Inspection on 10/12/07 for Tyndale Nursing Home

This inspection was carried out on 10th December 2007.

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

Tyndale Nursing Home 07/07/09

Tyndale Nursing Home 04/06/08

Tyndale Nursing Home 27/07/06

Tyndale Nursing Home 29/11/05

Tyndale Nursing Home 07/09/05

Tyndale Nursing Home 10/02/05

Tyndale Nursing Home 07/09/04

Tyndale Nursing Home 31/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Tyndale Nursing Home 36 Preston Road Yeovil Somerset BA21 3AQ Lead Inspector Shelagh Laver Unannounced Inspection 10th December 2007 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 Tyndale Nursing Home DS0000043153.V355883.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. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tyndale Nursing Home Address 36 Preston Road Yeovil Somerset BA21 3AQ 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) 01935 472102 01935 706624 janipaul@aol.com Mr Christopher Michael Bruce Wharton Mrs Pauline Purnell Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Up to 27 elderly persons of either sex, not less than 60 years, who require general nursing care Up to two persons of either sex, between the ages of 18-60 years, who require general nursing care To provide day care for up to 2 persons per day between the hours of 0700 and 1700 Up to 3 places for personal care The registered manager, Mrs Purnell, will be supported by a deputy manager who works no less that 30 hours per week at the home. Date of last inspection Brief Description of the Service: Tyndale is a 27-bedded care home providing nursing and personal care for older people. The home is in Yeovil, which has all the facilities of a medium sized town including hospital, shops, theatre, churches and other leisure facilities. There are smaller shops and a park within walking distance. The home is situated on a site, which also includes a sheltered housing complex and residential care home. This affords service users from all three facilities the opportunity to socialise and maintain friendships should they move into different areas for care. Tyndale is an old converted house with a purpose built extension, built in 1987, attached by a short walkway/entrance hall. Accommodation is provided in 17 single and 5 double bedrooms on two floors, the first floor being accessible via a shaft lift. There is an attractive, large front garden that looks onto the main road and a quieter courtyard garden accessed from the lounge. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This Key Inspection was unannounced and took place over one day and was conducted by one inspector. A visit to the home was followed by a review of care documentation. A letter had been received by the Commission expressing concerns about the care of one person at the home and an investigation into these concerns was carried out as part of the inspection. The inspection took place shortly before the manager Mrs Pauline Purnell was due to leave the home for a new post. The proprietor Mr C Wharton had made plans for the management of the home that ensured continuity of care. There are plans to appoint the deputy manager and senior nurse at the home to manager and deputy manager. Prior to the inspection the manager had completed an Annual Assessment of Quality (AQAA) for service. The inspectors consulted with thirteen people who lived in the home and observed others. 3 visitors and 4 staff were also spoken with during the inspection. A tour of the premises took place where bedrooms and all communal areas were seen. During the inspection the inspectors observed interactions between staff and residents. Care documentation and records were reviewed and a detailed analysis of one persons care records was undertaken. What the service does well: We spoke with thirteen people living in the home and met with three visitors. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 6 All made positive comment about the home and said that staff were kind and helpful. One person said “I am well looked after…I couldn’t be better cared for.” She had a “nice large room.” The food was “excellent” and she knew who to talk to if she had any worries. Staff were “helpful and kind.” People were observed reading, listening to the radio or watching television. There were visitors to the home who came regularly and were always welcomed. One visitor said “I know they will call me if I am needed.” Another said “You can always get a cup of tea if you want one.” When one person was asked if the staff were kind there was an animated laugh “of course they are kind…what a question.” One person looking forward to her hundred and first birthday said “I couldn’t be happier…I have visitors most days.” One lady expressed her views on the social programme “I don’t like those activities!” She had been equipped with head phones in order to hear her television and had adequate supplies of reading materials. Staff were heard talking with people, laughing and paying attention to their needs. On arrival at the home some people were enjoying breakfast together in the dining room. Others liked a quiet breakfast in their room. The home was decorated for Christmas and a range of entertainments were planned. People knew who to talk to if they had a concern and were able to name key staff. These were described as “kind” and “ready to listen.” What has improved since the last inspection? What they could do better: Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 7 It is clear that people in the home feel well cared for and appeared well presented. The overall grading of the home is affected by key aspects of the nursing care. The home is registered to provide nursing care and provides care for some people with complex nursing needs. The four care plans reviewed did not provide sufficient information and reflect the changes in peoples’ condition in a manner that would have enabled skilled care to have taken place. For