Inspection on 13/06/05 for Tunstall Hall

This inspection was carried out on 13th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tunstall Hall 18/08/09

Tunstall Hall 17/02/09

Tunstall Hall 20/04/07

Tunstall Hall 15/12/06

Tunstall Hall 20/06/06

Tunstall Hall 24/01/06

Tunstall Hall 01/11/05

Tunstall Hall 25/08/04

Tunstall Hall 13/05/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

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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 TUNSTALL HALL MARKET DRAYTON SHROPSHIRE TF9 4AA Lead Inspector JANET ADAMS 13 TH Announced JUNE 2005 09.30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service TUNSTALL HALL Address MARKET DRAYTON SHROPSHIRE TF9 4AA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01630 652774 01630 658270 GUARDIAN CARE HOMES (UK) LTD CARE HOME 34 Category(ies) of 10 DEMENTIA - OVER 65 YEARS OF AGE registration, with number 24 OLD AGE of places TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 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. 2. Care staffing levels must be maintained as: Up to and including 22 service users:7am - 2pm 2pm - 9pm 9pm - 7am 1RN, 1SNR & 2 CAs 1 RN, 1SNR & 2 CAs 1 RN & 1 CA Up to and including 30 service users:7am - 2pm 2pm - 9pm 9pm - 7am 1 RN, 1SNR & 3 CAs 1 RN, 1SNR & 3 CAs 1 RN & 2 CAs Up to and including 33 service users:7am - 2pm 2pm - 9pm 9pm - 7am 1 RN, 1SNR & 4 CAs 1 RN, 1SNR & 4 CAs 1 RN & 2CAs 3. 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 4. An additional 15 hours per week will be included for an Activities Co-ordinator. Date of last inspection 25th August 2004 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 Manager of the home is Mrs Sheila Lovatt who is a first level registered nurse, who was recently promoted to this position . The staff team, which has male and female members, consists of qualified nurses, care staff and ancillary staff, some of whom have achieved NVQ levels 2 and 3. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and commenced at 9.30am lasting till late afternoon. The Area Manager for Guardian Care Homes, Gaynor Harding and the acting manager, Sheila Lovatt and staff on duty were welcoming and helpful throughout the inspection. Since the last Announced Inspection in August 2004, the home has been inspected on three other occasions, on 16th December 2004, 28th January 2005, and 2nd February 2005, to investigate a complaint, and issues raised by the fire service as well as following up the progress of statutory requirements made following the August inspection. Copies of all of these additional visits are available to the public upon request. As part of this announced inspection, comment cards were circulated to residents, relatives and visiting professionals so that their experiences of Tunstall Hall could be included in this report. It was obvious a lot of preparation had been undertaken to make sure all information needed was available, and the details the home provided to CSCI (Commission for Social Care Inspection) before the inspection was most worthwhile. On the inspection day, information was gathered in a variety of ways, which included observing activity within the home, inspecting the premises, looking at records, ‘case tracking’, talking and listening to residents, their visitors and staff who held a variety of roles and responsibilities. What the service does well: It was obvious that a friendly, sincere rapport existed between residents, visitors and the various staff team members. Residents were observed being spoken to respectfully and attentively throughout the inspection. A small core of staff that have worked at the home for a long time have tried to make sure they deliver the care the care that the people need despite working additional hours to achieve this. Several comments received from relatives expressed their gratitude about this. A written comment received from visitors confirmed that people were ‘well fed’ and cared for. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Responses from resident’s relatives and staff members were unanimous that the home was short of staff. As a result of looking at the team rotas and discussing this with the Area Manager and acting manager, and many other people visiting and working at the home, the inspector was compelled to issue a Immediate Requirement notice in order for the home to take action to improve the numbers of staff on duty, especially during the day. Recent reorganisation of senior management within the company has had an obvious impact on staff morale. Restructuring of the senior management of Guardian Care has caused more uncertainty with the management team at the home, as people are concerned the company will not be providing the support they expected. The area manager commented that she was working the last week of her employment with the company, - all Area Managers in the company had been made redundant. This uncertainty has filtered through to relatives, who expressed concerns that although recent fees have increased twice, staff shortages were increasing. The home also needs to show that staff are getting the training they need to do their job. After a tour of the home it was disappointing to see that many projects to upgrade and improve the surroundings either had not been finished or had been