Inspection on 27/09/06 for Tusker House

This inspection was carried out on 27th September 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 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

Tusker House 29/08/08

Tusker House 11/01/06

Tusker House 26/07/05

Tusker House 08/02/05

Tusker House 05/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tusker House 57 Pine Avenue Hastings East Sussex TN34 3PP Lead Inspector Jason Denny Key Unannounced Inspection 27th September 2006 09:30 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.V305266.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. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 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.V305266.R01.S.doc Version 5.2 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 11th January 2006 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 in September 2005 and is working through making further improvements to the environment. Most double bedrooms are used as 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. Information on the range of fees charged is within the homes current statement of purpose/service user guide and currently ranges from £366 to £540 per week. The private rate is from £440-540. At present no one is paying above £525. Fees will also vary for self-funding [private] Residents depending on room facilities such as en-suite rooms. There are charges highlighted in the contract, for extras including personal items and min bus outings provided by the home, along with newspapers, perfumes, chiropody, and hairdressing. Where necessary families are encouraged to purchase personal toiletries, as these are not routinely provided within the fee. Basic items for personal care are provided by the home in exceptional circumstances. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept in the office area of the home and can be obtained via the manager. A service user guide is sent to any interested person [or their representatives] looking to move into the home. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 9.30am and 3.40pm on September 27, 2006. This inspection focused on the key major areas such as how needs are being met. Activities, lifestyles, environment, staffing of the home, along with the management of the home, and how concerns are dealt with, was looked at. During this inspection process, which covers the period since the last inspection January 11, 2006 and the week of the home visit, a number of social workers and relatives have been spoken with. In addition Ten [10] questionnaires were received from relatives, and 4 from Residents prior to the inspection, with comments mainly positive, especially about the care, the manager, and the staff. Some visitors, including relatives and professionals and 12 Residents were spoken with, along with others observed during the inspection visit. The visit also included discussion with some staff and observation of care-practices. The focus of the inspection was looking at the newest Residents who have moved in since the last inspection. Some diversity and equality areas were explored in relation to lifestyles. Care records for 4 Residents along with health and medication needs were looked at. Discussions with management looked at progress since the last inspection. The inspector toured all communal areas of the home along with front bedrooms. Meal arrangements were examined. A record of complaints was inspected. Staffing was looked at in detail along with the homes management, including measures to ensure quality for Residents. Six [6] areas are Good, and one [1] area is Adequate [ok] and in need of minor improvement. What the service does well: In keeping with most comments from visitors to the home one family described the “care for their Mother [resident] as exceptional” and liked how the home treats Residents with a dementia type illness as normal people. The home was again found to do most things well, excelling in some areas. The management team are well qualified and skilled at meeting the needs of Residents with the home running smoothly at all times. Staff were again found to be well trained, supervised, and dedicated to their work. Resident’s benefit from receiving a lot of attention from staff and management. Established staff were found to be working through National Vocational Qualifications and have attended other useful training courses, which helps them, to meet the complex dementia needs of Residents. There continues to be a low turnover of staff with a main core of well-established staff, which continues to impress visitors. The views of Residents are regularly sought and acted upon. Individual resident care is carefully monitored and reviewed with an emphasis on supporting people to Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 6 remain as independent as is safely possible. Comments from professionals such as care managers and district nurses are positive about the home especially about the personal care provided and the open approach from management. Careful attention to medication to ensure that residents are not overly sedated. Residents are supported to look their best. Residents enjoy flexible routines and high amounts of communal space. A range of regular inhouse activities is provided which is popular with many. Staff inductions and training during their first year is exceptional. What has improved 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.V305266.R01.S.doc Version 5.2 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.V305266.R01.S.doc Version 5.2 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): 1,2,3,& 5. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home provides both prospective and existing Residents, with a good level of information. Moreover, the way in which the home assesses prospective or existing Residents ensures, that it currently meets needs. Contractual terms and conditions are fair with only some minor additional information needed to improve transparency. EVIDENCE: A copy of the home’s service user [Residents] guide including a complaints procedure is on display in the office area along with the most recent Inspection report. The guide also contains a survey of resident’s views following completed questionnaires received in April 2006. This positive report also includes a suggestion about what can improve such as how information about menus is advertised within the home, how Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 9 improvements are constantly being made to cleaning arrangements to eliminate odours, and that the home plans to upgrade and refurbish the home. The 4 files looked at of new residents since the last inspection showed Preassessments carried out by the manager prior to admittance into the home and were found to be thorough with additional information from social services also obtained prior to, or on, admittance. These assessments accurately described the needs of the Residents concerned who the inspector met with. Staff interviewed also revealed a good knowledge of these assessments. Fees range from the basic East Sussex rate paid for social service clients of £366 to a higher rate of up to £540 for new self funded Residents, many existing self funded Residents pay less £420 to £455 [if en-suite] and have not been asked to increase their contribution. No one currently pays higher than £525. Resident’s families are invited, as not covered in contract price, to provide personal toiletries. The home continues to stock shampoos and soaps for personal care, for use in exceptional circumstances, where the home is unable to access personal allowances for Residents from their families. The inspector found that all new permanent residents since the last inspection had a written contract on file although not all were signed to show agreement. The contacts clearly indicated the fee and room number and the home’s right to vary fees. The home was advised in light of the amendment to Care Homes Regulations [5] effective from September 2006 in relation to contracts. Namely that contracts need to show who is responsible for paying and whether the fee would be different if they were self-funding with this explained on the contract. Two self-funded residents were found to be charged £440 and £455 respectively, with the home explaining and showing that the higher fee was due to the person having an en-suite room. However this information was not on the contract. The homes management were positive about making these documents more transparent and began revising them for future use during the inspection visit. Some Residents spoken with confirmed that they had opportunities to have trial visits before moving in although in the main they relied on their relatives to make a decision. Such trial visits are also recorded within the homes initial assessment information on the prospective new resident. Evidence was also seen of the home sending out its guide to prospective new Residents as well as making this information available within the home. Relatives spoken with confirmed that they had full information before deciding on the home. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 10 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 Good. This judgement has been made using available evidence including a visit to this service. The manager and staff are very aware of Residents needs and respond quickly to any changes. A lot of attention is given to good personal care. Medication arrangements are soundly managed in the best interests of Residents with a minor improvement recommended in respect of information. Residents are treated with dignity and respect with their wishes respected. EVIDENCE: The inspector sampled the care-plans of 4 of the 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 who showed a good knowledge of the plans and what was important for each Resident. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 11 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 Residents’ 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 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 with some describing this as “exceptional”. Visitors including care managers and district nurses commented on how well presented Residents are indicating good personal care and that advice and guidance is acted upon with all necessary equipment used correctly to support service users, along with good care-plan notes kept. 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. There was no evidence of any Residents being over sedated with Residents found to be lively and sociable. The manager explained how the use of behavioural drugs is kept to a minimum in order to assist Residents to be able to express themselves and have a good quality of life. The home was advised to record in care-plans the reasons for and effects of each medication listed so that staff are aware of why they are giving medication and what side effects to monitor for. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 12 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 Good. This judgement has been made using available evidence including a visit to this service. The home provides a good range of activities based on resident preferences and which are advertised and regularly reviewed with Residents. Some thought should be given to outdoor activities such as outings. Routines are flexible for Residents who are treated as individuals. Food is under constant review and is good, tasty, varied, and healthy, in good portions and is popular with Residents who have a range of choice. EVIDENCE: The home provides a range of appropriate activity for Residents. The inspector met with the dedicated activities co-coordinator at the last inspection 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. Most Residents spoken with who could give an answer said that they enjoyed the singing and the motivate session. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 13 Relatives also indicate a good knowledge of what the home offers. During previous years some previous residents used to have regular summer outings. Some relatives commented to the inspector that they would like to see such outings resume. The manager was open to this idea as she feels that some of the newer Residents might benefit. The home was advised to research options on the basis of organising some regular outings to test feasibility. Care-plans showed the varying levels of Resident involvement in activities. The home is also looking at utilising the smaller lounge for some of the more able Residents for alternative activities. Routines were observed to be flexible with residents having breakfast from any time between 6am and 9am depending on choice, followed by mid morning tea in the lounge at varying times. Visitors to the home confirmed the flexibility afforded to them in relation to their visits. Residents confirmed satisfaction with these arrangements. The home has since the last inspection updated its visitor’s policy to include any restrictions. 