruitment of staff which needs to be followed consistently in order to protect service users Lack of training provision means that staff are not trained and competent to do their jobs, putting service users at risk EVIDENCE: The present staffing arrangements for the kitchen are such that two or three tea-times per week care staff are having to “cover” meal preparation in addition to their critical care duties. This situation is not consistent with the intention to provide choice of hot/cold alternatives at each meal time and does not fit comfortably with promoting hygiene and infection control, particularly when coupled with a lack of appropriate training. Staff rotas show that only on two occasions has the home been short of staff under that required by the conditions of registration. These have been notified to the Commission as they occurred under Regulation 37. The home is still unable to admit service users who require nursing care for their dementia.
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 21 The complaint of 26.10.05 questioned whether there had been a staff shortage that resulted in inadequate care to the service user. This was not upheld. Inadequate care has resulted because of a lack of training and supervision. Two staff have attained the NVQ2 accreditation and one has attained NVQ3. The home has not and will not achieve the 50 ratio within 2005. The home’s deputy manager has conducted a personnel file audit in October 2005 which highlighted shortfalls in the processes followed in the past. However, some significant shortfalls e.g. lack of any references, are in relation to people who have been employed at the home for over twenty years. Other identified shortfalls relating to more recent practice such as lack of photographs and not always having two written references, do require improvement. The manager is taking steps to make up the shortfalls, even for the “historic” issues. All files were identified as having evidence of interview, of CRB, of PIN and work permits (where applicable). CRB disclosures are now stored separately from the main personnel files. The file for recently appointed members of staff were seen and were satisfactory other than one lacked a second written reference (although a verbal reference had been sought) and both lacked photographs. The organisation needs to establish a process by which records are kept of discussions, assessments and decisions regarding appointment of staff when criminal convictions are identified. Training returns were seen for May 2005 and October 2005 and the home’s manager has conducted a training audit in line with submitted action plan. The May 2005 return identified that almost none of the 37 staff had attended moving and handling training, 1st Aid training, Food Hygiene training, Fire, Health and Safety or COSHH training. Since then 12 staff have attended moving and handling training (with another having already attended in February), 15 staff have attended Fire training and 7 have attended “dementia” training. No certificates or details of the course content were seen. The home’s manager was asked to identify priority areas for training in May but none of the priorities identified, including wound care, have been actioned by the organisation. Neither of the kitchen staff on duty on the day of inspection have attended Food Hygiene training, the kitchen assistant having been in post since February 2005. The only wound care training seen on records was that the Deputy Manager attended a tissue viability course in 1997 and a lecture on wound care in 2003, as did another of the trained staff. The action plan from the previous inspection stated that training would be organised on health and safety, infection control, POVA, customer care and marketing – this has not taken place. An induction programme in line with NTO requirements has recently been established. The orientation programme for the newest recruit to the home had been started but only the first two basic elements had been completed, so although having been in post for a month, elements relating to the building, residents, basic care, health and safety, and staffing had not been signed off,
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 22 although an appraisal had been conducted some three weeks after appointment – in which the employee states that she has had “no training”. An element of the complaint received 26.10.05 referred to the possible lack of training of staff that possibly resulted in a lack of skin care to the service user in question. This is upheld. The complaint also made reference to lack of observation and monitoring and implementation of the care history provided by the complainant. This part of the complaint is upheld. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36, 38 Staff are not appropriately supervised which has a detrimental impact on the standard and consistency of care provided within the home EVIDENCE: The home does not have a registered manager in post and steps are being taken by Guardian Care to recruit a suitable person. In the meantime arrangements have been made for managerial input. These personnel are available to speak with service users, staff and relatives. A staff meeting is due to take place on 2.11.05. Not all supervision records were available, but the home’s manager stated that staff supervision had not been maintained. It is essential that a commitment to this process is made to ensure that training, when provided, the care planning process and key working all come together to improve outcomes for service users. It is suggested that a matrix which simply records date of
Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 24 supervision and signed off by both supervisor and supervisee is maintained overall for monitoring purposes. The lack of training overall means that that safe working practices are certainly not in place for all areas mentioned in standard 38. The maintenance person stated that fire drill training is set to improve but there is not evidence of this as yet. The fire risk assessment of the premises is complete and has been approved by the Fire Authority. The upgrade to the L1 system is almost complete. The magnetic hold open devices to the kitchen fire doors do not work and parts are being obtained. Although these doors were seen to be closed, a wooden wedge was on the floor by them. Fire alarm tests are carried out weekly except when the maintenance person is away. There was a gap in alarm testing for 3 weeks whilst this member of staff was on holiday. Portable and fixed electrical equipment has been tested and 101 faults identified. Priority is being given to urgent works to be completed. Although the deputy manager stated quotes for stair gates to the main staircases have been obtained they have not been erected yet and neither is a risk assessment regarding this hazard in place. A regulation 26 visit and report into the conduct of the home by Guardian Care has been received for September 2005 only. This is required to be sent to the Commission each month. Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 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 x 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 1 1 1 1 X X 1 1 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x x x x 1 x 1 Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 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. Standard OP1 Regulation 4, 5 Requirement The home must revise its Statement of Purpose and service users guide to include the most recent inspection report and information on how to contact the CSCI in the event of a complaint. (Outstanding from October 2004) The assessment process must be documented in full. (Outstanding from 13.6.05) Care plans must display a photograph of the service user. They must have evidence of service user/supporter involvement. (Outstanding from 13.6.05) Staff involved in food preparation must be provided with food hygiene training. Menus must offer a choice of meals (Outstanding from 13.6.05) Staff offering assistance with eating must do so discreetly and sensitively To respond in writing to the Commission regarding the complaint of 26.10.05
DS0000059307.V263809.R01.S.doc Timescale for action 17/11/05 2 3 OP3 OP7 14(1) 15(2), 17(1)(a) sch3 09/12/05 09/12/05 4 5 6 7 OP15 OP15 OP15 OP16 12(1)(a) 16(2)(i) 12(4)(a) 22(3)(8) 09/12/05 09/12/05 11/11/05 02/12/05 Tunstall Hall Version 5.0 Page 27 8 9 OP15 OP19 16(2)(i) 23(4) 10 OP19 23 11 OP25 23(2)(b) 12 OP26 23(2)(k) 13 OP26 13 (3) 14 OP28 18(1)C 15 OP27 18 16 OP29 19(5) 17 OP30 18(1)(a)C 18 OP38 18 (1)(a)(c) Training relating to nutrition of the elderly should be provided The home must continue to comply with the requirements made by the Fire Authority within their agreed timescales. The home must ensure that all outstanding maintenance, refurbishment and redecoration work is completed. Window frames must be repaired as per the findings of the window audit carried out by the Guardian Care. The home must install three sluicing disinfectors, one on each floor of the home. (Outstanding from December 2004) Paper towel dispensers must be fitted at all hand washing facilities. (Outstanding from November 2004) The home must provide an action plan as to how it intends to increase its levels of care staff trained to NVQ2 to 50 The management team must address issues of staff recruitment and retention in order to provide continuity of care. The home must obtain two written references before appointing staff (Outstanding from 13.6.05) A staff training and development plan must be put in place which ensures that staff are equipped with basic skills and can meet the needs of service users. (Outstanding from December 2004) Staff records must show they have all received appropriate mandatory training to maximise safe systems of work. (Outstanding from 13.6.05)
DS0000059307.V263809.R01.S.doc 09/12/05 31/01/06 31/01/06 31/01/06 30/05/06 09/12/05 17/11/05 28/02/06 11/11/05 17/11/05 09/12/05 Tunstall Hall Version 5.0 Page 28 19 20 OP38 OP38 26 13(4) Reports detailing the conduct of the home must be sent to CSCI on a monthly basis. Risk assessments must be in place regarding the main stairwells. 11/11/05 11/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tunstall Hall DS0000059307.V263809.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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