Inspection on 24/04/06 for Tutnall Hall Nursing Home

This inspection was carried out on 24th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Tutnall Hall Nursing Home 06/11/06

Tutnall Hall Nursing Home 20/02/06

Tutnall Hall Nursing Home 14/09/05

Tutnall Hall Nursing Home 20/03/05

Tutnall Hall Nursing Home 12/07/04

Tutnall Hall Nursing Home 06/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Tutnall Hall Nursing Home Tutnall Lane Tutnall Bromsgrove Worcestershire B60 1NA Lead Inspector N Richards Draft Unannounced Inspection 24th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tutnall Hall Nursing Home DS0000004149.V291386.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. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tutnall Hall Nursing Home Address Tutnall Lane Tutnall Bromsgrove Worcestershire B60 1NA 01527 875854 01527 875742 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) Alpha Health Care Limited Mrs Susan Mary Dempsey Care Home 40 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2006 Brief Description of the Service: Tutnall Hall is situated in a quiet, rural position between Bromsgrove and Redditch, and is part of Alpha Health Care Limited – a company that operates a number of care homes for older people (several of which are within Worcestershire). The home is registered to provide nursing care and accommodation for a maximum of 40 residents over the age of 65 years. As part of this registration, the home can also accommodate up to three older people with a dementiarelated illness. A trained nurse is on duty in the home at all times. Accommodation is provided on three floors that are accessed via (two) passenger lifts or two staircases located on either side of the building. There are a total of 19 single bedrooms (16 of which have en-suite facilities) and 10 shared rooms (of which, six have en-suite facilities). Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over two days. The home’s manager and deputy manager made themselves available to provide some information during the inspection process, while other methods were employed to gather further information about the service provided by the home. This included talking to residents and visiting next-of-kin, interviewing of four staff, the observation of care practice, a tour of the premises and an examination of care, staffing and health and safety records. 28 residents were living in the home at the time of the inspection. Several residents and their visiting relatives were interviewed during the inspection, and all those that were interviewed stated how good the service was, and how good the care provided was. The evidence from this inspection emphasises how the home has progressed to improve the service it provides for residents since the time of the previous inspection. While the home has not yet managed to address all of the requirements from the previous inspection report, significant work has been undertaken to attempt to remedy the deficits identified within the previous report. 21 of the 30 Standards assessed were being complied with by the care home. However, 9 of the 30 Standards were not being complied with. What the service does well: What has improved since the last inspection? What they could do better: Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 6 The training, development and supervision of staff within the home requires further investment to ensure that effective and consistent care is provided to residents to promote their health and well being. Care records require substantial development to (a) evidence the care provided and (b) ensure that care is provided in safe and consistent manner. Staffing levels and social, recreational and leisure care must be reviewed once occupancy levels start to increase, as at the time of inspection, the occupancy level was only at 70 . 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. Tutnall Hall Nursing Home DS0000004149.V291386.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 Tutnall Hall Nursing Home DS0000004149.V291386.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): 2, 3, 4 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home adequately provides prospective residents with the information they need to make an informed choice about the home. EVIDENCE: A comprehensive, written pre-admission assessment is undertaken for all prospective residents by a registered nurse prior to their admission to the home. Where prospective residents are to be funded by the local authority, a community care assessment is completed and provided to the home. This demonstrates the care needs of the individual, and enables the home to form a judgment about whether (or not) it can meet the person’s needs. Next-of-kin interviewed confirmed that a pre-admission assessment had been undertaken prior to their relative being admitted into the home. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 9 All care files examined contained a written contract/statement of terms and conditions that clearly specified the rights and obligations of the resident and the home. A copy of the home’s statement of purpose and complaints procedure was held in each bedroom, and relatives confirmed that they were aware of the existence of both documents. The provision of a contract and statement of purpose helps to provide clarity about the service for residents, and enables people to understand what they can expect from the service, and how to complain when the service falls short of their expectations. It was noted that paragraph 9 of the home’s contract required slight amendment as it states; “If in the opinion of the Person-in-Charge/Care Team/GP and/or the Social Worker, the resident’s care changes from Residential to Nursing or vice versa, this will result in consultation with the Resident and/or the next-of-kin, before a change is affected”. This paragraph needs to (a) reflect current commissioning protocol i.e. the local authority or health trust will assess the individual’s level of need and (b) reflect the change in registration criteria since the implementation of The Care Standards Act 2001. Since the time of the previous inspection, the home has developed a letter of confirmation, which is sent to prospective residents and/or their next-of-kin confirming that the home is capable of meeting the individual’s needs. The home does not provide intermediate care. