Inspection on 20/04/07 for Tunstall Hall

This inspection was carried out on 20th April 2007.

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 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

Similar services:

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Tunstall Hall Market Drayton Shropshire TF9 4AA Lead Inspector Keith Salmon Key Unannounced Inspection 20th April 2007 09:15 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.V335316.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.V335316.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 vacant post 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.V335316.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. 15th December 2006 Date of last inspection Brief Description of the Service: Tunstall Hall is owned by Guardian Care Homes (UK) Ltd and provides accommodation and personal care for up to 31 Residents. 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, and Guardian Care Homes (UK) Ltd make their services known to prospective service users in their Statement of Purpose, Company Brochure and on the Web Site. The current range of fees is from £304.15 to £420 per week. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection of ‘Key’ Standards commenced at 9.15am, concluded at 3.30pm, and was conducted by Mr Keith Salmon. Present on behalf of the home were Marita Williams (Manager) and Sue Bower (Senior Carer). In addition to the inspection of Key Standards, this Inspection also sought to review progress by the home in meeting ‘Requirements’ arising from the previous Unannounced Key Inspection, held in December 2006, and the home’s response to recent complaints regarding the quality of some aspects of care. This Report is based on observations made during a tour of the Home, a review of care related documentation, staff duty rotas and staff files, plus a range of other documents/records reflecting the general operation of the home. The Inspector also held individual discussions, with 8 Residents and 1 Visitor, in additional to the Manager, the Senior Carer in charge of the shift and several other staff members. The Manager was not on duty at the commencement of the Inspection but attended when made aware that this was taking place. It should be stated the nature of the client group cared for at Tunstall Hall constrains the number of Residents able to participate in an in depth discussion with the Inspector. Since the previous Inspection, the quality of the home’s care provision has been brought into question by a series of complaints, received mostly from one source. The issues raised have been subject to an internal investigation by the Guardian Home’s Regional Manager for this area (Ms Karen Williams). Following this a written response was received by the CSCI outlining any disagreement as to the validity of claims, or the action taken/proposed where claims were indeed accepted as valid. During this Inspection, the Inspector took time to examine the veracity of Guardian Homes’ response, and, as such, the content of this Report makes reference to the areas identified in the complaints and which fall within the remit of the Care Homes Regulations and Standards. Therefore, the main elements of the complaints are addressed in the Outcomes covered by this Key Standards Inspection or, by exception, where they would not be covered by the Key approach. What the service does well: Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 6 The home provides a homely, comfortable environment, amid peaceful surroundings, where day-to-day focus is centred on the needs of Residents. The standard of food is good with meals being varied, and offering choice to accommodate individual preferences. All of the Residents who held discussions with the Inspector were quite positive as to their experiences in being cared for at Tunstall Hall – reflected in comments such as, … “I came initially for respite, but liked it so much I asked to come permanently.” …“I visit every day and my Wife is clearly very happy to be here, which is good enough for both of us.”…. The Staff make me very welcome when I visit and nothing is too much trouble” …“I’m happy here and do really like my room.” What has improved since the last inspection? At the previous Unannounced Key Inspection three Requirements were cited, relating to:Amendments to the Service User Guide Amendments to the contract between the party paying for the service and the home in respect of the ‘amount to be paid’ Ensuring that medication administration records are accurately maintained. The evidence reviewed demonstrated all Requirements have been met. Inspections by the CSCI over the past year have identified areas of care provision requiring improvement. There is evidence the Manager and Staff have made in-roads into these shortfall areas and are now providing a care service which is better planned, organised, and with a more structured approach in place. For example: The home now has a planning matrix, which sets out clearly, for each Staff member, training completed, and training/refresher training to be undertaken In addition to updating documentation related to raising concerns, or making a complaint, the Management and Staff have responded speedily in taking effective action to shortfalls identified in recent concerns/ complaints. In summary, there is clear evidence, established through an exhaustive review, indicating a positive approach in response to remedying these shortfall areas, many of which have already been robustly and effectively addressed. There appears a determination to maintain and build on these improvements. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 7 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.V335316.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Residents, or their Representative(s) are able to assess the suitability of the home in meeting their needs through printed information provided by the home. The written Contract/Statement of Terms and Conditions issued by the home is now in accordance with the requirements of the relevant Standard. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. EVIDENCE: At the Key Standards Inspection, held in December 2006, two requirements were cited under this Outcome area, and outlined as follows:1. “The registered person shall amend the service user guide to provide the detail required by the amendment Regulations 2006.” Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 10 A review of the home’s Service User Guide demonstrated this has been amended appropriately and the Guide, currently in use, now conforms to the requirements of the Standard. The inspector found it to be clearly laid out with comprehensive content, including – Reference to provision of care services, e.g. staff identification, the ‘Key Worker’ system, personal care planning, provision of professional clinical and social care services, listing of individual bedroom sizes Daily living activities, e.g. meals and meal times, visiting, telephone provision, smoking policy, enabling/supporting residents in continuing religious practices, social activities Complaints procedure, and contact details for other agencies, including the Commission for Social Care Inspection This ‘Requirement’ has been met. 2. “The registered provider shall detail in the contract the amount to be paid by all parties.” A review of the home’s amended ‘Statement of Terms and Conditions’ evidenced the home now provides information on what the Resident, or the paying agency, may expect to pay in return for Services provided. This ‘Requirement’ has been met. ‘Case Tracking’ involving the detailed review of 7 residents’ care plans/files, selected at random, demonstrated all potential Residents have their care needs assessed by the Manager, or Deputy Manager, prior to taking up residence, and the assessment is utilised as a basis for care plan development. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The model of Care Plan utilised by the home is of a comprehensive design and easy to read. The care provided by the home is effective in meeting the Residents’ assessed care needs, and is delivered considerately and effectively. The storage, administration, and disposal of medicines are in accordance with accepted good practice. Residents’ privacy and dignity is respected. EVIDENCE: Prior to this Inspection, CSCI had been alerted to concerns that a (named) resident was not being enabled to undertake unescorted visits to the local Town due to an element of risk given the resident’s capabilities. Furthermore, it had been suggested the home was unable to facilitate such visits, through provision of an escort, due to alleged staff shortages. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 12 A review by the Inspector evidenced a fully documented risk assessment had been completed and the resident is accompanied to the town on one day per week. In addition, the home is in the process of recruiting assistance from a volunteer to increase the frequency of visits to twice a week, if required. The resident concerned informed the inspector of his understanding of the home’s action and found the current situation acceptable. A further observation, by the same source, was that residents who had been incontinent of urine were not being attended to. A written response to CSCI by the Regional Manager stated that residents who are unable to take themselves to the toilet are escorted there on a regular basis, and evidence gained by the inspector through discussions with ‘case tracked’ residents supported this statement. In addition, the inspector observed the home does have a policy/procedure in place for the management of continence, and a review of care plans confirmed, where relevant, documented risk assessment of continence, and daily entries recording staff input. However, given the importance, and difficulty of successfully managing this area of care, within such a client group, a greater focus of attention is necessary. It is ‘Recommended’ that the Policy/Procedure for the management of continence be reviewed, with day to day application, i.e. risk assessment, action, reporting, and review, more clearly recorded within residents’ care plans. The Manager agreed that such an approach would be beneficial and necessary action will be undertaken. Care plans/files relating to ‘case tracked’ residents were reviewed, discussions held with the respective residents, a visitor, the manager, and other staff, plus observation made by the inspector. Records were found to be current, easy to follow and provided evidence of involvement of the resident, relative or advocate; made direct reference to risk assessment in respect of moving and handling, use of bedrails, nutritional status/needs, pressure areas. There was also clear evidence of regular audit of care plans by the manager. At the previous inspection, held in December 2006, a ‘Requirement’ relating to the management of medicines was cited, i.e. “The registered provider shall ensure that medication administration records are accurately maintained.” A review was undertaken of the policies/procedures relating to the management/administration of medicines, i.e. records relating to the supply, storage, and disposal of medicines (including records of ambient and medicine refrigerator temperatures), the maintenance of medicine administration records (MAR Sheets), and the maintenance of the Controlled Drugs Register. The inspector also reviewed the contents of the medicine trolleys, secondary back-up storage and storage of medical gases, and all were found to be satisfactory. This Requirement has been met. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 13 A concern has recently been raised, by a relative, regarding lack of access to residents’ care plans, and their lack of involvement in the care planning process. The home refutes this claim, and in support of this the manager showed the inspector a ‘Relative’s Communication Sheet’ which recorded, by individual resident, any communication between the staff and ‘Relatives/Agents/Supporters’ of that resident. It was observed that, where possible, the agreement of the resident to this arrangement is sought, and documented. The manager undertook to ensure the relative involved in this reported instance is aware of the home’s policy and provisions in respect of this matter. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure opportunities provided are consistent with residents’ capabilities. The home facilitates achievement of desired lifestyle through residents conducting the pattern of their day, where possible, as they wish, including contact with family and friends, and continuation of religious practices. There is a daily choice of attractive and nutritious meals. EVIDENCE: A number of elements within the complaints previously referred to in the Summary on Page 6 above, relate to aspects within this ‘Daily Life and Social Activities’ Outcome area. Specifically – A lack of staff to escort residents around the home’s ground’s The gravelled paths preventing wheel-chair use Residents not always able to go to bed when they choose Tea not being made properly Supper not served at all on some occasions Evening/occasional drinks not available Afternoon Tea meal not served in dining room Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 15 Residents hungry even after lunch Fresh fruit not available Nowhere quiet for residents and their visitors to meet and insufficient additional chairs for visitors to use The value of residents’ meetings were questioned The home’s activities:o Are too few o Lack stimulation o Lack one to one conversations Prior to this Inspection, the Regional Manager from Guardian Homes had investigated all of these issues, and in a written response to the CSCI recorded a number as being unfounded, whilst, in respect of others, there was either partial, or full agreement, of the need for improvement. During this Unannounced Inspection the inspector reviewed the issues raised and found the following:From observation and duty rotas there would appear to be sufficient staff to escort residents around the grounds, though this was not ‘tested’ as the weather did not lend itself to such an activity on the day of inspection. However, residents engaged in conversation informed the inspector that in ‘the better weather’ they did go out into the gardens and enjoyed this facility. It is accepted that, whilst the nature of the gravel may not totally prevent wheelchair access, the size of the gravel may hinder ease of mobility. The Inspector was advised the home has made application for a grant from Shropshire County Council to pay for stone slabs to be laid on part of the gravel path to ease access and movement. Residents, with whom the inspector had discussions, stated they went to bed when they wished, either of their own volition or with the assistance of staff. In this instance, the complainant had given no details of specific incidences, so it was not possible for the manager to take action. Notwithstanding this, the manager had reminded staff that such an approach is not acceptable, and several members of staff confirmed they had received this reminder. With regard to the various issues raised relating to meals and beverages the inspector’s review established the following outcome:o Residents reported that occasionally the quality of the tea was not what they might have preferred. The manager agreed some members of staff had needed, and received, instruction in what constituted a ‘good cup of tea’. Matters had now improved. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 16 o Residents confirmed supper and evening drinks were always provided if they wanted them, and also stated residents who may not be able to instigate a request for themselves were… “well looked after by the staff, who always ask.” o The manager agreed there had been a tendency for the afternoon tea meal to be served in the lounge and, whilst this is quite appropriate for residents who wished this, it is more appropriate for some residents to eat their meals in a more formal setting, e.g. in situations of certain physical disabilities and confusional states. o Residents confirmed the menu comprised the…“sort of food we like” and there is always enough food available to match their appetites. Observation of the menu demonstrated mainly traditional fare, plus the recent introduction of less traditional foods, such as lasagne, which the manager stated had been well received. o Bowls of fresh fruit were observed in the communal rooms for Residents to eat as they wished. Residents