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Inspection on 29/11/05 for Tyndale Nursing Home

Also see our care home review for Tyndale Nursing Home for more information

This inspection was carried out on 29th November 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Records inspected were managed well. The standard of meal provision is high. Residents spoken with expressed satisfaction with the care they receive and the kindness of staff in the home. More than 50% of care staff employed in the home hold a minimum level 2 in the NVQ care award. Care staff are also supported to levels 3 and 4 in NVQ health and social care. This is commendable. No requirements or recommendations are made to the home as a result of this inspection visit

What has improved since the last inspection?

No requirements or recommendations were made at the last inspection. The ground floor bathroom has been upgraded since the last inspection following the installation of a new bath earlier this year suitable for use by more physically disabled residents. The bathroom is now attractively decorated and provides a pleasant space in which to bath or shower. The home still plans to provide a permanent staff room with changing, seating and washing facilities following a CSCI requirement in a previous inspection report. The progress of this will be monitored via subsequent inspections and verbal contact with the home.

What the care home could do better:

The inspection findings were positive. Care at the home seems professional and sensitive. The staff work well as a team. The home struggles to provide enough storage space for some of the nursing equipment routinely used in the home and this gives an overall effect of making the home appear cluttered in some areas, which is a pity. The information provided for prospective residents and/or their relatives in relation to fee charges could benefit from being more transparent at the time of initial enquiry. Staff need to be vigilant that chemicals used for cleaning in the home are stored in locked cupboards away from potential access by residents.

