Inspection on 06/11/06 for Tutnall Hall Nursing Home

This inspection was carried out on 6th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tutnall Hall Nursing Home 24/04/06

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

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Maple Lodge

Heathlands

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE Tutnall Hall Nursing Home Tutnall Lane Tutnall Bromsgrove Worcestershire B60 1NA Lead Inspector N Richards Unannounced Inspection 6th November 2006 13:35 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tutnall Hall Nursing Home DS0000004149.V309516.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. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 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) alphacarehomes.com Alpha Health Care Limited None 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.V309516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 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). Fees are between £450.00 and £700.00 per week, and do not include items such as newspapers, private healthcare (i.e. private chiropody), toiletries and hairdressing. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home’s deputy manager made herself 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, the observation of care practice, a tour of the premises and an examination of care and staffing. 33 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 further enhance the service it provides for residents since the time of the previous inspection. What the service does well: What has improved since the last inspection? What they could do better: Care records require development to (a) evidence the care provided and (b) ensure that care is provided in safe and consistent manner. Staffing levels must be reviewed. Please contact the provider for advice of actions taken in response to this Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tutnall Hall Nursing Home DS0000004149.V309516.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 Tutnall Hall Nursing Home DS0000004149.V309516.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. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not examined during the inspection process. EVIDENCE: These Standards were not examined during the inspection process. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Quality in this outcome area is adequate. 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: 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 “excellent” and she was “treated beautifully here”; while one relative described the staff as “very polite” and went on to explain how staff treat her and her husband well. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 10 Written feedback from residents was also positive. One person wrote: “All staff at the home give both myself and my family very good care and support…The staff always tend to any medical needs and if needed they ring for a doctor as soon as they can see that your health has deteriorated”. Three 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. 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, and the care objectives regarding effective and stable blood glucose management. This is important if care staff are to understand the care they are supposed to be providing. 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, care records require further development as one file contained a “Waterlow” pressure ulcer risk assessment that cited the individual as being at “high risk” of pressure ulcer development, and a risk assessment that cited the individual as being at “high risk” of nutritional problems. However, the risk assessments had not been regularly reviewed, and no plans of care had been formulated to address the potential problems. 5. Care plans for pressure ulcers did not effectively demonstrate the nursing care and nursing interventions necessary to address the problem/s identified. 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. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 11 All medication is administered to residents by a registered nurse. The medication is stored securely in a treatment room. 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. Medication administration record (MAR) charts were examined, and had been accurately completed by nursing staff within the home, resulting in entries having been made against all administration times. Some variable dose medication (such as painkillers) had been given with nursing staff recording the actual dose administered. This level of record keeping creates a clear safeguard to the health and safety of residents. Residents spoken to were happy to confirm that staff within the home were meeting their care needs in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents. Tutnall Hall Nursing Home DS0000004149.V309516.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. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not examined during the inspection process. EVIDENCE: These Standards were not examined during the inspection process. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not examined during the inspection process. EVIDENCE: These Standards were not examined during the inspection process. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 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.V309516.R01.S.doc Version 5.2 Page 15 Separate lounge and dining room facilities are provided within the home. 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.V309516.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Staffing levels are generally suitable to ensure that residents’ needs are identified and effectively met. However, the CSCI has been made aware that, on occasions, staffing shortfalls have compromised resident choice. EVIDENCE: There were suitable nursing and care staff on duty to provide care and support for the 33 people who were resident in the home at the time of inspection. During the morning period, two registered nurses and six carers staff the home, while one registered nurse and five carers staff the afternoon period. During the weekend period, the morning staffing levels are reduced by one registered nurse. In addition to nursing and care staff, there are also ancillary staff on duty to support service provision. The deputy manager said that the home was currently operating a staffing shortfall of 200 hours each week. This was being covered internally and by agency staff, and the organisation had recently advertised for additional staff. During the inspection, opportunity was taken to interview visiting relatives. One person said “things do slip up”, and that “half the time there’s not enough staff”, that there is “a lot of agency” and the “agency don’t know the residents”. The relative gave an example from the previous day when her husband had been taken to bed by staff at 3.45pm as the home was “short Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 17 staffed”, and also complained that, due to an absence of staff on occasions, relatives had to help other residents with their drinks. Opportunity must be taken to ensure that there are, at all times, sufficient staff on duty to meet the needs of residents – and this must include the safe supervision of residents, as there was very little supervision of residents in one small lounge and little supervision of residents who were accommodated in their bedrooms. This was further emphasised by the deputy manager who explained that most residents required the assistance of two staff members, and during the daytime period, seven of the 33 residents were located in their bedrooms. During the visit, call bells were activated, and staff responded speedily to them. The duty rotas confirmed that the staffing levels were stable, but there were occasions when staff had been absent through short-term sickness. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not examined during the inspection process. EVIDENCE: These Standards were not examined during the inspection process. However, there is no registered manager in post but the deputy manager stated that a new manager had been recruited and was to commence employment within the home on the following Monday. Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X X Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 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. Timescale for action 31/12/06 2. OP7 15(1) Care plans must be formally 31/12/06 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. 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 DS0000004149.V309516.R01.S.doc 3. OP7 15(2) 31/12/06 4. OP7 15(2) 31/12/06 5. OP19 16(2)(c) 31/12/06 Tutnall Hall Nursing Home Version 5.2 Page 21 covering that is marked or stained, and can be improved by cleaning must be cleaned. 6. 7. OP19 OP38 13 18(1)(c), 23(4)(d) 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. (This requirement was not examined during the inspection) 8. OP30 18(1)(C), 23(4)(d) Staff must receive appropriate training such as moving and handling prior to commencement of work with residents. (This requirement was not examined during the inspection) 9. OP30 18(1)(c), 23(4)(d) Training records must specify the 31/12/06 actual course content. (This requirement was not examined during the inspection) 10. OP30 18(1)(c), 23(4)(d) All staff must receive formal induction prior to undertaking direct care duties. (This requirement was not examined during the inspection) Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 22 31/12/06 31/12/06 31/12/06 31/12/06 11. OP36 18(2) All persons working in the home 31/12/06 must be adequately supervised. Care staff must receive formal supervision at least six times a year. Supervision must cover all aspects of practice, philosophy of care in the home, and career development needs. (This requirement was not examined during the inspection) 12. OP29 18(1)(a) Completed application forms 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. (This requirement was not examined during the inspection) 31/12/06 13. OP27 18(1)(a) Staffing levels must be reviewed to ensure that staffing levels are sufficient to meet the needs and expectations of residents within the home. A competent manager must be appointed to manage the home, and an application for registration must be submitted to CSCI’s Central Registration Team. 30/11/06 14. OP31 8 31/12/06 Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tutnall Hall Nursing Home DS0000004149.V309516.R01.S.doc Version 5.2 Page 24 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V309516.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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