Inspection on 15/12/06 for Tunstall Hall

This inspection was carried out on 15th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 20/06/06

Tunstall Hall 24/01/06

Tunstall Hall 01/11/05

Tunstall Hall 13/06/05

Tunstall Hall 25/08/04

Tunstall Hall 13/05/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Tunstall Hall Market Drayton Shropshire TF9 4AA Lead Inspector Pat Scott Key Unannounced Inspection 15th December 2006 10:00 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.V297002.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 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 www.guardiancaregroup.co.uk Guardian Care Homes (UK) Ltd *** Post Vacant *** Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31) of places Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of Thirty-One (31) service users. The home may accommodate a service user under the age of 65 years. Date of last inspection Brief Description of the Service: Tunstall Hall is a Georgian house that sits on the outskirts of the Shropshire town of Market Drayton. It stands in three and a half acres of grounds surrounded by mature parkland. There are good road links to the larger towns of Shrewsbury and Telford. The home is owned by Guardian Care Homes (UK) Ltd and provides accommodation and personal care. Guardian Care Homes (UK) Ltd make their services known to prospective service users in: The Statement of Purpose, Company Brochure and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. Tunstall Hall’s Service rates are reviewed annually and service users are notified one month in advance. The only additional charges to service users are for hairdressing and newspapers. Fees for Tunstall Hall as of 15th December 2006 are: £304.15-£420. All service users pay monthly by standing order usually two weeks in advance and two weeks in arrears. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. As some service users accommodated have varying types of dementia outcome judgements are based more on observation and written evidence. Service user views are recorded where appropriate. What the service does well: What has improved since the last inspection? The provider has been working towards introducing systems, to address shortfalls to meet the national minimum standards at previous inspections, so that the outcomes for service users in all areas of care are improved. In particular, the manager has delivered significant change in staff recruitment, training and induction. The home no longer provides nursing care. The manager has liaised closely with service users and their families to discuss change and the effect it will have on the service the home provides. These areas have been managed sensitively with due regard to service user involvement. The standard of décor and furniture and fixings has also significantly improved. This, together with the commitment to an on going maintenance regime has improved the health and safety for service users and staff. Service users spoken with welcomed the changes and felt that staff were more attentive to their individual needs. They also welcomed the chance to be involved in the home and liked to know what was going on. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 6 Records required by regulation for the protection of service users and for the efficient running of the business are better maintained, stored securely, up to date and accurate. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Key Standards 1.2.3.4. Prospective residents and their representatives do not have all the information needed to choose a home which will meet their needs They have their needs assessed and a contract which tells them about the service they will receive but lacking full detail about the fees. EVIDENCE: At previous inspections, the admission process was more process driven and not particularly personalised with little extra consideration of individual requirements. The manager consults the assessment information to see if the home can meet the prospective service user’s needs before they make the decision to accept the application for admission and offer a placement. Records seen at this inspection showed that the admission of new service users takes into account the individual needs, concerns and anxieties of the prospective service user Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 9 and their families. The manager has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the service users. Staff training to ensure that they have the necessary skills and ability to care for residents who are admitted is improving. The provider has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides basic information about the service. These documents are reported by the manager to be made available to service users in a standard format with an additional brochure. They were not on display in the home at this inspection. A copy of the service user guide was faxed over from head office. It does not contain recent CSCI inspection findings or comments and experiences of residents living at the home. The complaint process does not detail the fact that the home now has a named manager who can be approached re concerns/complaints, nor does it provide timescales for dealing with a complaint. The guide does not comply with the changes in the Care Home Regulations as amended in September 2006 with regard to fees and third party arrangements. Service users are provided with a statement of terms and conditions before admission to the home. It gives information on what service user can expect to receive for the fee they pay and sets out terms and conditions of occupancy. It does not include the fee when a third party is paying in whole or part. This is still outstanding from the inspection June 2006. A service user spoken with stated that she was satisfied with the information she and her family had received. She knew how much was to be paid and when it was due. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 7.8.9.10 The health and personal care, which a resident receives is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Three care plans were examined. These include the basic information necessary to plan the individuals’ care and include a risk assessment element. There was recorded evidence of updating information and changing actions in the care plans. This aspect has improved with the input of staff training. An example of a social care review undertaken demonstrated that the service user had significantly improved since being at Tunstall Hall. Service users have access to health care services that meet their assessed needs both within the home and in the local community. Service users have access to dentists, opticians and other community services. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 11 The service users’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and generally is able to provide the aids and equipment recommended. There is written evidence in the care plan of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. The home has a medication policy which is accessible to staff. Medication received, administered and disposed of is recorded. A number of gaps were noted on the MAR charts and hand transcribed prescriptions had not been signed by two staff members for accuracy. These were also variable in the clarity of direction to staff for administration, as some did not provide information about the dose, route of administration or frequency which is unsafe. The manager has been working towards improvement in this area and has accessed accredited training which staff are working through. The manager reported that staff will have a refresher workbook to work through every six months to ensure competency is maintained. Staff were seen to be aware of the need to treat residents with respect and to consider dignity when delivering personal care. Service users can enjoy the privacy of their own rooms. Service users spoken to stated they were happy with the way that most staff deliver their care and respect their dignity. