CARE HOMES FOR OLDER PEOPLE
Tusker House 57 Pine Avenue Hastings East Sussex TN34 3PP Lead Inspector
Jason Denny Unannounced Inspection 11th January 2006 10:35 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 Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 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. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Tusker House Address 57 Pine Avenue Hastings East Sussex TN34 3PP 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) 01424 421573 &715706 01424 427758 Mrs Paula Woolgar Mr Michael Goonane Mrs Paula Woolgar Care Home 72 Category(ies) of Dementia (72) registration, with number of places Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is seventy-two (72) Service users must be older people aged sixty-five (65) years or over on admission That two specific service users under sixty-five (65) years of age can be admitted to the home Service users with a dementia type illness only to be accommodated Date of last inspection 26th July 2005 Brief Description of the Service: Tusker House is a large detached care home situated in a quiet residential area of Hastings, East Sussex. The property provides two-storey accommodation for older people with dementia with level access and passenger lifts. It has enclosed garden areas for service users and plans to increase the accessible garden space and create level access. The home has been assessed by Occupational Therapist’s September 2005 and is working through making further improvements to the environment. All double bedrooms are now single use only. The home is close to the local shops and services of Ore village and Hastings town centre is close by. The home has a large amount of internal Communal space. The home currently has its own dedicated training officers and is a certified NVQ training centre. The home employs a number of activity co-ordinators and entertainers who visit the home on a regular basis throughout the year. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April 1st 2006], which took place between 10.35am and 3pm. The Inspection found that of the 16 National Minimum Standards inspected, that 14 of these standards had been fully met, with all others nearly met. This report should be read in conjunction with the last inspection report of July 26, 2005, which covered some standards not looked at on this visit such as Staff induction, quality assurance management, and assessment of new residents. The overall focus of the visit was on following up on the requirements made at the last inspection, and looking at some new areas such as activities, food, and seeing how new residents were settling in including how their health needs are being met. The inspector started the inspection by meeting with the deputy manager to review progress since the last inspection. A tour of communal areas and some bedrooms was undertaken along with looking at staffing records and medication. Comment cards were sent to the home prior to the inspection for circulation to residents, relatives, and other representatives such as visiting professionals. Comments received back were found to be positive. 6 Resident’s were spoken with although participation was partly affected by their dementia illness. What the service does well: What has improved since the last inspection?
Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 6 The overall cleanliness of the home was found to have improved significantly since the last inspection helped by the employment of more cleaning staff and more effective routines with a high range of cleaning observed through this unannounced inspection. A new carpet was found to be in the process of being laid in the small lounge. Some beds have been replaced. A programme of repainting walls and surfaces has speeded up. Further plans such as levelling access to the rear garden was found to be in place and part of the home’s annual development plan. The home has been assessed by Occupational Therapists, which confirmed a range of positive findings along with helpful recommendations with the home already addressing the priority areas. The home has tightened recruitment checks on staff prior to employing them, in line with changes to the law. The home was found to be working towards ensuring that at least half its care staff gain at least a National Vocational qualification level-2 as soon as possible with the target likely to be met by April 2006. One further staff person has achieved a National Vocational Qualification since the last inspection. 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. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed with Standard 3 found to be fully met at the last inspection of 260705. Standard 6 is not applicable. EVIDENCE: Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 9 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 The home was found to be meeting resident’s health and general Care needs. The quality of monthly care-plans reviews is exceptional and clearly shows how all needs are being met. Medication arrangements are sound. The rights of resident’s are strongly upheld. EVIDENCE: The inspector sampled the care-plans of the 3 newest Residents and found them to be fully completed, covering a range of areas including choice and what abilities and things that residents can do for themselves. The personal care sections specifically show what aspects the resident can manage and what help is needed. The inspector spoke to those senior staff that have been trained and have a responsibility for the maintenance of these plans. The monthly reviews of the plans included detailed sections on activity participation, health, continence, sleeping patterns, medication, mobility, and other areas. All information was found to be clear and useful. The decision to decline the facility of lockable storage space in Resident bedrooms is recorded in the care-plan along with the decision about whether or not to have a key to their room. Residents who do not have their own key
Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 10 are invited to indicate in their plan whether they are happy for their rooms to be locked during the day. Management, staff, and records including pre-assessments and care-plans showed residents full range of ongoing health needs and how these are supported such as continence. Care-plans, observations, and discussions with Residents and staff showed how Residents personal care needs are sensitively met with full regard given to their rights, dignity, and respect. Comment cards filled in by relatives all indicated satisfaction with the care being provided to residents. The inspector looked at medication stocks, record keeping, training records and observed trained staff dispensing medication all of which was found to be in order. The deputy manager discussed the range of checks carried out in relation to medication arrangements. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 11 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 Resident’s benefit from varied and regular provision of stimulating activities. Residents are encouraged to be involved in the running of the home. A clear written visitors policy is required to protect everyone’s interests. Food is good, varied, and popular with residents. EVIDENCE: The home provides a range of appropriate activity for Residents. The inspector met with the dedicated activities co-coordinator who organises Bingo, Skittles, and darts, on a Tuesday. On Thursday’s as seen during the last inspection, dancing and music is organised by both her and a visiting musician. There are other flexible activities on other days such as cooking and popular monthly “Motivate” sessions by visiting specialists, which include movement and quizzes. Visitors to the home confirmed the flexibility afforded to them in relation to their visits. Residents confirmed satisfaction with these arrangements. The home was found not to have a written visitors policy. Although the home states in its brochure that visitors are welcome at any time there is in practice some reasonable restrictions including what can be given to residents. The home was asked to write up and publish the actual practice including expectations. Decisions such as the choice of a bedroom key are carefully recorded in care-plans along with activities and dietary preferences. A meal was sampled and found to be tasty, well cooked, and healthy. Menus contain two clear choices along with individualised diets for some residents based on their choices and needs.
Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 12 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): None of these standards were assessed with Standard 16 and 18 found to be fully met at the last inspection of 260705. EVIDENCE: Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 13 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): 19,22,23 & 26 The Environment of the home was found to be well maintained, and clean, with scheduled ongoing work taking place to make further improvements. EVIDENCE: A full tour of the home was undertaken which included all communal areas and 12 of the bedrooms. The kitchen floor was found to have been replaced since the last inspection. A range of work has been undertaken on the external grounds resulting in a nicely landscaped front garden and the substantial repair of a cracked exterior wall. The enclosed gardens are popular with residents with plans to improve accessibility by the Summer of 2006. The interior of the home has received more focus since the last inspection. The overall cleanliness of areas such as bedrooms, lounges, and dining rooms, including floors was found to have greatly improved resulting in a pleasant and hygienic home free from any offensive odours. The home now employs more cleaners, and has improved cleaning schedules, with a number of cleaners observed cleaning rooms during the inspection.
Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 14 The priority of replacing the carpet in the small lounge was found to be taking place during the inspection. Some painting of corridors and doorframes was found to have taken place with the rest of work planned to take place shortly. A number of beds [8] have also been replaced. The home was found to be safe and free from hazards. Residents were found to have comfortable chairs in communal areas and bedrooms. All residents had adequate furniture and enjoyed a good amount of space in both their bedrooms and in communal areas with ample space to entertain visitors with a number of quiet areas. A Maintenance person carries out weekly checks with someone in the management team doing additional daily checks to protect residents from potential hazards. All hot water outlets have working safety valves with all radiators guarded. A detailed Occupational Therapist inspection report has been carried out on the home [September 2005] this report confirms the overall suitability of the building making a range of positive comments. Some necessary priority repairs such as some chairs where found to have been carried out. Other recommendations are forming part of the homes annual development plan for 2006, which includes levelling access to the back garden where there is currently a slope, to make it more accessible to Residents. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 15 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): 28 & 29 Staff training was found to be excellent and well planned with the only shortfall being the number of staff with NVQ qualifications with plans to shortly rectify this. Recruitment procedures and practice are now sufficiently tight with just a minor recommendation made. Standard 27 & 30 were not assessed and were found to be met at the last Inspection dated 260705 with staff inductions exceeding the standard. EVIDENCE: The percentage of staff with at least National Vocational level 2 has increased slightly to 12 although most other care staff [12] were found to be working through their National Vocational Qualification‘s with some senior staff on the advanced level 3 course. Evidence of training records showed that most staff where at an advanced stage of this course with most units now completed. The training officer confirmed that over half the care staff team will have a National Vocational Qualification by April 2006 with delays due to staff needing more support. A Senior staff person confirmed in discussion that she was close to completing her level 3 National Vocational Qualification Staff at the last Inspection confirmed that a range of training continues to take place such as bereavement, coping with challenging behaviour and selfprotection. The home was found to have two training officers along with an experienced deputy manager.
Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 16 Two Recruitment files were examined. The home was found to have implemented the requirement from the last inspection namely that a check is now carried out against the POVA [Protection of Vulnerable Adults register] list before someone starts in the home if the full Police Check has not come back. This evidence was seen in the employment of staff since the last inspection. Staff were found to have two satisfactory references before employment commences although it was not clear from the records in what capacity the referee knew the applicant other than they worked at the same workplace. The deputy manager confirmed that a query about a work permit had been positively resolved via a call from the manager to the Home-Office although no documentation was presented during the inspection the manager subsequently sent this to the Inspector following the visit. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 17 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 & 35 A motivated and highly competent management team ensures an exceptionally well run home. Staff were seen to operate with clear direction and confirmed how well supported they are. The home is openly managed in the best interests of residents. Resident’s financial affairs are soundly managed by the home where they have involvement. Standard 33 & 38 were not assessed and were found to be met at the last Inspection dated 260705, with Quality Assurance exceeding the standard. EVIDENCE: The manager has worked in the home for 26 years, 9 years as owner, and with 5 years as Manager. She has also been one of the owners for the 9 years of her involvement. She has both an NVQ 4 in management and in Care. The deputy manager has a Registered managers award and NVQ 4 in Management;
Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 18 she also assisted with the setting up of a NVQ assessment centre in the home. she found to competently manage the home in the registered managers absence. The home has two part-time training managers one of whom takes on the role of a deputy manager on occasion’s. The home has a dedicated deputy manager who was present throughout the inspection. Residents were observed throughout the inspection to walk in and out of the manager’s office when they wanted advice or support. Only the registered manager has involvement with the small number of resident’s personal monies that the home manages. These records were not available during the inspection as only the manager has access. On previous inspections these arrangements have been found to be transparent and sound with an accurate running total maintained. In the managers absence the home was found to have sufficient petty cash if residents required this. In the main families maintain residents monies with them invoiced in clear itemised way for any expenses incurred by the home, such as hairdressing. All activities, basic toiletries and some newspapers are purchased at the homes expense and are not charged to residents. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 19 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X 3 3 X X 3 STAFFING Standard No Score 27 X 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X X X 3 X X X Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP13 Regulation 4[1][c] Schedule 1.13 Requirement That the Registered Person implements an appropriate written visitor’s policy and displays this in the home and Statement of Purpose. That this policy shows the arrangements made for contact between service users [residents] and their relatives, friends and representatives including any reasonable restrictions. Timescale for action 11/04/06 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. 2 Refer to Standard OP22 OP29 Good Practice Recommendations That the home continues to work through the recommendations of the recent report undertaken by a Occupational Therapist. That the capacity of referee’s and their role in relation to applicants is clearly identified in employment records. Tusker House DS0000021275.V274639.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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