Inspection on 30/08/05 for Tweed

This inspection was carried out on 30th August 2005.

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

Other inspections for this house

Tweed 16/01/07

Tweed 24/01/06

Tweed 01/02/05

Tweed 01/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Tweed 8 - 10 Silverdale Road Eastbourne East Sussex BN20 7AL Lead Inspector Nigel Thompson Unannounced 30 August 2005 11:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Tweed Address 8 - 10 Silverdale Road Eastbourne East Sussex BN20 7AL 01323 733223 01323 649741 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Emilie Galloway Trust Mrs Jacqueline Heywood Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (OP) 20 of places Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 That service users must be aged sixty-five (65) years or over on admission 2 That a maximum of twenty (20) service users are accommodated 3 That a maximum of two (2) of the identified double bedrooms can be shared by service users at any time Date of last inspection 1 February 2005 Brief Description of the Service: Tweed is a large detached house on three floors, with a basement area, situated in the Meads area of Eastbourne, and five minutes walk from the seafront. There are local shops, and other social and leisure facilities in close proximity. Also public transport routes run near to the home, and there is a main line railway station in the town. Décor, and furnishings are maintained to a good standard. Service user accommodation comprises of ten single rooms and nine double bedrooms of which only two should be used for double occupancy at any one time. The home is registered to accommodate up to a maximum of twenty service users. All double bedrooms are currently being used as single bedrooms. The communal areas that service users can use, comprises of a separate dining room, and a large lounge and snug area on the ground floor. At the time of the inspection there were eighteen service users resident. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours in August 2005. It found that all of the twenty National Minimum Standards that were assessed had been met and the overall quality of care provided was good. Service users and relatives spoken to during the inspection expressed satisfaction with the home, the staff and the service provided. A tour of the premises took place and documentation, including service user and staff files was inspected. One of the service users’ relatives, three of the staff on duty and nine of the eighteen residents were spoken with. What the service does well: What has improved since the last inspection? The system for filing and maintaining documentation, including service users’ care plans, policies and procedures has been reviewed and amended to make information more readily accessible. A monthly programme of activities and entertainment has been developed and introduced. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 5 & 6 There is a potential risk for service users and staff as the individual care and support needs of prospective service users are not comprehensively assessed before they move into the home. EVIDENCE: Despite a requirement made following the previous inspection, there is still no evidence of a detailed needs assessment being undertaken prior to a service user moving in to the home. The manager confirmed that service uses are assessed both prior to and following admission, however it was noted that assessments that were examined were found to be incomplete and did not adequately detail significant information, including personal care needs, mobility and mental health issues. A tick in a box is unsatisfactory and certainly does not constitute a thorough assessment. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 9 There was also no evidence that personal risk assessments are routinely carried out. One service user, who during a conversation was clearly confused and disorientated, maintains responsibility for administering his own medication, goes out walking independently and buys and consumes alcohol, with no monitoring or risk management strategies in place. Another service user who had recently been admitted for a short-term ‘holiday’ stay had not been reassessed since her previous admission to the home several months ago. The manager confirmed that prospective service users are invited to visit the home to look around and meet with staff and existing residents. Intermediate care is not provided at Tweed and emergency or unplanned admissions are avoided. On admission to the home, each service user is provided with a contract, including terms and conditions of residency. It was noted that the contract is signed by the service user, or someone acting on their behalf, and is witnessed. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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 standard(s) 7 , 8 & 10 Service users’ personal and emotional care needs are not always fully met, as individual care plans are not consistently well maintained or regularly reviewed and amended to reflect changing needs. EVIDENCE: Improvements were noted to certain aspects of the care planning process. Service users’ care plans that were examined were found to be more organised and structured. Since the previous inspection individual plans had been divided into sections, making information more readily accessible. It was however evident that care plan ‘assessments’ were often incomplete. Details were also not recorded of the date of the assessment, who carried out the assessment and whether this information had been discussed with the service user. Plans that were examined did not contain sufficient detail regarding action to be taken by staff and it was also noted that the ‘Care plan Agreement’ had not been completed or signed. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 11 As previously documented there was no evidence of risk assessments being routinely carried out. Despite concerns regarding the mental condition and behaviour of a certain service user, little reference had been made to this in the progress and evaluation notes and there were no details of any management strategy or intervention by care staff. As part of their induction programme, all staff receive instruction on the principles of dignity and respect. This was evident, through discussion during the inspection, and from direct observation of staff interacting sensitively and professionally with service users. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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 standard(s) 12, 13 & 15 Social activities and meals are both well managed, creative and provide daily variety and interest for people living in the home. EVIDENCE: Since the previous inspection, a monthly activities and entertainment programme has been developed and introduced. Activities are designed to meet the individual and collective social care needs of service users and include weekly art classes; keep-fit; quizzes and games including ‘musical bingo’; ‘facials and manicures’; shopping; various outings and a monthly church service. During the afternoon of the inspection several residents enjoyed a game of pontoon in the lounge. A number of service users also go out independently and access a range of local facilities. Service users expressed overall satisfaction with the quality, quantity and presentation of the food that they receive. Those spoken to commented favourably on the standard of the meals provided: Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 13 ‘The food here is very good – you couldn’t have any complaints’ A four week rolling menu is in place, reflecting residents’ likes and preferences. Service users are provided with three full meals a day and there is a choice of menu provided at lunch and tea-time. Hot drinks and snacks are also available during the day, and some service users make hot drinks in their bedroom. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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 standard(s) 16 & 18 The open and generally inclusive atmosphere within the home enables service users, staff and visitors to feel able to express any concerns, confident that they will be listened to. Service users are safeguarded from abuse through robust policies, procedures and relevant staff training. EVIDENCE: There is a detailed complaints policy and procedure in place in the entrance to the home. The complaints log was viewed and there were no complaints recorded. A service user’s relative spoken with during the inspection, expressed a high level of satisfaction with the home and service provided. He confirmed that he would have no hesitation raising a concern or complaint with the manager and would be confident that it would be addressed. Policies and procedures are in place, and a copy of the East Sussex Brighton and Hove Multi-Agency Guidelines for Vulnerable Adults is available for reference in the home. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 15 Staff spoken with had an awareness of the relevant procedures and the majority have received specific training, in relation to abuse and adult protection. The manager is to ensure that all staff receive appropriate training. The home also has a detailed ‘Whistle Blowing’ procedure that staff are made aware of through formal supervision and as part of their induction training. An anonymous complaint was received by the CSCI on 30 March 2005 raising concerns in respect of the attitude and management style of the registered manager, risk management in relation to falls, staffing levels within the home and the competencies and experience of members of staff left in charge of the home. Two aspects of the complaint, relating to the management style and staffing levels were partially upheld. The aspects of the complaint relating to staff competencies and risk management were not upheld. No further complaints have been received in relation to these matters. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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 standard(s) 19, 20, 23, 24 & 26 The standard of the physical environment is generally good and provides service users with an attractive, comfortable and homely place to live. Service users benefit from living in a safe, clean and well maintained environment. EVIDENCE: Tweed is an established service and both its location in a residential area of the town and its layout remain clearly appropriate and suitable for its stated purpose. It has a long tradition of providing individual care and support for service users in a comfortable and homely environment. As with many of the environmental standards, the situation at Tweed regarding shared space remains largely unchanged. Adequate communal areas are provided to meet the individual and collective needs of the service users. There is a pleasant dining room, a spacious lounge, where regular social activities take place. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 17 All communal areas are decorated and furnished to a high standard. Furniture and lighting throughout is domestic in character. The manager confirmed that independence and individuality continue to be promoted within the home and this is evident from the personalising of service users’ private rooms, which clearly reflects individual tastes and interests. Domestic staff employed in the home continue to maintain a high standard of cleanliness and hygiene throughout. Satisfactory laundry facilities are provided and infection control policies and procedures are in place. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Sufficient staff are on duty at all times to meet the assessed needs of the service users. Thorough recruitment procedures help to ensure the safety and protection of service users. Staff have developed positive relationships with the service users and have a sound understanding of their individual care and support needs. EVIDENCE: Appropriate staffing levels are in place, with a minimum of two care staff being on duty at all times during the day and at least one member of the management team. The manager or the deputy manager is on call at all times outside normal office hours. This includes during the night, when there is one waking night staff on duty. Staff spoken to during the inspection were clearly happy in their work: ‘It’s a lovely place to work. There’s loads of training and everyone is very helpful and supportive’. Staff training within the home is generally provided by external trainers and includes first aid, control and handling of medication, moving and handling, infection control procedures, fire safety and food hygiene. All training is recorded. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 19 An indication of the commitment to training within the home is provided by an external training co-ordinator: ‘I am extremely satisfied with the dedicated effort of all the team at Tweed to take on new knowledge and practices’. A clear and updated duty rota is in place. Staff files that were examined were found to be well maintained, containing all necessary recruitment information, including two written references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. All new staff are provided with and sign a written contract, including a statement of terms and conditions. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 & 38 The home regularly reviews aspects of its performance, through an effective programme of self-monitoring and consultation, which includes seeking the views of service users. Staff are aware of and adhere to policies and procedures relating to health and safety, ensuring the health, safety and welfare of all service users and staff. EVIDENCE: The manager is hoping to complete the NVQ level 4, in management and care by the end of this year. The trust manager was able to confirm that formal supervision for the registered manager is to be reinstated, as required. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 21 The home operates effective quality monitoring systems, including satisfaction questionnaires for both service users and their relatives. Responses from a recent survey expressed a high level of satisfaction with the home and the services provided: ‘As I am happy with my care at Tweed, I can’ t think of anything to improve it’. Monthly monitoring visits to the home by individual Trustees continue and a copy of their subsequent report is forwarded to the CSCI. The manger confirmed that the health, safety and welfare of service users and staff continues to be of paramount importance within the home and staff training is provided in many aspects of safe working practices, including moving and handling; food hygiene; fire safety and first aid. All staff training is recorded. COSHH assessments and guidelines are in place. Temperature regulators are fitted to all hot water outlets, accessible to service users. All accidents, incidents and injuries are recorded and reported, as required. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x 3 x 3 Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 23 Yes 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 3 Regulation 14 (1) (a) Requirement It is required that no new service user is admitted to the home unless a full needs assessment has been carried out, by a suitably trained person. (Previous timescale not met.) It is required that the assessment of the service users needs is kept under review and clearly reflects any change of circumstances. It is required that the service users care plan be developed and regualrly reviewed with the involvement of the service user, or a representativve. It is required that the service users care plan, including risk assessments, be updated to reflect changing needs. (Previous timescale not met). Timescale for action 30.08.2005 2. 3 14 (2) (a) & (b) 30.08.2005 3. 7 15 (1) 30.09.2005 4. 7 15 (2) 30.09.2005 5. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Tweed Refer to Good Practice Recommendations H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 24 1. Standard 33 It is recommended that the satisfaction questionnaires for service users and relatives be amended, as discussed, to provide opportunity for additional comments and suggestions. Tweed H59 H10 S21276 Tweed V218104 300805 stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 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. 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