confirmed this was normal practice with the supply replenished on a daily basis. Bearing in mind a proportion of the Residents have confusional disorders, and, therefore, may not voluntarily take advantage of the available fruit, the inspector suggested the fruit be sliced into pieces and offered by staff to residents once or twice a day between main meals, thus ensuring the benefit of fresh fruit to all residents. The manager agreed to commence this practice with immediate effect. As with many care homes there is sometimes tension between meeting the needs of those who may wish to watch television, listen to the radio/music, and others who wish for a quieter environment, e.g. for simple ‘peace and quiet’, to read or to talk with others. In discussion with the manager and staff the inspector was informed that many residents, and their visitors, would make use of the resident’s own bedroom if seeking a quieter/more private environment. Staff further stated that should additional seating be required they would move chairs from adjacent rooms. Residents, and the one relative in attendance, who visits virtually every day, confirmed this to be so and in keeping with their expectations. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 17 Residents’ meetings, serviced by the manager, are held on a 3 monthly basis and prospective days are posted on a notice board in the entrance hall. Minutes of the meetings were seen, and residents who were able confirmed their attendance at the meetings, and felt their views helped ‘shape’ the way in which the home functions. Residents also confirmed the staff spent time trying to facilitate input from those residents whose confusional state made involvement difficult. As to such meetings being of questionable value, the Inspector considers that any process of this nature is preferable to a care home not pursuing arenas which enable involvement and the opportunity for discussion and input. It is accepted by the home’s management that there was an issue with regard to activities prior to the appointment of the current manager, who took up post September 2006. Efforts are now being made to address this shortfall with the appointment of a new staff member with specific responsibility for the planning and co-ordination of leisure/social activities. This member of staff will provide 15 hours input per week, usually allocated as 3 hours per day, Monday to Friday, between 2.00pm and 5.00pm. It is also expected the time will be used flexibly to support ‘out of hours’ pub visits, shopping activities, and events such as the home’s garden fete. In conclusion, the home, whilst refuting some of the allegations made in the complaint, have acknowledged shortfalls existed, hitherto, in the service they provide to residents. There is clear evidence, established through an exhaustive review, indicating a positive approach in response to remedying these shortfall areas, many of which have already been robustly and effectively addressed. There remains a determination to maintain the improvement. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 18 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): 16 &18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are protected from abuse by the home’s policies and procedures, which include systems to ensure concerns or complaints are dealt with promptly and effectively. Staff are aware of their role in protecting residents from abuse. EVIDENCE: The previous inspection report highlighted that the home’s Complaint Procedure did not indicate who should be approached with regard to concerns/ complaints, nor did it provide timescales for dealing with complaints. The amended Service User Guide now complies with this Standard with details displayed prominently for the benefit of residents and visitors. A review of accident and incident documentation showed full and accurate recording, with action taken, in relation to incidents reported to the CSCI, through Regulation 37 submissions. Staff training documentation, and discussions with staff confirmed that ‘adult protection’ training is covered at induction and through ‘on-going’ staff training. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a generally safe, well-maintained environment with communal rooms and bedrooms which are satisfactorily decorated with furnishings being in good order and presenting a ‘domestic’ ambience. Specialist equipment, consistent with meeting the assessed care needs of service users and the demands of tasks carried out by care staff, and is appropriately serviced and maintained. The cleanliness and general state of repair in the home is good. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Summary (Page 6 above) refers to recent complaints, some elements of which relate to aspects within the ‘Environment’ Outcome area. Specifically – A damp patch by the second floor staircase A ‘persistent’ lack of hot water to some Residents’ bedrooms Failed light bulbs in the library Lack of emergency call system in the communal rooms A tour of the home, discussion with residents, a visitor, the manager, and with other staff evidenced:The damp patch referred to is to be remedied as part of the home’s redecoration programme – timescale for completion by the end of July 2007 A programme for the regular monitoring of hot water supplies to residents’ bedrooms is part of the Handyman’s routine activities. Records were observed which provided evidence of this. It is accepted, by the home that there has, from time to time, been a failure in the provision of hot water to bedrooms, said to be due to faulty thermostatic valves. A number of valves have been replaced and during the inspection the inspector tested the hot water outlets in 50 of bedrooms, and all were found to be satisfactory, i.e. ’close to 43o C.’ The home’s management also accepts there has been a delay in the replacement of failed lighting fitments, e.g. ‘hidden’ fluorescent tubes in the library. The inspector observed these have now been replaced. The inspector was shown alarm call bell pushes in the communal rooms, all of which clearly labelled ‘alarm bell’. On testing they were found to be in working order. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 21 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): 27,28,29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers on duty, and skill-mix, were sufficient to meet the assessed care needs of current residents. Recruitment and employment practices are consistent with the safeguarding of residents. The commitment of the home in providing training for care staff is satisfactory, and in accordance with individual staff member’s learning needs. EVIDENCE: A review of duty rotas, and discussion with staff, confirmed staffing numbers and skill-mix enable a service provision, which meets the care needs of the service users. Staff were observed to carry out their duties in an enthusiastic and professional manner and residents stated they were satisfied with the care they receive and confirmed that staff meet their needs. It was noted that due to staff turnover the proportion of care Staff with minimum qualifications of NVQ level 2 or equivalent had slipped below the 50 proportion required by the Standard. However, the home does have an established policy to enable staff to complete such training. The Manager informed the Inspector that arrangements have been made for new staff to commence training as soon as a course becomes available. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 22 The service’s recruitment procedures have maintained the improvement noted at the previous Inspection demonstrating evidence of full compliance with the Standard and Schedule 2 of the Regulations. Again, in addressing the concerns brought to the attention of the CSCI the inspector held discussions with residents, a visiting relative, management and staff to investigate the following allegations:Staff are brusque and rude to residents, generally ignore residents, and are untrained with regard to respect and thoughtfulness Lack of in-service training e.g. fire safety training Staff numbers inadequate particularly on night duty Poor laundry service o Woollen clothing ruined by boiling o Clothing returned to ‘wrong’ residents o Items lost It was reported, in the Regional Manager’s ‘Regulation 26 Report’ that no incidences of questionable approaches to residents by staff, e.g. brusque, rude, disrespectful, unthoughtful, inattentive, were observed. Residents informed the inspector they were happy with the way in which staff addressed them and generally dealt with them, and the one visitor, who attends most days, confirmed that he had no reservations as to the attitude of the staff. Observations during the inspection would appear to support these comments. A review of staff training files, and the training plan for the coming year, introduced since the previous inspection, provided evidence of a thorough, and relevant, orientation/induction programme, followed by the required ‘foundation’ programme training. Topics covered include; moving and handling, fire safety, first aid, health and safety, care of substances harmful to health (COSHH), infection control, ‘adult protection’, food hygiene, dementia awareness, anger management, safe handling of medicines, nutrition. A review of duty rotas, and discussion with staff, confirmed staffing numbers and skill-mix enable a service provision which meets the care needs of the service users. Staff were observed to carry out their duties in an enthusiastic and professional manner and service users stated they are satisfied with the care they receive and which meet their needs. A specific issue raised by the complainant was the safety implications of allocating three care staff to a night duty shift covering a home with bedrooms situated over three floors. This matter was discussed with the manager, and although not ideal, the inspector is satisfied that given the relatively small number of bedrooms on the ground floor, which accommodate residents with lower dependency needs, and the grouping of residents with higher dependency needs on the middle floor, the safety of residents is not Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 23 compromised by the temporary lack of presence of a carer on each floor, which may occur when assistance is required with more dependent residents or during the administration of medicines. However, it is recommended that the manager undertake, and document, a ‘whole house’ risk assessment of the rationale for the number of staff on the night duty shift, and their deployment. Thus, it should be easier to respond appropriately, to changes in resident dependency, which can occur over a period of time. The response from the Regional Manager shows agreement that inappropriate laundering has spoilt some woollen items. Although it is company policy to suggest to residents/relatives that woollen articles of clothing (unless machine washable) are taken away from the home for laundering by relatives, on the occasions when the home has been responsible for such an error replacement of the item has been offered and provided. Similarly, replacements have been offered for items of lost clothing, though it is maintained this occurrence is rare. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 24 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): 31,33,35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by the manager, Marita Williams, and provides an ambience, which is warm, friendly, and inclusive with the central purpose being ‘the best interests of residents’. Operationally, it is now well organised with lines of accountability being clearly defined and observed. The views of residents and other interested parties are sought by the home and acted upon. Service users are safeguarded by the financial procedures operated in the home. All staff are subject to effective support with regular supervision, and appeared involved and happy in their work. Health and Safety Policies/Procedures/Practices were satisfactory. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Manager, who has attained NVQ Level 4 in Care, has been in post since September 2006, and has commenced the process of applying for Registered Manager status with the CSCI. Prior to her taking up post CSCI inspection reports identified an unsatisfactory situation in respect of management. This was reflected in such comments as… “The lack of a registered manager means that on going support for staff is lacking and the overall conduct and management of the home is fragile.”… “Formal supervision (of Staff) has not commenced.” Inspection reports since the appointment of the current manager have indicated an improvement in the quality of management at the home through comments such as … ”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 more user focused, and is working in partnership with family of service users and professionals.” It was apparent at this inspection the previously reported progress has been maintained. Furthermore, now the manager has had the opportunity to take a more considered and strategic view of how the quality of service can be improved, there is evidence of success in achieving change and the development necessary to further improve the overall service quality. Much of this evidence has been illustrated in the preceding sections of this report. Examination of service records confirmed the maintenance of equipment and appliances is in accordance with Regulations. Health and Safety Policies/Procedures/Practices were satisfactory, as are COSHH requirements, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. COSHH data sheets were found to be current. Records are maintained for hot water supply to baths, and water temperatures tested during the Inspection were found to be satisfactory. Records reviewed evidenced any accident/incident is 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 are able to do so. Records reviewed demonstrated that where monies are held by the home, on behalf of service users, there are full records of transactions. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 26 A component of the complaint(s), referred to previously in this report, revolved around the cleanliness of some aspects of the home and concomitant cleaning practices. Specifically:‘Sticky’ toilet floors Cobwebs in some rooms Dirty side tables Carers doing cleaning and shabby uniforms ‘Unlabelled’ toilet, no alarm bell is now staff toilet Wheelchair footrests A tour of the home by the inspector, which included all toilets/bathrooms, found them to be clean and properly equipped with soap dispensers, paper towels, and waste bins. Throughout the inspection there was no noticeable evidence of dirty tables, cobwebs or other specific uncleanliness. Designated staff employed as Domestic Staff provide the home’s cleaning service, with cover for holidays, or sickness, provided by way of care staff working additional shifts. The manager informed the inspector there had previously been an issue regarding the uniform worn by care staff whilst undertaking ‘domestic’ duties. This situation has now been addressed in that these members of staff now wear tabards when carrying out such duties. The toilet identified as lacking indication as to whether it was intended for the use of residents, visitors, or staff, and which also lacks an alarm call facility is presently used as a toilet for staff only. It is proposed it will be reserved for the use of residents only, subject to necessary up-grading. With regard to the use of wheelchairs without footrests, during the visit the Inspector made a point of observing all wheelchairs in use and all had footrests, which were in use. Similarly, the Regional Manager reported the same situation whist undertaking the most recent ‘Regulation 26’ visit. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 27 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 3 3 3 3 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 3 X 3 X 3 X X 3 Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP27 Good Practice Recommendations It is recommended that the Policy/Procedure for the management of continence be reviewed. It is recommended that a ‘whole house’ risk assessment of the rationale for the number of staff on the night duty shift, and their deployment. Tunstall Hall DS0000059307.V335316.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 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.V335316.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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