carried out without the consideration of the residents wishes. It was reported by one relative that the bathroom nearest to her mother’s bedroom had been out of use for nearly a year, and as a result has had to reluctantly resort to the indignity of having a commode in her bedroom. Four written comments were about the unsatisfactory laundry service provided in the home, which must be improved. Health and Safety arrangements, including fire safety were also seen to be an area of concern, despite assurances given on the day of the inspection, these will be closely monitored in the near future. Many residents and their relatives did make comments that communication in the home could be improved. Several people wrote comments that there was a language barrier between staff recruited from overseas, and during discussion with relatives, they commented that when there were a few family members TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 7 enquiring about the same person living at the home, they did not always get the same information as other family members, which was an area of concern. As many individuals who live at the home have dementia type illness, and are unable to relay information to staff and their family members, the home management team must prioritise this situation to be improved as soon as possible. Out of 33 statutory requirements made since last August, when looking at the information received about the home from a variety of sources it was a matter of concern to see that only a fraction of these had been fully met. This showed that conditions at the home had deteriorated since the visits by inspectors in January and February of this year. This is no longer acceptable and CSCI will now consider action to make sure permanent improvements can be achieved at the home. 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 CS0000059307.V196330.R01.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, &3. Information provided to help potential residents of Tunstall Hall make their mind up and decide if the home would suit them, needs further development to ensure people have all the necessary information about the home. Further specialist assessment for residents with dementia related illness is required to assure individuals needs will be met. EVIDENCE: The home Statement of Purpose and Service User Guide dated June 2005 was looked at. It was seen that some information had not been included in both documents. For example, the Statement of Purpose did not have the number and size of rooms listed, and it did not contain the correct details about the Managing Director or the qualifications of the person registered as the Responsible Individual for the home. Although the service user guide had most of the information, it never had a summary of the most recent inspection report. Neither documents had information to guide people how to contact the local social services and health care authorities. The specialist assessment form used to make sure the home could look after a person with dementia related illness properly was not seen in any care records TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 10 looked at, this needs to be introduced in order for the home to show they can meet the needs of everyone moving into Tunstall Hall. Although many people spoken to felt the home was caring for their relative well, the written information needs improving to reflect this. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, 9 &10. A care planning system is not fully in place to adequately provide staff with the information they need to satisfactorily meet the service users needs, nor fully assure people that staff know how to fully deliver the care they require. EVIDENCE: Care records for four residents were looked at including those for individuals with dementia, and continence challenges as well as those of a resident, who had recently had a fall at the home. Records had not been personalised with enough information about the people or their medical conditions to reflect how those people needed to be looked after. It was seen that a requirement made at an earlier inspection, “The home must ensure that the all aspects of the health of those residents with dementia are monitored and promoted effectively in accordance with current practice. Had not been met. All care plans seen for persons who needed assistance to manage incontinence did not give staff written guidance the resident agreed to what type of aids such as pads and bed protectors were needed for different times of the day and night. After talking to relatives it was seen that information about their family member was not written down to give enough detail for staff to look after the person. For example, the ‘mobility’ part of the care plan of a resident who gets TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 12 walked every day by a visitor did not have this information written in it. One r elative recalled that the person he visited at Tunstall Hall had experienced two falls- this was not detailed in the falls risk assessment part of the care plan. It was clear that the residents had not been fully involved with the care plans, and some relatives of residents with dementia related illness expressed dissatisfaction of not being involved in this process as well. It also appeared