example in one care plan a wealth of information was provided to the home but this was not transferred into the care plan format. For one person a key need was to have adequate pain relief. There was no care plan for pain management. Daily records recorded the persons’ pain but there was no plan that set out all possible measures that could have been used to alleviate it. Another key issue was the management of urinary problems. There was no plan for this area of care which caused the person much anxiety. This meant that when specialists provided detailed guidance this was not transferred to the care plan and no one has any idea whether the advise was known, followed or whether it was effective. In assessments people were stated to have mental health needs. One assessment stated that one reason why the person needed nursing care was “to have access to a nurse at any time due to anxiety and depression.” There was no care plan to address these needs. On the day off the inspection no one was on a fluid balance chart or turn chart. However the recording of fluids in one person case tracked was poor. It was most disturbing that in one plan daily records contained inappropriate comments and language. Medication administration records showed some missed signatures and instances where changes had been made to the records without signatures or counter signatures. There were no clear records of dressings undertaken and the resulting healing or otherwise of the wounds. Nursing staff are experienced and well qualified but there is a need for updating of skills in some key areas to ensure that all staff are aware of best practice. 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. The summary of this inspection report can be made available in other formats on request. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 8 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 Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is adequate. All people undergo a process of assessment before they enter the home. It is important that all information received during the assessment process is transferred to the care plan documentation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people are assessed prior to admission to the home by a trained member of staff. In some files observed there were assessment documents from health and social care professionals in addition to the homes assessment. It is important that information available through assessments are collated and used as the basis of the care plan. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 Quality in this outcome area is poor. Care planning in the home is not sufficient to give a clear view of peoples needs and the actions taken to meet them. Medication administration is basically sound but attention must be paid to detailed recording. Recording in care notes does not always reflect the respect to which people are entitled. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to confirmed that the doctor would visit if required and that if they needed to visit the hospital or other health professionals the home would arrange transport and escort. There was evidence that people did see a range of health specialists when required. Whilst the general personal care of people in the home seemed good there was evidence that aspects of nursing care needed to be reviewed and up-graded. The home cares for some people with complex nursing needs. Written care plans were brief and it was difficult to track peoples current needs in some Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 11 areas. For example one person who had been receiving thickened fluids was now having nothing by mouth. And yet only by reading all care documentation was it possible to see this. Similarly it was difficult to determine whether or not a person had a catheter and what care was required. Three care plans were observed on the day of the inspection and when issues were raised with the manager surprise was expressed that they were “sketchy.” Further discussion with the manager indicated that care planning was undertaken by nurses in the home. It must be noted that the manager of the home is responsible for the care planning and a system of audit and review should be implemented. The care in this home depends on the fact that nursing staff are established and know the people in the home and much practice may be in place but not recorded. A concern was raised about the care of one person in the home. The care plan examined in detailed showed poor care planning and recording. There was no clear plan to alleviate this person’s pain and the administration of analgesia had been ad hoc. Daily records showed that the person complained regularly of pain for a long period of time. Analgesia prescribed four times a day was rarely given that often. There were many records of unsettled nights but no record of a possible range of actions that could have been taken was found. There was evidence that some nurses made their own decisions about the allocation of analgesia. There must be established a sound body of knowledge and practice in the home that is informed by current best practice in palliative care and pain management. Whilst on the day of the inspection people were very positive about the care received from staff daily records for one person were seen to be often disrespectful and inappropriate. Medication charts were observed. Hand written instructions did not always have two signatures. Medication that was prescribed on a regular basis had been changed to “when necessary” There were a small number of “gaps and were seen to have several errors of recording. Tyndale Nursing Home DS0000043153.V355883.