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key Standards 12.13.14.15 Residents are able to choose their life style, social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Staff spoken with demonstrated their awareness of the need to plan the routines and activities of the home in a way which meets the choice and wishes of service users. The home tries to be flexible and now attempts to provide a service which is more individual by using its staff and resources effectively. Service users are consulted on how the home can work to provide them with a flexible lifestyle, and they have been able to make some changes which help to achieve service users’ wishes. A significant example of this is that the manager has introduced regular meetings for service users/families/supporters to provide a forum where they can air their views. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 13 Service users are given the opportunity to take part in a variety of activities both within the home and in the community; these are arranged by staff after consulting with service users. The service attempts to consider the preferences of the majority of its service users but may not always please everyone. The home now has an activity coordinator for 15 hrs a week. The home has open visiting arrangements and service users spoken with knew that they could entertain their family and friends in their own room. If they prefer they can use communal areas of the home to talk to visitors and some private areas can be used. The food in the home is of good quality, well presented and meets the dietary needs of residents. The cook has basic food hygiene training, consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. Service users are able to choose to eat in their own room if they wish. Regular drinks and snacks are available. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 16.18 Residents have access to a complaints procedure but lack of detail regarding this would not assure people that their complaint would be appropriately dealt with. Service users are protected from abuse and have their legal rights protected. EVIDENCE: The service has a complaints procedure which is explained in the service user guide. The complaint process does not detail the fact that the home now has a named manager who can be approached re concerns/complaints, nor does it provide timescales for dealing with a complaint. This does not meet the national minimum standards and regulations. The complaints procedure was visible within the home. Links with external agencies are satisfactory and include the CSCI, police and adult protection teams. Service users and others associated with the home state that they are satisfied with the service provision, and feel safe and supported. A concern regarding care delivered to a deceased service user had been brought to the attention of the CSCI. The care plans and accident records were seen for this individual. It is considered that appropriate care had been provided for the service user. However, the CSCI should have been sent Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 15 regulation 37 notifications for the service user in relation to the death. The complaint log detailed that two complaints had been made to the home and that the service had provided written responses regarding all issues. A recommendation was made regarding the daily notes in the care plans. Staff should document communication between individuals very clearly so that should a query arise at a later date the records can resolve this. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key Standards 19.26 The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: Guardian Care Ltd has provided resources to significantly upgrade the home. It now has a rolling programme that has improved the decoration, fixtures and fittings. Service users can personalise their rooms. There is a choice of lounge areas and a large dining room. Service users stated they are comfortable, the home is clean, warm, well lit and there is sufficient hot water. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 17 The home is clean and tidy, and there have been no outbreaks of infection. The laundry room is well organised with each service user having individually named laundry in baskets. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 27.28.29.30 Staff in the home are starting to be trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of residents. EVIDENCE: Service users stated that they are satisfied with that the care they receive and that staff meet their needs. They feel that staff are receiving more training and able to deliver their care needs. Staffing rotas try to take into account the times of high and low activity. Induction programmes are in place and starting to be used with new staff, examples of which were seen. Plans for supervision and appraisals to monitor the performance of staff are in place and in progress. The service is now recognising the importance of training, and is planning to deliver a programme that meets statutory requirements. The manager has identified priorities for training, which has previously been lacking e.g. dementia, medicines, and infection control. Although the training staff participate in is documented, the manager agreed it is good management to have a yearly training plan. Staff are more clear regarding their role and what is expected of them. Observation of their practice showed good interaction between them and service users. The service’s recruitment procedure has improved and now meets the regulations and the national minimum standards. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Key Standards 31.33.35.38 The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by the company. EVIDENCE: The manager has not undergone the registration process with the CSCI as she has been in post for approximately 4 months. She is starting to be aware of and work to the basic processes set out in the National Minimum Standards. The manager has an awareness of the need to develop a programme to train and develop staff so that they are competent and maintain their competence to care for older people. The service is planning to be more user focused, and is working in partnership with family of service users and professionals. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 20 The provider has developed an improved approach to manage the health and safety requirements of legislation. The manager reported that a quality survey will be conducted in the New Year and the results collated. Records seen showed that accidents and incidents are now recorded and monitored by head office. The service provider takes responsibility for the home’s accounts and business development. Service users have the opportunity to manage their own money if they wish, and facilities are provided to help keep it safe. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 21 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 1 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 5A Requirement The registered person shall amend the service user guide to provide the detail required by the amendment Regulations 2006. The registered provider shall detail in the contract the amount to be paid by all parties. The registered provider shall ensure that medication administration records are accurately maintained. Timescale for action 15/01/07 2 OP2 5A 15/01/07 3 OP9 17(1)(a) 15/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The registered provider should ensure that catering staff DS0000059307.V297002.R01.S.doc Version 5.2 Page 23 Tunstall Hall have received training in nutrition for the elderly. Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tunstall Hall DS0000059307.V297002.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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