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service The standard of care records within the home is poor. Records are not sufficiently detailed to ensure that individual residents’ needs are met in a consistent manner. However, care practice discussed and examined, along with feedback from residents and their relatives confirms that appropriate action is taken to meet the clinical needs of residents. EVIDENCE: A total of seven people within the home had a pressure ulcer (representing 25 of the resident population). Although this figure may seem high, of the seven people with a pressure ulcer, six (86 ) had sustained them whilst in hospital. One person had sustained a pressure ulcer whilst in the home, but this had developed as a result of a general physical deterioration. Nursing staff were adopting appropriate care to heal the pressure ulcers – often in conjunction with the community tissue viability nurse, and appropriate Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 11 pressure-relieving equipment was available for those individuals who required pressure-relieving equipment. Opportunity was taken to talk to several residents and their visiting next-ofkin. All people interviewed were very positive about the quality of care, and the general quality of service provided by the home and its staff. One person said that the care was “10 out of 10”, another relative rated the home “8 out of 10” and one resident and their next-of-kin said that the home was “excellent” and (the resident) “couldn’t have had better treatment”. During the inspection, a GP was noted to be undertaking a routine visit to the home. The GP expressed his positive opinion about the home. Four residents’ care files were examined during the inspection. Each resident had a care plan in place, which had been completed by a registered nurse, but the quality and content of care plans varied considerably. While some care documents effectively specified how care is to be delivered, some care plans failed to effectively specify how care is to be delivered. This was of particular concern for individuals who are diabetic, and for those individuals who possessed pressure ulcers. The following deficits were noted about care documentation; 1. Care plans had not been formally agreed with and counter-signed by the resident and/or their next-of-kin. This is necessary to ensure that the home (a) works in participation with the individual (rather than working to preclude the individual from the care process), (b) engages the individual within the care process, and (c) ensures that the individual understands and consents to the care provided. 2. Some care plans need to be more specific and directive. For example, one care plan relating to the management of diabetes failed to clearly specify the signs and symptoms of hypoglycaemia and hyperglycaemia. This is important if care staff are to understand the symptoms they are supposed to be monitoring. 3. Care plans were not being reviewed in accordance with the frequency specified by the National Minimum Standards i.e. at least once a month. This is important to ensure that (a) any changes to a person’s condition are noted, and (b) the plan of care is amended in response to any change/s noted. 4. Although each file contained a range of risk assessments and health care assessments, some required further development as; (a) one file failed to contain any weight record, (b) one file contained a “Waterlow” pressure ulcer risk assessment which cited the individual as being at “high risk” of pressure ulcer development. However, the risk assessment had not been regularly reviewed, (c) one file contained a risk assessment for the use of bedside rails which identified the individual as being at “high risk”. A consent form for their use had been countersigned by the resident’s next-of-kin, but the consent form did not specify the risks of Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 12 using bed side rails, neither did it specify the benefits and risks of their use. 5. Care plans for pressure ulcers did not effectively demonstrate the nursing care and nursing interventions necessary to address the problem/s identified. 6. Some care plans demonstrated problems with communication. For example, one care plan cited “***** is having medical history of asthma” (sic). The interventions cited were as follows; “Good nursing care is more important. Observe breathing. Provide propped up position from quick relief of wheeziness. Ensure that free from allergic products. Give nebulizer and inhaler as ordered” (sic). Apart from the obvious language difficulty, the care plan was also scant in terms of relevant nursing information/content. 