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): 12 13 14 15 Quality in this outcome area is good. People are able to make choices about how they spend their day. Contact with family and friends is supported by practices in the home. The food in the home is nutritious and varied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence that people were able to make choices and spend their time in different ways. One person had a wide selection of videos and music and was able to communicate about visits home and outings that he had been on. Three other people had visitors with them. Both people who lived in the home and visitors spoke of the kindness of staff and the welcome given to them. There were positive comments about the food. People were observed having lunch. Tables were set attractively and members of staff were sitting at the tables assisting where needed and talking to people at the table. The food served was a home cooked casserole accompanied by fresh vegetables. In the afternoon of the inspection there were carols in the sitting room. Tyndale Nursing Home DS0000043153.V355883.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): 16 18 Quality in this outcome area is adequate. There is a complaints procedure in place. People are protected from abuse by policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place. The home ensures that staff do not start work at the home until all recruitment checks have been made. Staff have received training in adult protection but training must reflect the most recent local guidance. Tyndale Nursing Home DS0000043153.V355883.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): 19 26 Quality in this outcome area is adequate. People live in a home that is clean, pleasant and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building confirmed that the home is well maintained, clean and homely. Peoples’ rooms contained their own possessions and family momentos. In one room there was a large collection of soft toys. It is to the credit of the cleaning staff that all are regularly dusted and kept in pristine condition. A new kitchen had recently been installed and the home was “getting back to normal.” There had been a period of upheaval in the home due to building work and the home still needed to be tidied thoroughly. Some areas needed sorting out and this was planned in the near future. There were several examples of inappropriate or inadequate storage. For example cleaning materials including Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 15 bleach was observed to be stored in a corridor. These were waiting to be returned to the new kitchen and the issue was dealt with immediately. The new kitchen provides improved facilities and space. Some carpets on the first floor are showing signs of wear. Most rooms have a pleasant outlook with some ground floor rooms overlooking the gardens. Tyndale Nursing Home DS0000043153.V355883.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): 27 28 29 30 Quality in this outcome area is adequate. Staff are on duty in sufficient numbers to meet peoples needs. There is sound recruitment practice. Staff receive regular training and up-dates but a programme of training is required to address key areas of nursing care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rotas of staff on duty showed sufficient numbers including an increase in staffing numbers on night duty since the last inspection. A review of the documentation for the most recently recruited person indicated that practice is robust and people are safeguarded by the practices in place. A check list of recruitment documentation could be improved by the inclusion of the dates on which references and POVA checks were received. There was evidence that people are receiving regular training in-house. The basic care up-date was targeted to issues in the home which is good practice. There is evidence that some further training is required in key areas including care planning, pain management and symptom control. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 17 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): 31 33 35 38 Quality in this outcome area is adequate. The registered manager must ensure care practice in the home is regularly monitored and audited. The home is maintained regularly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home at the time of the inspection was responsible for two adjacent units. It was clear from discussions that much of the daily nursing care including care planning and medication was not regularly reviewed by the manager. The manager should implement a system of review and audit of care plans and medication to ensure that peoples’ needs are met. Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 18 Maintenance is planned and organised by a weekly maintenance man. Key areas are contracted to regular technicians. Records were seen for the hoists servicing. Fire records were kept according to guidance. Tyndale Nursing Home DS0000043153.V355883.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 OP8 Regulation 15(1) 12(1) 18(1) Requirement Care plans must adequately reflect the care needs of people. There must be clear guidance to staff regarding the personal and nursing care required. Nursing and care staff must receive training in the use of the care planning documentation used in the home. The registered manager must ensure that all nursing staff are aware of current best practice in pain relief and symptom management. Staff must be made aware of the importance of making appropriate daily records that show appropriate respect. The registered person must provide appropriate supervision and appraisal to trained staff. The registered manager must ensure the medication administration records and practices conform to best practice. Timescale for action 01/04/08 2. OP30 01/03/08 3. OP30 18 (1) 01/04/08 4. OP10 12(4) 01/02/08 5. 6. OP36 OP9 18(2) 13(2) 01/04/08 01/02/08 Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 21 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 Tyndale Nursing Home DS0000043153.V355883.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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