Inspection on 20/06/06 for Tunstall Hall

This inspection was carried out on 20th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tunstall Hall 18/08/09

Tunstall Hall 17/02/09

Tunstall Hall 20/04/07

Tunstall Hall 15/12/06

Tunstall Hall 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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Ravenhurst

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Inspirations

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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 Unannounced Inspection 20th June 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.V296974.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.V296974.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 None Care Home 34 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24) of places Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 34 service users of which a maximum of 22 beds may accommodate service users requiring nursing care. Of the total 34 service users, the home may accommodate 10 clients suffering from dementia. Care staffing levels must be maintained as: Up to and including 22 service users: 7am-2pm - 1 RN, 1 SNR and 2 CAs 2pm-9pm - 1 RN, 1 SNR and 2 CAs 9pm-7am - 1 RN and 1 CA Up to and including 30 service users: 7am-2 pm - 1 RN, 1 SNR and 3 CAs 2pm-9pm - 1 RN, 1 SNR and 3 CAs 9pm-7am - 1 RN and 2 CAs Up to and including 33 service users: 7am-2pm - 1 RN, 1 SNR and 4 Cas 2pm-9pm - 1 RN, 1 SNR and 4 CAs 9pm-7am - 1 RN and 2 Cas The Manager will be supernumerary as follows Up to and including 15 service users - 15 hours Up to and including 25 service users - 20 hours Over 25 service users - totally supernumerary An additional 15 hours per week will be included for an Activities Coordinator. 26th April 2006 2. 3. 4. 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 is currently registered to provide accommodation and care, including nursing care, to 34 older people. The accommodation has been refurbished to provide 31 single bedrooms and there are large communal rooms including a library. 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. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 5 The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in the home’s entrance hall. Tunstall Hall’s Services 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 1st April 2006 are: £304.15-£400. All service users pay monthly by standing order usually two weeks in advance and two weeks in arrears. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 6 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 general 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. The CSCI has conducted random inspections to Tunstall Hall during 2005/6 as serious shortfalls to meet some national minimum standards and Care Homes Regulations 2001 had been identified. This key inspection took into account all key national minimum standards and progress made to meet previous requirements from random inspections. Thus there are some new requirements to be addressed. What the service does well: What has improved since the last inspection? The range of topics covered by training has improved. A plan is in place to deliver a programme of mandatory training, with evidence now being kept of training attended by individual staff. Staff spoken to were more clear regarding their role and what is expected of them. Service users able to make comment reported that staff working with them know what they are meant to do and were content that their needs were being met. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 7 Interim arrangements for the management of the home prior to the new recruit taking post have ensured that the overall conduct of the home, although fragile, has made movements towards improvement and stability of the service. 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. Tunstall Hall DS0000059307.V296974.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.V296974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home which will meet their needs They have their needs assessed and a contract/terms and conditions which tells them about the service they will receive. EVIDENCE: The service has developed its statement of purpose, which sets out the aims and objectives of the home and includes a service users guide, which provides basic information about the service. The information is on display in the entrance hall. The company has recently developed a brochure. Records of terms and conditions are kept on individual files. This details what service the service user can expect to receive for the fee they pay and the terms and conditions of occupancy. These documents need to reflect the fees paid when another party is involved in the funding of the care. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 10 Care files seen contained a pre-admission assessment and an admission assessment of need. Tunstall Hall DS0000059307.V296974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a service user receives, is based on their individual needs and aims to promote good health. EVIDENCE: Each service user has a care file. Evidence was seen of service user involvement in the development of these. The plan includes basic information necessary to plan the individuals’ care and includes a risk element. There was evidence of updating information and changing actions appeared in the care plans. However, two out of the four files seen did not contain a care plan for wound, pressure area and nutritional care and support, even though initial assessments had identified the problem. One service user, who had nutritional problems and had had noticeable recent weight loss, had no detail in the plans whether they had been referred to the GP or dietician re this problem. There was a record of health care treatment and intervention for most other identified problems. There are still gaps in information but staff were able two give a verbal update. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 12 The home has a system for dealing with medication within the home. Records were not correctly completed for all medicines received, administered and disposed of. This area has been identified by management as one requiring improvement and the registered provider is about to implement a new system based on the monitored dosage system. The homes training plan includes the topic of safe administration of medicines. Staff spoken with were aware of the need to treat service users with respect and spoke of how they consider dignity when delivering personal care. Service users able to comment said that they were happy with the way that most staff deliver their care and respect their dignity. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are unable to choose their life style, social activity but can keep in contact with family and friends. Social and recreational activities do not meet service users’ expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: The provision for meals and choice of food has improved in recent months. The dining room is light and pleasantly furnished and the menu for the day was displayed in the foyer and the dining room. Kitchen staff have received food hygiene training and further training is planned for other staff. The kitchen facilities meet with the Environmental Health requirements and the management have recruited a new member of staff to work on the vacant evening shifts. Staff are busy carrying out personal care and do not usually have the time to consult service users regarding their choice of daily activity. Very little is happening in the way of arranged activities which the general manager stated Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 14 was being reviewed. Service users commented that “there’s not a lot going on so every one goes to sleep” and another stated that “there are no activities apart from chair aerobics and the access to outside is poor”. Service users were seen watching television or reading a book. Two other service users said that they didn’t really want to be involved in anything. The registered provider recognises this as an area of particular weakness and will plan to improve the outcomes and choice for the service users. Diversity is considered and respected when supporting service users faith needs. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 have access to a robust, effective complaints procedure that enables them or their supporters views to be listened to and acted upon. EVIDENCE: Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. The CSCI has not received any complaints about the home. Nor have their been any recent adult protection issues. One compliment had been received via telephone about the “excellent care provided by staff”. Service users were seen to speak easily to staff and were comfortable in their company. Staff were heard to communicate well with service users to ascertain their well-being. The reviews that take place give a forum for concerns to be aired. Tunstall Hall DS0000059307.V296974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: Rooms entered into were personalised according to individual wishes and tastes. Communal areas were clean and comfortable. The refurbishment of the premises has improved the outcomes for service users. Service users have poor access to a large garden. The laundry is equipped to deal with ordinary and soiled linen. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 17 The registered provider plans to install a second sluice disinfector to meet requirements from previous inspections. One has already been installed. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. There is a choice of bathing facilities and a number of toilets placed around the home. The management stated that two toilets without hand washing facilities would be converted to one disabled toilet. Tunstall Hall DS0000059307.V296974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are now being trained to fulfil the aims of the home and meet the changing needs of residents. EVIDENCE: The registered provider has recognised the importance of training and plans to deliver an annual programme to meet statutory requirements. The service has also identified other training that is needed such as dementia. Training for staff has improved. Topics are planned, allocated, attended and recorded with certificates kept on individual files. Recruitment of two new staff had been carried out according to the home’s policies and induction had commenced with some mandatory training having been provided. Staff communicated well with service users and seemed committed to their work. Service users commented that they were well looked after and that staff were friendly and helpful. One stated she had been assisted to have a bath by a male carer and she felt her hair had been done well. Tunstall Hall DS0000059307.V296974.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ethos of the home is based on openness and respect with quality assurance systems developed by the registered provider. Staff work to achieve good outcomes for service users in all areas of care. EVIDENCE: A new manager has been recruited who has NVQ 4 in care. The general manager stated that this person will implement the supervision and appraisal policies for the home. Fire systems, equipment and checks are all carried out and recorded. Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 20 Hot water checks are carried out but the results showed that many of the outlets register above the maximum safe limit of 43 degrees Celsius. The general manager stated that this will be rectified. General home maintenance records are all maintained and easily accessible. Tunstall Hall DS0000059307.V296974.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 3 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 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 3 3 3 X 3 2 3 3 Tunstall Hall DS0000059307.V296974.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP2 OP7 Regulation 5A 15(1) Requirement The registered provider shall detail in the contract the amount to be paid by all parties. The registered provider shall ensure that all service users have a plan of care for all identified needs. The registered provider shall ensure that medication administration records are accurately maintained. The registered provider shall ensure that service users have the opportunity to exercise their choice in relation to leisure and social activities and cultural interests. The registered provider shall provide external grounds which are suitable for, and safe for use by, service users. The registered provider shall install the second sluice disinfector. The registered provider shall provide all lavatories, used by staff or service users, with wash hand basins. DS0000059307.V296974.R01.S.doc Timescale for action 20/07/06 20/07/06 3 OP9 17(1)(a) 20/07/06 4 OP12 16(2)(m)( n) 20/09/06 5 OP19 23(2)(o) 20/09/06 6 7 OP26 OP19 23(2)(k) 23(2)(j) 20/07/06 20/07/06 Tunstall Hall Version 5.2 Page 23 8 OP28 18(i)(a) The registered provider shall ensure that a minimum of 50 NVQ trained members of care staff is achieved The registered provider shall ensure the correct regulation of hot water temperatures. 28/07/06 9 OP38 13(4) 20/07/06 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 have received training in nutrition for the elderly. Tunstall Hall DS0000059307.V296974.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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tunstall Hall DS0000059307.V296974.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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