staff do not sell themselves in writing about the care they deliver. One lady who was seen to get regular checks during the night did not have this detail written down as part of her sleep management. Daily reports did not detail how residents needs had been met. The care plan of the person who was injured as a result of a fall did not have a specific plan to manage this. It was seen in the daily report that pain relief had been given, but when her medication administration record was looked at, it did not have any painkillers prescribed on it. Also it was seen that the falls risk assessment for the lady had not been reviewed after the fall to make sure the person was not at risk of falling again. This was an area of concern as the person suffered facial injuries and as a result her vision was affected by the swelling she experienced. Although staff were seen to attempt to maximise privacy and dignity for residents as part of their daily routines, this was compromised when the downstairs toilet was seen used, as the door cannot be closed, it was reported a person has to use the toilet with the door open and a screen in place. A lady also has had to resort to using a commode in her bedroom due to the fact the nearest bathroom to her bedroom has been out of use for almost a year. Several comments about laundry were received from concerned relatives and residents themselves. The clothes did not come back clean enough, and one resident commented she didn’t like to see someone else wearing her clothes. Another commented that she had to wear a pad, as the staff did not have time to take her to the toilet. One visitor takes laundry home due to the lack of confidence in the home’s laundry service. Some service users seen at the inspection had some stains on their clothing. The laundry assistant was seen despatching resident’s clean clothing to their bedrooms. She was seen using a wheelchair for this purpose, and the clothes, which were on hangers, were seen to be getting creased due to the plastic crates of clothes stacked on top of them. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14, &15, Social activities seen organised for the residents at the home do not provide the stimulation to meet peoples needs, choices or expectations. Some of the meals provided at Tunstall Hall have little evidence that residents are offered quality or choice. EVIDENCE: Visitors were seen coming and going throughout the inspection. It was obvious that a friendly, sincere rapport existed between visitors and the various staff team members. Residents and staff talked to both inspectors about daily pastimes in the home. Although the home has an activity organiser the person has only been in post for a fortnight at the time of the inspection and was reported to be still settling into her role. It was confirmed that she would need to undertake additional training in order for the activity needs for everyone living at the home could be met. It was seen that an activity programme was posted up on the notice board for June and July which listed only 10 various activities such as a pamper afternoon and painting. Discussions with residents confirmed there had been no outings lately, and there is no in house entertainment.Another resident confirmed she gets ‘cheesed off’ as the days can seem so long. The acting manager confirmed the activity budget was still being looked into. In the dining room, the tables were seen to be beautifully set with damask cloths and fresh flowers. Many responses from residents and relatives were TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 14 complimentary about the meals. The menu supplied to look at was seen to have a variety of nutritious food from which to choose what to eat for breakfast lunch and tea. No supper was listed. Also a relative wrote in to CSCI to state that the teatime menu was not provided as it was written down. It was commented that more often than not residents don’t get a choice of hot meal at teatime, as pre- prepared sandwiches were being regularly provided. Discussion about this with some residents confirmed this to be the case, although they were served cheese on toast for tea on the inspection day. It was seen that for residents on a soft diet, choice was not offered, as food was seen all blended together thus preventing any stimulation of appetite and enhancement of tastes and flavours. This practice must cease. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, &17 Concerns or complaints are dealt with promptly and professionally. Efforts are made by the home to ensure residents legal rights are protected. EVIDENCE: The home has a clear complaints procedure, which is explained in the homes statement of purpose, which is given to all prospective service users or their family/representative before moving into the home. The complaints log was seen to have been completed appropriately, however the latest complaint known to CSCI was not logged in it. This was discussed with the area manger at the time of the inspection and rectified. One relative spoken to was fully aware of the complaints procedure and how to make a complaint if they needed to. They were satisfied that any issues taken to the manager were dealt with correctly. Residents spoken to also commented that they had used postal votes at the last election. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,24,25,26 Although Guardian Care embarked on refurbishment of the home, this has been put on hold with the result that there are a number of serious matters outstanding. These put people at risk and do not provide safe and comfortable surroundings for everyone to live and work. EVIDENCE: Although some parts of Tunstall Hall offer homely comfortable, surroundings, this was not seen to be consistent throughout the home. Many works reported as needed to be carried out at the Announced Inspection of August 2004 had still not been completed ten months later. This is not acceptable. CSCI will be taking further action to ensure this is in hand as a matter of priority. Attempts to remedy some issues have not been effective and have resulted in residents not being happy with their lifestyle at Tunstall Hall. For instance, in an effort to reduce the number of flies coming into the building in the communal areas, it was seen that voile had been attached to the window frames with ‘Velcro’ hook and loop tape. This had resulted in residents not being able to enjoy the glorious countryside views, and was a TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 17 topic of dismay for many people. Although the library had been designated as a smoking area for residents, it was seen that the small ‘tobacco extractors’ were not effective for the size and expanse of the room. It was seen that the sash windows were still being propped open with books, although this issue was raised to be remedied in August 2004. The peeling paintwork on some of the internal windows have deteriorated so much that they posed as splinter risks. Several bathrooms and toilets were either out of use or not fit for the job they were meant for. For example Bathrooms 1 and 6 had a signs up saying work in progress. It was confirmed that a relative’s comment about them being out of use for almost a year was accurate. One of these bathrooms was open and had been left in a dangerous state should a resident wander in to it. This was closed off at the time of the inspection. Sharp edges from broken tiles and split bath panels seen in other bathrooms were a cause for concern. Lavatories were seen to require toilet roll holders, and carpeting to these areas meant they posed a challenge to clean. One bath was seen to be full of continence pads, and the condition of two bath seats meant they were not fit to use. However, a shower room was seen to have been refurbished. Although some bedrooms were seen to be furnished to a good standard and personalised to suit the residents ’s tastes, some were seen to be furnished with poor quality furniture. Many bedside cabinets were seen to be very worn. Some residents did not have locking storage in their rooms. One bedroom was observed to have an unpleasant smell, and an armchair and a commode were seen to be stained with body waste in other bedrooms during the home tour. However, it was pleasing to be informed that the home had acquired eight new nursing beds lately. Creams seen in communal cupboards were seen to pose an infection control risk, as did a clinical waste bin, which was located in the corridor, and to be accessible by residents. It was pleasing to see that the staff had alcohol hand rub to disinfect their hands between tasks, although there was no liquid soap seen in dispensers – including one in the sluice. It was confirmed that requirement made for a sluicing disinfector to be installed had not been done. The laundry was still seen in need of an upgrade, as the poor condition of the sink, pipe works and flooring challenged cleaning tasks. A container seen used to soak clothes in was stated to contain Milton. This was not labelled or dated. The person working in the laundry said it was the responsibility of a colleague to make up the solution. This system needs to be reviewed as it challenges COSHH regulations. It was confirmed by the Environmental Health department that the home had complied with the requirements made by the time of their second visit. The home has been inspected twice in recent months by the fire service many requirements have been made, including the need for a fire risk assessment for the home. It was reported at the time of the inspection the home had not received the report of May 2005, as it had gone to Head Office. Discussion of this whilst at the inspection confirmed that the matter was in hand and several recommended actions had already been undertaken. However it was seen that a fire door had been secured shut by a plastic tie wrap – this was not acceptable and was removed immediately. The passenger lift was seen to be working satisfactorily, TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 18 although there was no emergency instructions inside, and there was no handrail for residents to hold onto whilst the lift was in motion. A requirement made at the inspection of August 2004,to have the home assessed by an occupational therapist had not yet been carried out. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. The training, supervision, deployment and number of staff available is not sufficient to meet the need of the residents at all times. EVIDENCE: When the duty rotas for the week of the inspection and the week after the inspection were looked at, several staffing shortfalls were seen. In one week of duty rota there was a shortage of staff for the late shift for 5 out of 7days. This information confirmed responses from residents, relatives and staff who felt the staffing levels were low. Two people commented that upon visiting the home residents were seen unsupervised for long periods of time. Upon discussion of this matter with the area manger and the acting manager, it was confirmed that agency staff could not be used, as there were unpaid agency bills. Furthermore, it was confirmed that although RGN’s at the home were willing to fill in carers vacancies, the acting manager was not allowed to authorise this. It was also confirmed that an incentive to get staff to cover shifts had been stopped by the new senior management team. Staff morale was reported to be low due to recent changes in terms of employment. One relative commented ‘they do need more staff, the staff are very good what are there, but they are overworked Another wrote. ‘Tunstall Hall continues to suffer the problem of staff shortages. The fees have recently increased to support better staffing and client comfort, but all care staff and kitchen staff have had their hours cut and are still expected to carry out the same duties. The staff are under constant TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 20 pressure which leads to resignations and rapid staff turnover. Guardian Care Management fail to listen to their overworked staff and client relatives. The above statement reflects the need of the company to explore quality assurance in the home more effectively. An Immediate Requirement Notice was issued on the inspection day in order to ensure the home was adequately staffed at all times. The manager was made aware that she needed to remain supernumery in order to have the time to get appropriate staff cover for the home, until such a time there were no shortfalls in the rota. Likewise, in the absence of the manager, the deputy was to remain supernumery in order to get staff cover. It was also confirmed that despite a requirement made at a previous inspection, that that the Deputy Manager continued to work all her ‘hours on the floor’ Examination of the most recent staff files demonstrated that poor recruitment procedures had been followed, including concerns that staff had been started to work at the home without criminal records clearance checks being carried out. Records seen to recruit an overseas staff member did not contain evidence that any employment history had been confirmed, or photocopies of references being validated. Examination of five staff files, including new members of staff and a longstanding member of staff showed lack of information about training. As well as mandatory training, the home must provide training to staff in specialist areas, which are considered to be appropriate to the homes category of registration. It was confirmed that staff members are expected to pay for any training other than the mandatory training. Some supervision records indicated this was in the process of being carried out for staff members. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 &38 Some practices in the management of the home do not promote and safeguard the health, safety and welfare of individuals living and working at Tunstall Hall. EVIDENCE: Written comments received from relatives confirmed that the acting manager Sheila Lovatt, a qualified nurse, was a well-respected individual. CSCI and staff concerns were raised as to whether she would get the support she needed from the company, bearing in mind the recent changes in the reorganisation of Guardian Care Homes. Feedback from various staff members and some relatives (based on their own experiences) confirmed that there was a lack of confidence in the ‘Senior management’ of the company. It was confirmed that following reorganisation the manager would have more responsibility in the home. There was not a business and financial plan available for inspection, and when accounts were discussed it seems that although the home has ‘comfort funds’ including £300 raised at Xmas paid into head office, the home management team had not been able to access it. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 22 As recorded earlier, it was seen that staff training records need to be improved to evidence they receive all health and safety training. It was pleasing to hear that many had attended recent fire training held. All information provided to CSCI before the inspection about necessary safety checks and servicing were looked at on site at the home and most was satisfactory. However, it was seen that the Legionella risk assessment needed to be updated to ensure the shower heads are managed properly, and that the water temperatures are checked weekly. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 1 2 1 2 x 2 2 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 2 2 x x x 3 x 2 TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 24 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 OP1 Regulation 4 Requirement The home must revise it’s Statement of Purpose to include all of the information detailed in subsection 1.1 of Standard 1 (NMS OP) and in Schedule 1 of the Care Homes Regulations 2001 (Previous timescale of October 2004 not met) The home must produce a Service User Guide which contains all of the information detailed in subsection 1.2 and 1,3 of Standard 1 (NMS. OP). Previous timescale of October 2004 not met) The home must ensure that the all aspects of the health of those residents with dementia are assessed in accordance with current practice. Prior to their admission. Care plans must have evidence of residents involvement or, in the case of people with dementia related illness a named representative for that person. Timescale for action 10/10/05 2. OP1 5 10/10/05 3. OP3 14 10/10/05 4. OP7 13 (2) 10/10/05 TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 25 5. OP7 13 (2) Care plans must have falls risk assessments up to date with history of any falls experienced, with a reactive management plan to make sure falls risk will be minimum. Service user plans must contain evidence all appropriate risk assessments including those for falls, nutrition and moving and handling are reviewed at least monthly as well as after any incident or ACCIDENT that has affected the wellbeing of the individual. Service users with continence challenges must have details of all equipment/aids used identified in their care plan to maximise their independence. Service User plans must be reviewed to ensure that they clearly identify all needs and action to be taken. The plans must show evaluation, improvement and deterioration. The home must ensure that the all aspects of the health of those residents with dementia are monitored and promoted effectively in accordance with current practice (Previous timescale of October 2004 not met) Medication administration records must clearly show any medication given to a resident. Continence aids must not be used for residents for the convenience of the staff. 12/09/05 6. OP7 15 (1)13 (1)13(4) 12/09/05 7. OP8 16 (2)(c) 12/09/05 8. OP8 15 (1) 15 (2) (B) 12/09/05 9. OP8 15 (1) 15 (2) (B) 15/08/05 10. OP9 13 (2) With immediate effect With immediate effect 11. OP10 12 (4) (a) TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 26 12. OP10 12 (4) Toilet facilities provided in the home must be improved to meet the residents needs to maximise privacy and dignity. The home must arrange leisure and recreational activities which suit the needs, preferences and capacities of all service users. 12/09/05 13. OP12 16(2)(m) (n) 15/08/05 14. OP12 16(2)(m) (n) Up to date information about 15/08/05 recreational and leisure activities must be made available to all service users in formats suited to their capabilities. All residents at Tunstall Hall must have evidence that they are involved in their mealtime choices, including those on soft diets. Any menus introduced must be a true reflection of the meals that are served. The home must ensure that all residents know they can have supper if they wish. The home must comply with the requirements made following the fire officers inspection of December 2004 Previous timescale of March 2005 not met) The home must comply with the requirements made following the fire officers inspection of May 2005. Fire exits must not be secured shut by any means other than that recommended by a fire safety officer. 15/08/05 15. OP14 12.(3)16 (i) 16. OP15 16 (i) 15/08/05 17. OP15 16 (i) With immediate effect 15/08/05 18. OP 19 23(4) 19. OP19 23 (4) 12/09/05 20. OP19 23 (4) With Immediate effect TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 27 21. OP19 23 The home must ensure that all outstanding maintenance and refurbishment work identified throughout the inspection report of 25/8/04 is completed (See Standards 19, 22, 24, 25 and 26) Screening that deters flies but still retains the views of the home must be installed in the communal lounges in the home. Effective smoke extracting equipment must be installed in the smoking lounge All bathrooms and toilets which are halfway through refurbishment must be completed. The toilet facilities on the ground floor must be improved to meet the needs of the current residents. All damaged tiling must be replaced. All bath panels must be in sound condition and not pose any risk to residents. Toilet roll holders must be installed in all toilets. Flooring in lavatories must be readily cleanable. 10/10/05 22. OP20 16 23 (2)(p) 12/09/05 23. 24. OP20 OP21 13(4) 23 (2)(j) 12/09/05 12/09/05 25. OP21 23 (2)(j) 12/09/05 26. 27. OP21 OP21 23 (2)(j) 23 (2)(j) 12/09/05 12/09/05 28. 29. 30. 31. OP21 OP21 OP21 OP21 23 (2)(j) 23 (2)(j) 23 (2)(j) 23 (2)(j) 12/09/05 12/09/05 The two bath seats not fit for use 12/09/05 must be replaced. All furniture in residents bedrooms including commodes must be kept in a clean, safe condition. With immediate effect TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 28 32. OP22 23 (2) (n) The home must be assessed by an Occupational Therapist with specialist knowledge of the needs of service users with sensory and cognitive impairment. (previous timescale of November 20004 not met) 12/09/05 33. OP22 16 Facilities, and communication 12/09/05 aids must be provided which is appropriate to people with sensory impairment or dementia. (previous timescale of November 20004 not met) The lift must be fitted with emergency signage and any appropriate handrails. The furniture provided in bedrooms must be in good order and suitable to the needs of individual residents. There must be no unpleasant smells in residents bedrooms. Each resident must be