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. Relatives and all Residents spoken with confirmed that they liked the food. One relative commented how the home sent food to the local hospital due to the hospitalised resident preference for the home’s food. The inspectors found 4-weekly menus on display with the introduction of advertised choices on both the menus and the notice board. The cook was observed to be consulting each resident as to his or her supper choice. Residents confirmed that alternatives are offered if they do not like the meal to be served. The Cook also interviews new Residents as to their preferences when they arrive at the home. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 14 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. The home operates in an open manner and has not had a formal complaint since the last inspection. All complaints and concerns are well handled. The home maintains a clear record of complaints made and advertises a clear procedure which Residents and visitors are aware of. Staff continue to demonstrate a sound understanding on how to prevent and report abuse in accordance with the homes updated policy. EVIDENCE: The home has a comprehensive complaint policy. This procedure and forms are in the reception area to the home. There was no record of any complaint made to the home since the last inspection. One anonymous concern communicated directly to the Commission was found to be without foundation in relation to fire exists being chained up. It was also evident that the manager’s promotion of an open culture has encouraged Residents and relatives to feel confident about raising any issues. All staff cover the homes policy on adult protection and prevention of abuse during their induction. This policy has recently been updated. Evidence was seen of video training followed by marked exams for the staff team as a whole. Staff who spoke with the inspector demonstrated a full understanding of all the issues involved, including whistle blowing and who to report concerns too. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 15 All Residents spoken too confirmed the sensitive care they receive and were knowledgeable about whom to report concerns too. Staff were observed by the inspector to operate in an appropriately caring and patient manner. Tusker House DS0000021275.V305266.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, 22, 24, & 26. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home has benefited from recent investment in some parts of the building although the overall impression is affected by some obvious areas of necessary improvement which once addressed will benefit residents and create an good impression for visitors. The home was found to be clean and free from offensive odours aided by continuous improvements to the cleaning schedules. EVIDENCE: A tour of the home was undertaken which included all communal areas and those bedrooms at the front of the home, as the rear bedrooms were covered at the last inspection January 11, 2006. Since the last Inspection the front entrance hallway has had a new carpet installed creating a positive impression, the odours were also fresh smelling as compared with previous visits. This positive impression was affected once you Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 17 enter the main lounge, which in the opinion of staff and visitors and comment cards needs updating along with a new floor. Although it was clean the carpet is stained and the walls need redecoration. The main dining room could also be more homely. The manager identified that this work will be planed shortly. The small lounge was found to be impressive having just been refurbished although it was evident that at present few residents are using it [none observed during the inspection]. The area is useful for residents to speak with visitors in private. Most bedrooms looked at were fine, clean and well equipped, however two needed repairs to furniture. It was evident that the homes own system of maintenance checks could improve. Paintwork around doors on the second floor was in need of attention. 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 a previous plan to improve accessibility by the Summer of 2006. The inspector found that gardens needed further work to be safe for most Residents. The manager explained that the gardener had plans but was behind schedule and was hopeful that the work will be completed by the next inspection. The interior of the home has received more focus over the last year. 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 and lounges during the inspection. The home was found to be safe and free from hazards. Residents were found to have comfortable chairs in communal areas and bedrooms. 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 replacing 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. The manager identified that work was behind schedule with planned grab-rails due to be installed. The inspector recognises that although the environment could be better overall much work has taken place over the last two years to bring this large home up to standard. Tusker House DS0000021275.V305266.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 Good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of experienced staff on duty who are well supervised and who continue to benefit from increased training. Tight recruitment and disciplinary procedures are followed to protect the interests of Residents with all new staff having exceptional inductions into the job with regular training. Staff are on course to meet all training targets in the near future. All Residents and visitors praised the quality of the staff. EVIDENCE: Staffing levels are matched to the needs of the 50 plus Residents as evidenced during the inspection. Staff and visitors confirmed that there was enough staff to meet needs. 8 care staff run the morning shift, 5 the afternoon, and 5 the waking night shift. The rota was accurate but needs improvement to clearly show the role and capacity of each worker. The percentage of staff with at least National Vocational level 2 has increased slightly to 40 although most other care staff [8] were found to be working through their National Vocational Qualification‘s with some senior staff on the advanced level 3 course. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 19 The home had previously hoped to meet the basic target by April 2006 but is optimistic that this should be achieved within the next year. No recommendation was made given the closeness of the target and the overall quality of the training. A Senior staff person confirmed in discussion that she had just completed her level 3 National Vocational Qualification. Staff again confirmed that a range of training continues to take place such as pressure care, bereavement, coping with challenging behaviour and selfprotection. The home was found to have two training officers along with an experienced deputy manager. Staffing files looked at showed that an exceptional range of training occurs for new and existing staff to bring them quickly up to standard. The home also benefits from having its own training facility. Regular training is undertaken in dementia and related illnesses to ensure staff are aware of residents needs. Three Recruitment files were examined. The home was found to have carried out all checks such against the POVA [Protection of Vulnerable Adults register] list before someone starts in the home if the full Police Check has not come back. The home generally waits until the full CRB back comes back before someone starts in the home. All staff work under supervision before the CRB comes back. The home was found to making arrangements for the new common induction standards. Files showed that new staff had made good progress with their TOPPSS and foundation standards prior to moving on to National Vocational Qualification in Care. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 20 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, & 38. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The management of the home is highly competent and provides clear leadership. An exceptional range of Quality assurance measures are regularly carried out based on Residents being fully involved in the running of the home. Overall management of the home is Good and will be assessed as excellent once quality is improved in respect of the environment and minor administrative areas. Record keeping such as service user finances and health and safety is good. EVIDENCE: The manager has worked in the home for 26 years, 9 years as owner, and Manager. She has both an NVQ 4 in management and in Care. The deputy Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 21 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 takes on the role of a deputy manager on occasion’s. Residents were observed throughout the inspection to walk in and out of the manager’s office when they wanted advice or support. Overall quality assurance measures are good with the exemption of the environment, which can improve further. A detailed survey of resident’s and their representative’s views took place in April 2006 with the results published in the home’s service user guide. The overall outcome was highly positive for the home. This positive report also include a suggestion about what can improve such as how information about menus is advertised within the home and how improvements are constantly being made to cleaning arrangements to eliminate odours, and that the home plans to upgrade and refurbish the home in light of some views from relatives. Care-plans were found to have detailed reviews on a monthly basis. Only the registered manager has involvement with the small number of resident’s personal monies that the home manages. On previous inspections these arrangements have been found to be transparent and sound with an accurate running total maintained. In the main families maintain Residents monies with them invoiced in clear itemised way for any expenses incurred by the home, such as hairdressing and personal toiletries which families are encouraged to purchase as stated in the contract. All activities, with the exception of mini-bus outings] and some newspapers are purchased at the homes expense and are not charged to Residents. The Commission’s questionnaire filled in by the home prior to the inspection confirmed that all necessary health and safety checks have been carried out including regular servicing of all necessary equipment. There are no outstanding recommendations or requirements from the last environmental health inspection. All staff have received training such as first aid, health and safety, fire, and Moving and handling. The inspector saw evidence of regular fire drills and a range of fire training. The policy is not to evacuate Residents from the building due to the confusion and the fire doors and other safety measures in the home, unless it is safe to do so. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 22 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 X 3 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 2 X X 2 X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 23 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 OP19 Regulation 23 Requirement That the Registered person must send the Commission by the date shown its programme of routine maintenance and renewal of the fabric and decoration of the premisesThat the plan includes the replacement of the flooring and decoration of the Main lounge. That consideration is given to any possible improvements to the main dining room. Timescale for action 27/12/06 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 OP2 Good Practice Recommendations That the Statement of Terms and Conditions [Contract] shows who is responsible for paying the fee. That the contract shows whether the fee would be different if the person was self-funding. That any variations in fees are explained such as higher fees for en-suite rooms. That the contract is signed on or before admittance. DS0000021275.V305266.R01.S.doc Version 5.2 Page 24 Tusker House 2 OP9 3 4 5 6 OP12 OP22 OP24 OP27 [Amendment to regulation 5 effective from September 1, 2006] That the effects of medication and the reason for them being given to individuals is recorded [In the Care –plan]. That where possible full consultation takes place with stakeholders during the pre-assessment process. That a programme of outings [such as mini bus excursions] is explored. That the home continues to work through the recommendations of the recent report [September 2005] undertaken by an Occupational Therapist. That the schedule and checks of routine maintenance are reviewed to ensure the prompt repair of bedroom furniture and paintwork. That the Rota maintained shows the role and capacity of each person along with who is in charge of the home at any time. Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 25 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 © 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 Tusker House DS0000021275.V305266.R01.S.doc Version 5.2 Page 26 - 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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