7. Following discussion with nursing staff, it transpired that some care plans were in place for problems that were no longer health care problems. A range of health care risk assessments had been undertaken (such as fall risk assessments and pressure ulcer development risk assessments). When risks had been identified through assessment, plans of care necessary to reduce or eliminate the identified risk had been completed. All medication is administered to residents by a registered nurse. The medication is stored securely in a treatment room. On the day of inspection the outside air temperature was high and, as the treatment room had no ventilation, the temperature within the treatment room was 31°C. This temperature was too high, and action needed to be taken to improve ventilation within the treatment room to reduce the temperature to a maximum 26°C (as this is the recommended maximum temperature below which medication should be stored). The home uses a monitored dosage system for medication administration. A member of the nursing team was observed administering medication to residents. Medication was administered safely, sensitively and diligently to ensure that the right medication was administered to the right person, at the right time and in the right dose – thereby promoting the safety and well-being of residents. However, it was noted that some medication administration record (MAR) charts had not been accurately completed by nursing staff within the home, resulting in no entries having been made against some administration times, and some variable dose medication (such as painkillers) had been given without nursing staff recording the actual dose administered. This lapse in record keeping poses a potential risk to the health and safety of residents. Residents spoken to were happy to confirm that staff within the home was meeting their care needs in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 13 Care records clearly evidenced the accessing of multi-disciplinary healthcare professionals such as general practitioners (GPs), speech and language therapists, chiropodists, dentists and opticians, in response to changes in healthcare need (reactive care), and as a preventative measure (proactive care). Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Social care within the home is adequate. Residents have opportunities to participate in leisure and recreational activities that meets their needs and expectations. Contact with family and friends is supported, and opportunities for residents to exercise choice over their lives has been improved to enable them to maximise personal autonomy. EVIDENCE: Individual residents and their next-of-kin who were spoken to stated that there was opportunity to engage in meaningful activities. The home’s activities coordinator works for 20 hours each week with residents, and was very enthusiastic about her role. She has started to record a diverse range of individual activities with residents – with most activity provided on a 1:1 basis. The individual preferences of residents have been carefully sought, and the activities being undertaken reflect the preferences conveyed by the residents within the home. It is pertinent to note that the level of social, occupational and recreational care afforded the current occupants of the home is sufficient given the current level of occupancy. When occupancy levels increase, the level of activity organiser/co-ordinator input should increase accordingly to Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 15 ensure that residents receive the same (or improved) level of social, recreational and occupational activity. Residents and visitors confirmed that family and friends are made welcome, and visiting restrictions were kept to a minimum. Residents are able to receive visitors within the communal areas of the home, or in the comfort and privacy of their own rooms. If residents choose and are able, they manage their own financial affairs. The home actively operates to ensure minimal contact with residents’ finances occurs. A number of people living in the home were spoken to and everyone who commented on the food said how good it was, and that they welcomed the daily choices offered. Menus were inspected and found to be balanced and interesting and mealtime arrangements are also flexible enough to accommodate individual preferences. Menus were based on a four-week rotational basis. The main meal served on the day of inspection comprised of a choice between lamb hot pot and vegetable bake. People with swallowing difficulties were provided with a soft-textured diet based on the main menu option/s. Dessert consisted of rice pudding and egg custard, and residents could partake of up to three cooked meals a day if they so desired. Catering staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. Several residents interviewed explained how they had been provided with breakfast of their own choice. The chef keeps a record of each resident’s meal selection on file for reference purposes, and residents are asked on the morning of the day in question what they would like for lunch. If individuals did not want a choice from the main menu, the chef would make alternative arrangements based on the preferences of the individual resident/s. Residents’ weight charts confirmed that residents were not losing weight unexpectedly, and that weights were stable. During the morning and afternoon periods, care staff were seen providing residents with drinks and snacks. Care staff were seen providing direct assistance to people with their lunch in a sensitive, discreet and relaxed manner. Residents said that the dining facilities were suitable to their needs. Residents could choose to have their meals in their own rooms, in the dining area or in the lounges. A food survey had been undertaken with residents, and the results were made available during the inspection. 11 out of 28 forms had been returned. The feedback from the returned forms are as follows; 4 people regarded the food as “excellent”, 6 people regarded the food as “good” and 1 person regarded the food as “poor”. The home had taken on board the criticism/s provided and was in the process of responding to the criticism/s. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 16 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Complaint management and adult protection within the home is adequate. Complaints are handled objectively and residents are confident that their concerns will be listened to, taken seriously and acted upon. A vulnerable adults procedure is available to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a simple and clear complaints procedure, and the complaint records indicated that this is followed. A register of concerns and complaints has been developed since the time of the previous inspection, and the records clearly demonstrated the outcomes from the concern/complaint investigations. A copy of the complaints procedure had been given to all residents, and was available to visitors and relatives. Residents spoken to were confident that concerns could be raised with the home. A procedure for responding to allegations of abuse is available. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 17 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service A rolling programme of investment within the home continues to ensure that an adequate environmental standard is maintained. There are, however, areas within the home that would benefit from investment to improve the home’s physical appearance. EVIDENCE: Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 18 Separate lounge and dining room facilities are provided within the home. The previous inspection report raised concerns about the provision of dedicated dining space for the numbers of residents within the home. However, discussions with residents confirmed that the option of using either the dining areas, lounge areas or their own bedrooms was deemed as acceptable by the residents interviewed. Systems were in place for the management of infection control, and the home was clean, tidy and free from offensive odours. Each bedroom seen had been furnished with residents’ personal possessions, thereby generating ownership and a sense of autonomy for individuals. The standard of the environment within the home is acceptable, providing residents with a homely place to live. Residents confirmed that they appreciated the physical environment. It was noted that several areas within the home possessed floor-coverings that required replacement due to fatigue, or marking. The provision of replacement floor-coverings to affected areas will help to enhance the appearance of the home. It was also noted that several areas of glazing were fatigued, and require replacement. Hot water temperatures have been risk assessed and had been regulated to prevent people being accidentally scalded when they have a bath, and radiators had been guarded and restricted to prevent people being accidentally burnt through intentional or unintentional contact All the windows located at or above first floor level had been restricted to prevent people from being injured through falling out of the windows (accidentally or deliberately). There were sufficient toilet and bathing facilities throughout the home to effectively meet the needs of residents. The home employs a “handyman” who undertakes maintenance and decorative work to an effective standard. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 19 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Staffing within the home is poor. Staffing levels are generally suitable to ensure that residents’ needs are identified and effectively met. However, staff training is necessary to ensure that all care staff can effectively meet the care needs of people living within the home. EVIDENCE: Three staff files were examined, along with a range of duty rotas and staff training files. There were suitable nursing and care staff on duty to provide care and support for the 28 people who were resident in the home at the time of inspection. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 20 Some limited training had been provided to staff, and planned training included moving and handling. Training was not being identified or accessed as a result of the needs of residents, to ensure that care delivered was appropriate to and in response to the needs of residents. Staff said that they had not received any training relating to the care and management of people with memory loss problems, diabetes, learning disabilities, nutrition or continence management (all these areas were identified as a result of the clinical needs of residents within the home). Opportunity was taken to examine three staff files. All files contained an application form, but not all files contained two written references. Limited supervision records were available, but were not sufficient to ensure that all staff had received suitable, formal supervision. Staff supervision had started in March 2006, but not all staff had been formally supervised and the staff supervision records examined were scant in terms of content. A staff training matrix for 2006/7 was available, and examined. The training matrix only included moving and handling, infection control, food hygiene, fire safety, abuse, health and safety, first aid, drug administration and waste segregation. Nobody had been identified for first aid training during 2006/7, and records only showed that four people had undertaken any first aid training. Many staff had not received moving and handling training, abuse or health and safety training. Training records failed to specify the course contents. First aid training certificates merely cited; “…has taken part in a training session on first aid”. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service Management of the home is poor in relation to staff training and development. There is clear leadership, guidance and direction to staff by the home’s manager to ensure residents receive consistent care, but an absence of critical training based on the assessed needs of residents serves to potentially place residents at risk. Employment procedures also need developing. EVIDENCE: There is a registered manager, and she is competent and appropriately qualified and experienced to manage the service. Staff and residents spoke very highly of her, and significant diligence and action has been undertaken to maintain the quality of the service provided by the home since the time of the previous inspection. Residents and their visiting next-of-kin clearly expressed their opinion that the home was being run in the best interests of the residents Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 22 The manager did take the opportunity to explain that she had tendered her resignation due to her imminent plans to emigrate. Four care staff were interviewed during the inspection. Periods of employment within the home ranged from three days to 15 years. Some staff said that they had not received any formal induction, and had not been given the opportunity to read through care files. One staff member said that she had been given an interview, had commenced employment but had not completed an application form and had not received any moving and handling training despite having provided hands-on care. One member of staff said that, since commencing employment within the home, her training had comprised of watching a video about fire safety for one hour, watching a video for one hour about waste management and undertaking a four hour basic food hygiene training session. No formal manual handling training had been provided. Staff were not being formally supervised to ensure that they understood and delivered the philosophy of the home. When interviewed, residents and their families expressed their satisfaction with the staff and the service provided by the home. Staff were rated “10 out of 10”, and were described as “excellent”, while some people rated the home “8 out of 10”. One person explained how their relative “couldn’t have had better treatment”. Residents and their next-of-kin interviewed expressed their opinion that the home was being conducted in the best interests of the residents. Environmental records confirmed that the home was being conducted so as to promote and safeguard the health and safety of residents, visitors and staff. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 23 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 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 3 3 3 2 3 3 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 1 Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15(1) Requirement Care plans must be developed to include the care required to meet the assessed needs of residents. Care plans must be written to ensure staff understand the care to be provided, and to ensure that care is provided in a consistent manner. Care plans must be formally agreed either with the resident, or with their representative when the resident is unable to provide informed agreement. Care plans’ effectiveness must be reviewed (at least) monthly by a registered nurse. Risk assessments must be regularly reviewed when a risk has been identified. Appropriate ventilation must be provided to the treatment room to ensure that the air temperature is kept at, or below 26°C. A registered nurse must sign all MAR charts when the prescribed medication has been administered. If a prescribed medicine is not administered to a DS0000004149.V291386.R01.S.doc Timescale for action 01/08/06 2 OP7 15(1) 01/08/06 3 4 5 OP7 OP7 OP9 15(2) 15(2) 13(2) 01/06/06 01/06/06 30/06/06 6 OP9 13(2) 01/06/06 Tutnall Hall Nursing Home Version 5.1 Page 25 7 OP9 13(2) 8 OP12 16(2)n, 18(1) 16(2)(c) 9 OP19 10 11 OP19 OP38 13 18(1)(c), 23(4)(d) 12 OP30 18(1)(C), 23(4)(d) 18(1)(c), 23(4)(d) 18(1)(c), 23(4)(d) 18(2) 13 14 15 OP30 OP30 OP36 resident, the reason for nonadministration must be clearly recorded on the MAR chart. Nursing staff must record the actual dose administered on MAR charts for all medication that has been prescribed on a variable dose basis. Increase the level of recreational, social and leisure activities in line with increasing occupancy levels. All floor coverings within the home must be audited, and any areas that are fatigued, ripped, loose fitting or irreparably marked or stained must be replaced. Any area of floor covering that is marked or stained, and can be improved by cleaning must be cleaned. Fatigued items of glazing must be replaced. All persons employed by the registered person to work at the care home must have training appropriate to the work they perform. This is to include first aid training, dementia care training, infection control training, moving and handling training, abuse training (all subjects were required in the previous inspection report) and nutrition training. Staff must receive appropriate training such as moving and handling prior to commencement of work with residents. Training records must specify the actual course content. All staff must receive formal induction prior to undertaking direct care duties. All persons working in the home must be adequately supervised. Care staff must receive formal supervision at least six times a DS0000004149.V291386.R01.S.doc 01/06/06 01/06/06 01/09/06 01/09/06 01/09/06 01/06/06 01/06/06 01/06/06 01/06/06 Tutnall Hall Nursing Home Version 5.1 Page 26 16 OP29 18(1)(a) year. Supervision must cover all aspects of practice, philosophy of care in the home, and career development needs. Completed application forms 01/06/06 must be submitted to the home prior to any job interview being undertaken. These must be scrutinised prior to interview, and used to influence the structure of the interview to ascertain the suitability of each applicant. 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 Paragraph 2 of the home’s contract should be amended to (a) reflect current commissioning protocol and (b) reflect the change in registration criteria since the implementation of The Care Standards Act 2000. Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Tutnall Hall Nursing Home DS0000004149.V291386.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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