CARE HOMES FOR OLDER PEOPLE Tyndale Nursing Home 36 Preston Road Yeovil Somerset BA21 3AQ Lead Inspector Judith Roper Announced Inspection 29th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 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.V258509.R01.S.doc Version 5.0 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 474520 01935 706624 janipaul@aol.com MR CHRISTOPHER MICHAEL BRUCE WHARTON MRS AMANDA SUSAN WHARTON, MR ANTHONY NICHOLAS ROGER 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.V258509.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 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 7th September 2005 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.V258509.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by one inspector and took place over one day between the hours of 10.00 am – 3.30 pm. 24 residents were at the home on the day of the inspection. There are currently 2 vacancies at the home. The inspector was able to interact with 7 residents and see most others. 3 feedback cards about the service from residents were sent to the CSCI prior to the inspection. Feedback cards from 6 visiting health care professionals and 16 relatives/visitors were also received at the CSCI prior to the inspection. One comment received was that the standard of cleaning at the home appeared to have slipped; another comment was that the home was clean, friendly and welcoming. Staff were described in comment cards as, excellent, attentive and kind. Food was described in a card as particularly good. One relative contacted the CSCI prior to the inspection to discuss fee levels and administration charges for the refundable nursing care element of the overall fee set. Feedback cards from visiting health professionals was positive regarding working relationships with the home and care delivery at Tyndale. The feedback card comments have been discussed with the home management. The home has recently been routinely re-assessed for the Investors In People award. The home is awaiting the outcome if this. Staff on duty were able to give time to speak informally with the inspector. The registered manager Ms. Purnell and one of the proprietors Mr. Wharton were available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff carried out their duties in an attentive and professional manner. This focus of this inspection was to assess Standards not inspected at the previous unannounced inspection in September 2005. Some core Standards were also inspected. Records examined during the inspection were 2 care and support plans of recently deceased residents, 3 staff recruitment files, a sample private contract, maintenance records and records of equipment servicing in the home, staff training records and records kept by the home of monies held on behalf of residents. The home also completed and submitted a pre-inspection questionnaire to the CSCI in preparation for the announced visit. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? 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. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 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 Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4. The home provides a welcome pack to new residents, which provides good information about the home, its services, fees and facilities. In discussion with the management it would be helpful to prospective residents if the fee breakdown and administrative costs in the application and managing of the free nursing element of care costs be explained to enquirers before admission and before the resident agreement (contract) is sent to the resident. In this way the home’s fees would be transparent from the onset. The staffing structure at the home is defined well and staff are supported to obtain professional qualifications in their job roles, thus providing residents with a service that is delivered by skilled staff in all disciplines in the home. EVIDENCE: The home has a detailed Statement of Purpose and Resident Agreement (contract and service user’s guide). Fee breakdown is explicit in these documents. The home charges a 5 administration charge in applying for and handling the RNCC (free nursing care element of the resident fee). A discussion was held with the home management regarding letting residents or their representative be aware of this administration charge prior to admission Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 9 following a concern raised by one relative recently. The management accepted the concern raised and took this comment on board without prejudice. The home is staffed twenty four hours a day by an appropriately qualified nurse and a team of care staff, many of whom have a number of years experience in caring for elderly people. The home uses a named nurse and key worker system for continuity of care. The care staff are supported and encouraged to achieve NVQ awards in care. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 11. The focus on care records for this inspection was on palliative and terminal care management in the home. The two care records examined of recently deceased residents who lived at Tyndale gave good detail of their managed care over the final weeks of their lives at the home. EVIDENCE: The two care plans inspected demonstrated that palliative and terminal care is managed well. Liaison with community GP services was appropriate, with pain control regularly re-assessed and amended as appropriate. GP surgeries gave positive feedback with regard to their dealings with the home. Nursing care and support to manage terminally ill resident needs was documented very well and included regular symptom control review. Relatives were kept informed of changes in their loved ones condition and this was echoed positively in feedback cards from relatives of current residents. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 11 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): 14, 15. Resident choice is valued at the home giving residents a feeling of self-worth knowing that their wishes and feelings will be respected. The standard of meal provision at the home is high with choice of meals pleasingly presented and nutritionally balanced menus. EVIDENCE: Advocacy services for residents are advertised in the home via Age Concern. The home has arranged for bereavement counselling for residents who have suffered personal loss recently. Residents spoken with during the inspection said that their wishes and preferences are respected at the home for their dayto-day living. The standard of meal provision and meal presentation at the home is very high. Residents and relatives reported this. The home has seasonal menus and residents are invited via a committee to make menu planning suggestions. Residents have the choice of two dining room but some residents choose to have some meals in their rooms. Following an environmental health office (EHO) inspection earlier this year some recommendations were made to the home. These recommendations have now been addressed. Staff were observed assisting residents to eat in an unhurried and attentive way. Meal times are a social occasion with some residents at Coverdale Court, the supported living unit on the site complex, coming over to Tyndale to take lunch with residents and staying for a conversation after the meal in the lounge at the home. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 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): 16 The home has complaints procedure and the management makes routes available for residents and families to contact them in order to express concerns. EVIDENCE: The complaints procedure is displayed in the home and is in the Statement of Purpose and Welcome Pack for new residents. There is also a suggestion box in the home where suggestions can be made anonymously. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 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): 19, 21, 22, 23, 24, 25, 26. The environment at Tyndale is suitable to meet the needs of residents. The proprietors continue to invest in improving the facilities in the home for residents and staff. There is a lack of storage space at the home, which gives the home a cluttered look in some areas. The home is clean and inviting, making a pleasant home for residents to live. The gardens are attractive and are used for social events involving the other homes on the site giving a community feel at the complex. EVIDENCE: Tyndale is a large house converted to meet the needs of nursing residents. There is both a shaft and stair lift to the first floor. The gardens are pleasing and accessible for wheelchair users. Furnishings in bedrooms and communal spaces are homely and inviting. The home has three communal bathrooms but one is not used. Staff reported that the number of bathrooms in use is sufficient to meet the bathing needs of the current residents. One ground floor bathroom has been upgraded this year to improve the disabled facilities for bathing and showering and the bathroom is now attractive and inviting. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 14 Staff needs to be reminded to ensure that cleaning chemicals remain locked away when not in use. The cupboard in the sluice used to store cleaning materials was unlocked and some bottles of cleaning products were outside of the cupboard. A bath cleaner was left out in one bathroom. It is the policy of the home to lock cleaning materials and chemicals away as not to pose a risk to residents. 4 commodes at the home are suffering from wear and tear on the padded backs. The registered manager has taken action to source a company that can repair these and this progress will be monitored at the next inspection. There are some shared rooms at the home and appropriate screening is provided in these rooms. Bedrooms are lockable if residents wish to hold their room key and lockable storage space is provided in rooms for valuables and this is recorded in resident’s care plans. The home has suitable adaptations and equipment provided for nursing needs. The proprietors plan to provide a permanent staff room and this was discussed at the inspection. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. The staff team is a cohesive unit and appear to work well together to meet resident needs. There are sufficient numbers of staff rostered on duty to achieve this goal and staffing levels are flexible, increasing if resident dependency rises. Residents and relatives spoke highly of staff attitudes and attributes. There is a strong commitment to the development of the staff team at the home through staff training. Recruitment practices are robust, thus providing protection for vulnerable adults at the home. EVIDENCE: Copies of four weeks staffing rosters were submitted to the CSCI on request prior to the inspection for scrutiny. Comment cards form residents and relatives in the vast majority of cases said that staffing levels at the home are sufficient. There have been occasional periods due to unavoidable staff sickness where the staffing compliment has fallen for a short period whilst a replacement is sourced for the shift. The registered manager monitors resident dependency levels via monthly clinical dependency analyses and she has adjusted staffing levels accordingly should dependency levels rise. There is a high percentage of staff holding NVQ awards at and beyond level 2 at the home. Care staff are supported to progress to levels 3 and 4. Both the registered manager and her deputy hold NVQ levels 4 in care home management. Both are registered nurses. This commitment to staff accredited professionalism in the home is commendable. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 16 Staff recruitment was discussed, staff records examined via the pre-inspection questionnaire and by examining 3 staff recruitment records. Staff recruitment is systematic and protects residents from potential abuse. The home has an annual staff training plan and individual staff training records, which includes identifying and planning for staff training to meet individual staff training needs. There is recorded observed clinical practice at the home, which is good practice. There has been a good staff training exercise in 2005 in recognition and prevention of abuse, other staff training has included mandatory fire and moving and handling training, care and nurses have also received several useful clinical update training sessions. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 37, 38. Systems for accounting for and handling resident’s pocket money in the home are robust in order to safeguard residents from financial abuse. Records inspected were maintained very well demonstrating good record management. Health and safety is organised well, two suggestions have been made regarding health and safety, which were looked into during the inspection. EVIDENCE: The handling and record keeping of resident’s pocket money was inspected. This was recorded clearly and is audited regularly. Staff receive training in understanding and identifying potential financial abuse of residents at induction and thereafter at abuse prevention updates in the home. Records examined were in good order and stored appropriately in order to protect resident confidentiality. Health and safety equipment servicing records were submitted to the CSCI on request prior to the inspection. These were cross-referenced during the Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 18 inspection against servicing certificates and were true. Other health and safety records inspected were bedrail safety checks records, hot water outlet temperature record and safety monitoring, fire records and hoist servicing, nursing equipment and maintenance of hot water systems in the home. In discussion with the home management, two suggestions were made by the inspector to continue to improve management of health and safety in the home. It was suggested that samples of lying water be taken from the water system at least annually for microbiological analysis, in particular to test for Legionellas organisms. It was suggested that further professional advice be taken on this. The home’s proprietor acted upon this. It was also suggested that when the home has in-house moving and handling training that the course sections, such as health and safety Law, care of backs, anatomy of the spine etc, be recorded individually and staff sign each section to acknowledge that they have understood the course content. This would protect staff member, trainer and Company and clarify that training has been understood and is effective. The home arranges for observed recorded practice of moving and handling techniques, post training. This is good practice. Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 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 3 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x 3 3 Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? N/A 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. Refer to Standard Good Practice Recommendations Tyndale Nursing Home DS0000043153.V258509.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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