CARE HOMES FOR OLDER PEOPLE
Tusker House 57 Pine Avenue Hastings East Sussex TN34 3PP Lead Inspector
Jason Denny Unannounced 26 July 2005 09:50 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 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 H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tusker House Address 57 Pine Avenue Hastings East Sussex TN34 3PP 01424 421573/715706 01424 427758 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Paula Woolgar, Mr Michael Goonane Mrs Paula Woolgar Care Home 76 Category(ies) of Dementia (DE) 76 registration, with number of places Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated is seventy six (76) 2. That two specific service users under 65 years of age can be admitted to the home 3. Service users with a dementia type illness only to be accommodated Date of last inspection 8 February 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. It has enclosed garden areas for service users and plans to increase the accessible garden space. 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 visist the home on a regular basis throughout the year. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [first of two planned before April1st 2006], which took place between 9.50am and 2.20pm. The Inspection found that of the 16 National Minimum Standards inspected, that 12 of these standards had been met, with most others nearly met. 4 standards were exceeded, with 1 standard [6] not applicable. The overall focus of the inspection was on new residents, staff, and the environment. Health and safety practices, along with how the home responds and records people’s views were also examined. The inspector started the inspection by touring the home including bedrooms and communal areas, speaking with residents [15 in total] and visitors in communal areas, along with 2 staff. A discussion with the management team took place around progress since the last inspection. Care and staff records, along with safety documentation were inspected. What the service does well: What has improved since the last inspection?
A lockable door has been fitted to a purpose built shower room enhancing privacy for residents. The popular front garden has been attractively
Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 6 landscaped with the rear garden on schedule for this along with a plan to create a water feature in the courtyard. The home’s visitor’s book now records the purpose of each visit to promote accountability. Staff continue to work through their NVQ’s with newer staff recently enrolled on this course. An additional training officer has also started to further support staff and improve training. The quality of the homes care-plans for residents has improved to exceed the normal standard in terms of detail, frequency of review, and support given to residents to maintain skills. The home has also approached occupational therapists with a view to a qualified person assessing the home’s environment to continue to ensure its suitability for the needs of older people. 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 H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 standard(s) 3 The way in which the home assesses prospective or existing residents ensures that it continues to meet needs. EVIDENCE: The Inspector looked at the assessment records carried out on all 4 residents who have moved in to the home since the last inspection. The forms showed both the assessment date, and the date the resident moved in to the home. The inspector found that all these residents were visited by the management team with a written assessment carried out several days or weeks before they moved in to the home as confirmed in records. All sections of the preassessment forms were filled in and covered the full range of areas as laid down by clinical, and best practice guidance as well as the Commission’s National Minimum standard. Areas covered included history of falls, risk of wandering, skin condition, mobility assessment, personal care needs dietary needs, life history, social and leisure interest. The inspector spoke to staff and some of the new residents referred too, and found evidence that all had settled in well to the home with their full range of needs having been identified and met. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 standard(s) 7 The home was found to be meeting resident’s health and general needs and was fully aware of what additional support was required. Care-plans were full, logically presented, and regularly reviewed and updated. The quality of monthly care-plans reviews was found to be exceptional and clearly showed how all needs were being met. The inspector judged that resident’s rights such as independence were strongly upheld. EVIDENCE: The inspector sampled the care-plans of the 4 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 inspector found that they had a good working knowledge of the needs of the Residents concerned. The monthly reviews of the plans included detailed sections on activity participation, health, continence, sleeping patterns, medication, mobility, and other areas. The decision to decline the facility of lockable storage space in Resident bedrooms is recorded in the care-pan along with the decision about whether or
Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 10 not to have a key to their room. Residents who do not have their own key are invited to indicate in their plan whether they are happy for their rooms to be locked during the day. One resident indicated to the inspector that she would like her own room key like some other residents. Records and discussions with management showed that she had her own key on several occasions only to lose it and for other residents to accidentally go in her room when it was left open. Records showed family consent to the current decision for staff to retain the key. The resident was found to have instant access to her room and staff. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: None of these standards were inspected during this visit. All lifestyle standards will be examined on the next inspection. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 standard(s) 16 & 18 The home operates in an open and pro-active manner. Staff continue to demonstrate a sound understanding on how to prevent abuse and continue to benefit from adult protection training. Residents continue to be registered to vote and have all their rights upheld. All residents and visitors are made fully aware of how to complain or raise concerns. The home continues to treat even minor concerns as complaints and purposely encourages residents to air their views. The home is competent and thorough in its investigation of concerns or complaints. EVIDENCE: The Complaints file looked at showed one complaint made to the home over the last year in April 2005. The complaint was not upheld and found to have no factual foundation with the home acting correctly throughout in relation to the care of a resident who had to go into hospital. The Commission had been kept fully informed during the homes investigation and supported the outcome. The home has a clear adult protection policy and procedure along with a whistle blowing policy. Staff interviewed again showed a good understanding of how to both identify and report abuse. This area is also covered during the induction of new staff, and on the National Vocational Qualification’s carried out by all care-staff. During the inspection the home developed a “Grumbles” book to help residents raise minor concerns about their peers. A number of such concerns tend to be based on confusion or are unreasonable. Recording such concerns and reaching an outcome supports resident’s rights and diffuses potential tension. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 standard(s) 19,21,22,24 & 26 A range of work has been undertaken on the external grounds resulting in nicely landscaped front garden and the substantial repair of a cracked exterior wall. The enclosed gardens are popular with residents with plans to improve the courtyard and the rear garden. More focus is now needed on the interior of the home. The overall cleanliness of communal areas such as lounges and dining rooms needs to improve to maintain a pleasant and hygienic home for residents. Combined with this is the need to replace some carpets and address interior paintwork to improve the homeliness of the building. Having an advertised written plan will show when these works will take place. This plan has been requested within 3 months of the inspection. The home was found to be safe. 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. All bathrooms are well fitted and all ensure privacy for residents. The premises are suitable for older people although the home has been requested to get a specialist [occupational therapist] assessment.
Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 14 EVIDENCE: A full tour of the home was undertaken which included all communal areas and 15 of the bedrooms. The kitchen floor was found to have been replaced since the last inspection. A shower room identified at previous inspections was found to have lockable door to allow residents privacy. The shower was also a modern walk- in type. The complexity of the work required a specialist. The carpet in the smaller lounge was found to be stained, unclean and discoloured, and as previously reported in need of replacing. Some other carpets areas were found to be unclean in the dining areas and other places. Some beds were found to need replacing due to slight odours in some rooms although the main offensive odour found was in a vacant room. Some hallways, and door-frames were in need of repainting. Some rooms inspected were due for a clean that day with the dedicated cleaner doing a tour. The manager explained that the usual number of cleaners was reduced during the week of the inspection. A maintenance person was found to do 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. The management team showed the inspector a list of potential occupational therapists that they are looking to contact with a view of getting an up to date assessment on the suitability of the premises. The specialist can also advise on any future adaptations, which might be useful. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 & 30 There continues to be sufficient numbers of suitable staff on duty to meet needs of resident’s along with the cleaning and cooking tasks. The popular staff team are experienced and have worked in the home for a long time. 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 rectify this, such as high numbers of staff already on these courses. Recruitment procedures and practice was found to need tightening. Confusion around these legal requirements had not affected residents. The induction of new staff was again found to be exceptional. EVIDENCE: Resident numbers were found to have reduced from a usual 60-65 down to 51. However staffing ratios were found not to have reduced in case this affected the needs of residents. Staff confirmed that these staffing levels were sufficient to do their jobs. 7-9 staff work the morning shift, 5 work the afternoon/evening shift, and 5 staff work waking nights. In addition the management team assist on shift when necessary. The home has cooks on every shift along with cleaners which ensure that care-staff can focus on residents. The percentage of staff with at least National Vocational level 2 was unchanged at 8 although most care staff were found to be working through their NVQ’s with some senior staff on the advanced level 3 course. Staff interviewed confirmed that a range of training had taken place since the last inspection such as bereavement, and coping with challenging behaviour and how to protect oneself.
Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 16 The induction of a new staff member was examined with her TOPSS workbook [now SKILLS FOR CARE] progressively completed over several weeks, along with a general in house induction. The home was found to have two training officers along with an experienced deputy manager. Recruitment files were not examined as the management verbally confirmed that some staff since the last inspection had started working in the home before a full police CRB check came back or any check made on the register based on the Protection of vulnerable persons[ P.O.V.A List] which contains a list of people unsuitable to work in the industry. This was clarified during the inspection with the home given clear guidance as to future conduct. No staff work in the home without at least 2 references one of whom is from the previous employer. Staff have to account for gaps in employment history on the application form. A range of dementia training was found to have been undertaken by staff. A staff member confirmed that she had recently achieved NVQ assessor status. The home is also an approved NVQ assessment centre, which is assisting staff to promptly complete their courses. One staff member was found to be using this training to prompt the home to review how they record minor concerns from residents. This directly led to a “Grumbles” book being introduced. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 & 38 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. The management of the home ensure that they are well informed about resident’s and staff’s viewpoints. The home carries out a full range of checks on the environment and equipment to ensure the safety of residents, which is also supported by well-trained staff. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 18 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; she also assisted with the setting up of a NVQ assessment centre in the home. The home has two part-time training managers one of whom is the deputy manager. Despite this being an Unannounced Inspection the Inspector found the home to be running smoothly initially in the managers. The inspector spoke at length with the management team including one of the training officers, along with residents, visitors and staff to establish how the home was being managed. Residents were observed throughout the inspection to walk in and out of the manager’s office when they wanted advice or support. A detailed questionnaire completed by 22 residents and some visitors in March 2005 showed high satisfaction levels with suggestions such as improvements to laundry arrangements implemented. A report of this survey was found to be published in the home and placed in service user guide in reception. Records and discussions showed that most staff had a range of health and safety training combined with first aid, Fire, Moving and Handling and food hygiene. The manager stated that gas safety and electrical certificates had been renewed since the last inspection as per the yearly schedule. Portable electrical appliances had also been tested regularly. The inspector found certificates for 2004. The manager stated that copies of this year’s certification not present during the inspection. This evidence was promptly sent to the Commission within 2 days of the Inspection. A range of building risk assessments were found to be up to date with both daily and weekly checks of the building and testing of alarms and water temperatures along with other checks. Fire equipment was found to be in order and regularly tested. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 3 3 x 3 x 1 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 x 4 x x x x 3 Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 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 19 Regulation 23[2][b]& 24 Requirement Timescale for action 26/10/05 2. 26 3. 29 That the Registered Person must send the commission by the date indicated; A plan for the renewal, redocaration, and maintenance of the home. That this plan makes mention of the small lounge carpets, some bedroom carpets and replacement of some beds. That the plan includes measures to impove paintwork and condition of some interior walls. 12[1][a] That the Registered person must 02/07/05 ensure that the premises are kept reasonably clean, and hygenic. 19,7 & 9 That the Registered Person must Immediate Amendme operate a thorough recruitmnet nts to procedure. That no staff can schedule commence employment in the 2 effective home until thay have had at from July least a P.O.V.A check along with 26, 2004. all other checks, with a full Police CRB check applied for. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 21 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 22 Good Practice Recommendations That the home makes arrangements for an assessment of the premises and facilities by an Occupational Therapist. Tusker House H59-H10 S21275 Tusker House V231327 260705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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