provided with lockable storage space unless a recorded risk assessment indicates otherwise. (timescale of November 2004 not met) All sash windows must be in good working order so they can be opened without being propped open by books etc. Window frames must be repaired to minimise the risk of splinter injury. The home must install a sluicing disinfector (previous timescale of december 2004 not met) CS0000059307.V196330.R01.doc 34. OP22 23 (1) (a) 15/08/05 35. OP24 16 12/09/05 36. OP24 13 (3) With immediate effect 12/09/05 37. OP24 16 (2)(l) 38. OP25 23(2) (b) 10/10/05 39. OP25 23 (2) (b) 10/10/05 40. OP26 16 10/10/05 TUNSTALL HALL Version 1.30 Page 29 41. OP26 16, 13 (4) Clinical waste bins must not be kept in areas accessible by residents. Creams for residents personal use must not be stored in communal bathrooms or cupboards. With immediate effect With immediate effect 42. OP26 13 (3) 43. OP26 16 The home must seek advice from 15/08/05 appropriately qualified persons on controlling fly nuisance. (previous timescale of October 2004 not met) Liquid soap and paper towel dispensers must be fitted at all hand washing facilities.. ( Previous timescale of November 2004 not met) The laundry must be upgraded to provide readily cleanable surfaces including the sink and flooring. The current system for soaking clothing in Milton must cease An alternative method to do this task must be implemented. The home minimum staffing levels must not be lower than the current CSCI staffing notice. 15/08/05 44. OP26 13 (3) 45. OP26 13 (4) 10/10/05 46. OP26 13 (4) With immediate effect With immediate effect. Immediate Requireme nt notice issued on inspection day. 12/09/05 47. OP27 18(2) 48. OP27 18 The management team must address issues of staff recruitment and retention in order to provide continuity of care. (Timescale of December 2004 not met.) CS0000059307.V196330.R01.doc TUNSTALL HALL Version 1.30 Page 30 49. OP27 18 The management team must have systems in place to ensure that staffing levels are determined according to service users changing needs. (Timescale of December 2004 not met) 15/08/05 50. OP27 18(2) CSCI must be informed if staffing With levels are below those on the immediate current CSCI staffing notice. effect Until such a time all shifts are fully staffed, two weeks in advance, the manager must remain supernumery in order to pursue this. The home must ensure recruitment practices are robust and fully embrace Schedule 2 to include employment history being explored. With immediate effect 51. OP27 18 (2) 52. OP29 19 With immediate effect 53. OP30 18(1)(a)(c The home must ensure that all ) grades of staff receive additional training in the care of people with dementia which is appropriate to their roles and responsibilities. (Timescale of December 2004 not met) 18(1)(a)(c A staff training and development ) programme must be developed from individual training needs profiles which takes account of the particular requirements of service user groups. (Timescale of December 2004 not met) 18(1)(a)(c The deputy manager must have ) agreed supernumerary hours to support the manager and provide effective cover in her absence. (Timescale of December 2004 not met) 12/09/05 54. OP30 10/10/05 55. OP31 With immediate effect TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 31 56. OP32 21 The higher management team must establish effective lines of communication with staff, residents and their relatives/representatives. (Timescale of December 2004 not met) Quality Assurance activities must take account of the views of all categories of service users, their relatives/representatives and other stakeholders in the community. (See subsection 33.7 standard 33 NMS OP) (Timescale of December 2004 not met) A copy of the homes business and financial plan must be forwarded to the CSCI. (Timescale of December 2004 not met) The home Legionella risk assessment must be updated to ensure showers are included, and that water temperatures are tested weekly. Staff records must show they have all received appropriate mandatory training to maximise safe systems of work. 15/08/05 57. OP33 24 10/10/05 58. OP34 25 15/08/05 59. OP38 13 (4) 15/08/05 60. OP38 18 (1)(a)(c) 10/10/05 61. OP38 23 (2)(b) The company must submit a 15/08/05 timebound schedule to confirm how all necessary works to improve Tunstall hall will be met. The laundering service in the home must be improved to ensure residents get all of their clothing back in a clean, well presented condition. With immediate effect. 62. OP10 12 (4) (a) TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 32 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 OP28 OP20 OP26 Good Practice Recommendations A minimum ratio of 50 trained members of staff (NVQ Level 2 or equivalent) is achieved by 2005. The owners should develop the gardens of Tunstall Hall to enhance the quality of life of the residents. The manager should request an infection control audit from the Community Infection Control Nurse Specialist. TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 33 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn SHREWSBURY SY2 5DE 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 TUNSTALL HALL CS0000059307.V196330.R01.doc Version 1.30 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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