Inspection on 18/08/09 for Tunstall Hall

This inspection was carried out on 18th August 2009.

CQC found this care home to be providing an Good service.

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 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 13/06/05

Tunstall Hall 25/08/04

Tunstall Hall 13/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Tunstall Hall Tunstall Hall Market Drayton Shropshire TF9 4AA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michael Moloney     Date: 1 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Tunstall Hall Tunstall Hall Market Drayton Shropshire TF9 4AA 01630652774 01630658270 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.guardiancaregroup.co.uk Guardian Care Homes (UK) Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 31, Old age, not falling within any other category (OP) 31 Date of last inspection Brief description of the care home Tunstall Hall is owned by Guardian Care Homes (UK) Ltd and provides accommodation and personal care for up to 31 people. A Georgian house, located on the outskirts of the pretty Shropshire Town of Market Drayton, it is set in three and a half acres of grounds, surrounded by mature parkland, and benefits from access to a wide range of local amenities. There are good road links to the larger towns of Shrewsbury and Telford. Care Homes for Older People Page 4 of 24 Over 65 0 31 31 0 1 7 0 2 2 0 0 9 Brief description of the care home Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have been revised and are readily available. The homes fees range from £550 upwards. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A range of evidence was used to make judgements about this service. This includes: information from the provider which included a self assessment document that they are required by law to complete, records kept in the home, medication records, discussions with the staff team, tour of the premises, previous inspection reports and talking with residents and their relatives, as well as observing the care experienced by people using the service. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking to live in the home and their representatives have the information needed to choose a home which will meet their needs They have their needs assessed so that the home can say whether or not they can meet them before they are offered a place there. Evidence: Should anybody wish to live in this home information was seen that outlines the service that they would receive, what they could expect of the staff and other information such as how to make a complaint and how much living there would cost them. The records of someone who had recently started to live in the home were also looked at. These showed that the home staff had assessed her needs before they had decided whether or not they could look after her. She had then been offered a place in the home. Care Homes for Older People Page 9 of 24 Evidence: Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that a person living in this home receives is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The records of three people who live in this home were looked at. All were seen to have care plans that were drawn up after their needs had been assessed. Records were also seen that showed that these care plans were reviewed by the staff each month so that any comments made by people such as doctors and district nurses could be noted and acted upon. The records contained guidance to staff about such things as when and how people liked to go to bed or get up in the morning and what sort of clothes that they liked to be dressed in. One person said that staff were very obliging in that way. A variety of risk assessments were seen to be in place. Not only were the more general issues assessed but so were such things as falls, manual handling and Care Homes for Older People Page 11 of 24 Evidence: nutrition. The manager also explained that every month people are given the opportunity to have their blood sugar levels and blood pressures taken as part of the homes efforts to monitor their general health. A number of the people who were living in the home said that they found the staff to be sensitive and discrete when helping them with their personal care. One visitor said of her relatives care, staff look after her so well, cant fault it at all. Medication administration and records were examined in detail for three people, including someone who has to have insulin by injection. Records were generally well maintained and demonstrated that people receive the medicines they require. Other records relating to medication were looked at and confirmed that receipt, storage, administration and disposal of medication is being well managed. Only senior members of staff who have undertaken training are allowed to give residents their medication. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are able to choose their social activity and keep in contact with family and friends. Social, cultural and recreational activities are to their liking. They are served a healthy, varied diet according to their assessed requirement and choice. Evidence: Talking with a number of people who live in this home and looking at the records kept by the staff showed that a variety of activities are made available for people to join in. The homes activities organiser has arranged something for most weekday afternoons. This included activities such as knitting, arts and craft, pub lunches, bingo and Hair and Nails sessions. The occupant of one room was seen to have decorated the window of her bedroom with a stained glass effect piece of work that had been made of coloured tissue paper in one of the arts and craft sessions. The home has its own hairdressing salon which is regularly used. One lady said of this service, I have mine done once in a while. She is very good dont you think? Care Homes for Older People Page 13 of 24 Evidence: Throughout the inspection groups of people were seen chatting to each other. Those groups included not only the people who live in the home but a number of their relatives and friends. Records of the meals that had been served showed that at each main meal time people had two different options to choose from. Examples of those choices were mixed grill or pastie, quiche or ham and egg salad, sausage or chop, fish or burger, shepherds pie or bacon, lamb roast or fish. Observing at meal times showed that each person was served food in a consistency that suited them with some being presented as an ordinary meals through to being fully liquidised. During the meal, however, one lady was seen to be left with a bowl of soup in front of her which went cold before staff realised that she was not eating it. Talking to the people who live in this home showed that they were satisfied with the meals that they are given. During the day staff were seen giving out a variety of drinks. At the last staff meeting the staff had been urged by the manager to offer drinks more regularly to those who may need them. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that, if they made a complaint, it would be investigated and responded to fully. People are protected from abuse by the homes policies and procedures and a trained workforce Evidence: The complaints procedure is on display at various points around the home and is contained in the organisations information for residents. One formal complaint has been made this year; this was recorded and a written response was made. People said that if they were unhappy with something they would be happy to talk to the manager and were confident that it would be sorted out. It was reported that all staff attended abuse awareness training in April this year and the home has policies and procedures in place should an issue arise. A recent incident concerning verbal abuse was dealt with internally and then referred to the multiagency procedures - although the service acted promptly and the outcome was that people were protected by their actions, it should be noted that the local authority should have been informed first. Managers and staff within the organisation have cooperated fully with any adult protection procedures which have been necessary. The manager and staff attended training in the mental capacity act and its implications for any steps taken which might restrict peoples liberty. Formal assessments of the current resident group have not yet been undertaken. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home gives anyone living there a safe, wellmaintained and comfortable environment. Evidence: Tunstall Hall was built as a large country house set in its own parklands near to the Shropshire town of Market Drayton. It has been converted to its current use in a way that keeps a number of the buildings original features, such as the panelled walls and moulded ceilings, for the people who live there to enjoy. There are three main common areas for people to gather. One is the dining room which is light and airy. Another is the large lounge which has views out over the well kept gardens. The third is the foyer area which has a number of comfortable chairs in it. On the day of the inspection those chairs were constantly occupied and when asked why the answer, we like to see people coming and going, was given by one of the people using them. Bedrooms were seen to be available on all floors in the house with a lift being Care Homes for Older People Page 16 of 24 Evidence: available for those people with mobility difficulties. Bedrooms were seen to be in a variety of sizes, some with en-suite facilities and others not, but all were seen to be clean, tidy and in good decorative condition. Many rooms were seen to contain personal possessions that had been brought from peoples homes to make them more homely. For those without en-suite facilities in their bedrooms bathrooms and toilets were seen to be conveniently spread around the building. The home was seen to have a laundry equipped to keep the clothing and the bedding of those people living in this home clean. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of people who live in this home. Evidence: Looking at the staff rota as well as talking with the people who live in the home, the manager and staff showed that there are enough staff on duty to make sure that the care needs of the people living in the home are met. The employment records of three of the staff were looked at and these showed that appropriate references had been obtained before people had access to service users as part of the procedure that ensures that they are fit do so. During the inspection a lot of conversations between residents and staff were seen and heard. The staff were always professional, clear and polite when they spoke. Talking with a number of the staff confirmed that they have received training that would ensure that they are able to meet the needs of the people living at the home. This was confirmed by talking with the manager and looking at the staff training records. Talking to staff, the manager and looking at records also confirmed that a significant Care Homes for Older People Page 18 of 24 Evidence: number of staff had achieved National Vocational Qualification level 2 or above in care and that others were making progress towards obtaining it. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The registered manager, Marita Williams, is qualified and experienced for her role. She has achieved the Registered Managers Award which is an appropriate qualification for someone who manages a service such as this. Our inspection earlier in 2009 found that residents and relatives had lost some confidence in the entire staff team, finding that care provision varied unacceptably depending on who was on duty/in charge at the time. It appears that this has been addressed by working with the staff group and making some changes to rosters. Communication is said to have improved with the staff group and regular meetings with staff, residents and their relatives have taken place. A recent satisfaction questionnaire revealed that residents and relatives are feeling more confident about the care although some staff responses indicated that they didnt feel listened to or valued. Ms Williams stated at this inspection that she felt that this was no longer the case and that the staff team were working well together. Care Homes for Older People Page 20 of 24 Evidence: On the day of inspection people said positive things about the staff and the way they worked. A new regional manager has been appointed and regular audit reports from a senior manager are provided to Ms Williams. The most recent report included an audit of the records and monies held on behalf of residents at the home, which were found to be satisfactory. Equality and diversity for the service users were seen to be promoted throughout the home within the assessments, care plans and policies Formal staff supervision does take place, although not always at the frequency expected. This now needs to be prioritised in order to ensure that staff morale continues to improve, that training is put into practice and to ensure good outcomes for residents. Various records were seen to be kept that monitored systems and the environment in order to make sure the people living in the home safe. These were seen to be kept up to date. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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