CARE HOMES FOR OLDER PEOPLE
Tweedmouth House 4 Main Street Tweedmouth Berwick-upon-Tweed TD15 2HD Lead Inspector
Suzanne McKean Unannounced Inspection 17th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tweedmouth House DS0000000636.V276006.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. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Tweedmouth House Address 4 Main Street Tweedmouth Berwick-upon-Tweed TD15 2HD 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) 01289 330618 01289 330492 chris@tweedmouthhouse.fsnet.co.uk Mrs P Thomlinson Mr C Thomlinson Mrs P Thomlinson Care Home 55 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (16), Old age, not falling within any other of places category (38) Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th July 2005 Brief Description of the Service: Tweedmouth House Nursing Home is a converted Grade II listed building comprising of three large traditional houses with some a modern extension to the rear of the building having been made to add to the premises size. It is situated in a very pleasant part of Berwick overlooking the river and with walking distance of local shops and amenities and near to the end of the old bridge connection this part of the town to the main shopping area of Berwick. The home is registered as a care home to accommodate fifty-five persons including seventeen places for those with a dementing illness and thirty-eight for older persons. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 4 hours. It is the second unannounced inspection the home has had in this year. All of the core standards have been examined over the two inspections. It is therefore suggested that both reports are looked at to get the full picture of the home. Twelve residents, three staff were spoken to directly although more were chatted to briefly. Four care plans, training records and the records for medication, staff files and training, health and safety records were examined. What the service does well: What has improved since the last inspection?
At the last inspection did not identify any requirements and none were made at this inspection. Two out of the three recommendations were met at the last inspection and it will take very little for the remaining one to be achieved. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tweedmouth House DS0000000636.V276006.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 Tweedmouth House DS0000000636.V276006.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): Standard 3 was examined at the last inspection and was met. The home does not offer intermediate care. EVIDENCE: Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Standards 7,8 & 10 were examined at the last inspection and were met. Care plans examined as part of this inspection were completed in detail and were reviewed inline with the homes policies. The residents receive their prescribed medication in line with safe working practices. The medicines in the home are well managed and safely disposed of as necessary. EVIDENCE: The systems for managing medicines in the home were found to be appropriate, the staff record the medicines being ordered, the prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. The medicines are then again checked against the records when received into the home so that any errors can be picked up. The home has a contract with a Pharmacist, which included giving advice as necessary. No residents are currently managing their own medication in the home. The General Practitioners carry out regular reviews of medication needs. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 10 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 Residents are satisfied with the flexibility of their routines for daily living and activities, which are appropriate to meet their cultural, social, religious and recreational interests and needs. Arrangements for residents to maintain contact with their family and friends and the local community are suited to each individual’s needs and vary accordingly. EVIDENCE: The residents described the ways they are encouraged to take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. Staff confirmed that they encourage resident to make choices about how they spend their day. Some organised activities are available and staff said that residents are able to choose whether or not they are involved, however due to the dependency level of some of the residents a number of the activities offered are less active and provided on a more one to one basis. The home employs two activities co-ordinators who have different skills and are interested in offering the resident differing opportunities including crafts, puzzles and sherry mornings. A display of recently made crafts is displayed in the home and is changed monthly. The residents enjoy visiting a local tea dance although on discussion with them they tend to enjoy watching others dance and partaking in the refreshments. Dominoes are particularly popular
Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 11 with the current relatives and the home has a “mini van which can take up to 6 residents or 5 with a wheelchair which Mrs Natalia Tomlinson feels is a good number to take out at a time. Two residents asked said “there is always something for us to do” and “even when there is nothing going on we can spend time chatting to friends in the home”. The records of the activities provided is not very detailed, and it is recommended that this is developed further to show the full extent going on in the home. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives are given information within the residents’ guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were examined at the last inspection and were met. EVIDENCE: Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were examined at the last inspection and were judged as having been met. EVIDENCE: Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 14 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): 30 Standards 27 and 29 were examined at the last inspection and were judged to have been met. The staff in the home are being provided with a good range of training including the statutory training in moving and handling, fire, first aid and food handling and hygiene. EVIDENCE: There is evidence of a significant amount of training in both statutory and clinical areas of practice. The staff are receiving training in line with the company policy and statutory requirements for fire training, moving and handling, first aid, food handling and hygiene and a plan is in place to address this on an ongoing basis. The home have student nurses placed who are undertaking their nurse training with the University. There are also adaptation nurses who are undertaking the course to be registered with the Nursing and Midwifery Council as they have received their nursing qualification in another country. These staff work as carers while awaiting their registration. Having learners in the home gives the staff the opportunity to discuss current academic practice with students as well as having their clinical practice challenged by having to explain the reasons for their actions on a daily basis. It is therefore to be commended.
Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 15 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): 33 Standards 31, 35, and 38 were examined at the last inspection and were met. The Manager, Mrs Tomlinson, ensures that there are systems in place to make sure that the home is managed effectively taking into account the needs and wishes of the residents. EVIDENCE: Mrs Tomlinson and the senior staff of the home are continually monitoring the views and wishes of the residents by speaking to them on a daily basis. The manager is continuing to arrange resident and relevant meetings although these tend not to be very popular with them. Two relatives confirmed on discussion that they did not feel that a formal method is needed for them as they speak directly to Mr or Mrs Tomlinson. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 16 Records were examined of the staff meetings which take place regularly and the contents of these suggest that there a broad spectrum of relevant issues discussed. During the last inspection visit there was a staff meeting taking place which was well attended by both on duty staff and some who were off duty, the content and the style were effective. Questionnaires have been used in the recent past to find out the resident and relative views and these are go be repeated in the near future. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 17 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 4 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 18 NO 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations It is recommended that the home develop a more effective way of recording social activities being undertaken by the residents. Tweedmouth House DS0000000636.V276006.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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