Inspection on 04/06/08 for Tyndale Nursing Home

This inspection was carried out on 4th June 2008.

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

Tyndale Nursing Home 07/07/09

Tyndale Nursing Home 10/12/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Tyndale Nursing Home 36 Preston Road Yeovil Somerset BA21 3AQ Lead Inspector Shelagh Laver Key Unannounced Inspection 09:30 4th June 2008 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.V362179.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.V362179.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 Vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Tyndale Nursing Home DS0000043153.V362179.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. 10th December 2007 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. Fees currently range from £480 to £550 a week. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. 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. The inspection took place over one day by one inspector. Prior to the visit to the home a detailed and comprehensive Annual Quality Assurance Assessment document was completed by the manager Carol Flowers. This provides information about the service and outlines plans for the coming year. There were 23 people living in the home. The inspector met with eleven of them individually and saw others in the communal sitting room. Records relating to the care of people and the running of the home were examined. What the service does well: What has improved since the last inspection? The care plans have been reviewed and rewritten. They now reflect the care needs of people in the home. Medication records at this inspection were accurate and complete. Nursing staff had received up-dates and training in pain control and medication. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 Quality in this outcome area is good. People have a full needs assessment prior to admission to the home. The home is aware of the importance of providing adequate information to people to enable them to make a choice about the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User guide has been up-dated. People are assessed prior to admission. People newly admitted to the home talked about their experience confirming that they had been visited in hospital or in their home. Files contained pre-admission assessments and supporting documentation fro other professionals. Respite care is available and some people return regularly. People are welcome to visit the home. There is a comprehensive residents agreement. People are welcome to visit the home prior to admission although often iot is relatives who will make the visit. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11 Quality in this outcome area is good. Care plans give staff clear directions to enable them to meeting peoples’ needs. It is important to record the ways in which people have been consulted in drawing up the plans. Medication systems are safe. People feel that they are treated with kindness and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an up-dated care planning system that is composed of two folders. One containing detailed directions for meeting peoples’ needs is kept in the bedrooms and can be easily accessed by staff. The other file is maintained by the nurses and contains all other information including evidence that people are referred to specialist health professionals when required. There were some examples of good practice. There was clear guidance for staff so that they could manage someone with mental health needs. A person with complex needs confirmed that he received the high level of care he needed. Four comment cards were received from doctors and nurse specialists that indicated that the home met the health care needs of people in the home “always” or “usually.” Medication records were accurate and comprehensive. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 10 The home is implementing a “Just in Case” system that allows a small amount of medication to be available for people who may experience symptoms that need rapid attention such as pain. In one care plan examined there was guidance on ensuring that regular and adequate pain relief was given. Nursing staff have received training on the medication issues of palliative care. The deputy manager has completed an Open University course in end of life care and showed the inspector the reference document that she kept in the home and used regularly. The care plan for one person who had received terminal care was reviewed. The plan indicated that the person had received the regular support of GPs and specialist nurses. Family had been in the home a great deal and care had been directed at ensuring that the person was comfortable. Attention had been paid to emotional and psychological support of all concerned. Throughout the inspection staff were observed to treat people in the home with kindness and respect. Records of fluids were often qualitative. For example “reasonable amount of tea, drinking well.” The need to keep detailed quantitative records in some circumstances was discussed. When a person has been assessed as being at risk of pressure damage then the care plan must state clearly exactly what action is planned to prevent damage developing as far as possible. There should be a system to record the involvement of people and where appropriate their representatives in the development of the care plan. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. People are able to make choices about how they spend their days. Food appeared to be adequate and nutritious however attention is required to ensure choice is maintained and a current menu is displayed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People were observed spending the day in a variety of ways at the home. Some chose to stay in their room. People were seen receiving visitors and listening to the radio. One person uses headphones so that she can hear well and not disturb other people. Others were seen in the sitting room. There is a monthly newsletter that details social activities and news. Some activities are at the adjoining home. People had celebrated some major birthdays the most recent being 101. During the afternoon of the inspection a communion service with music was held. There were photographs displayed of recent trips and events. People can ask for a 1-1 with the activities co-ordinator and this can encompass a manicure, reading, walk or chat. There were no complaints about the food at Tyndale. Although it was clear that there was flexibility in the menu this is not obvious to all people. One person who has a poor appetite was enjoying a jacket potato and home made coleslaw Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 12 which was her “favourite”. People did not know what the main meal of the day was although they were pleased with the roast lamb when it appeared. A menu should be displayed and choices should be made clear. There must be an accurate record available of what meals have been served. The “master menu” was informal and not easy to follow. Schedule 4 Care Homes regulations states that there must be “records of food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and otherwise and of any special diets prepared for individual service users.|” Tyndale Nursing Home DS0000043153.V362179.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 good. People are encouraged to talk to the manger and staff if there are any concerns. There is a complaints procedure in place. Policies and procedures seek to protect people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure that is clearly displayed. There had been no complaints. People spoken to during the inspection felt happy to talk to the manager or keyworker if they had any concerns. There is a system of keeping peoples finances safely. Recruitment procedures are in place to protect people however see comment in staffing section. A training up-date on protection from abuse has been organised. Tyndale Nursing Home DS0000043153.V362179.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 an environment that is clean and well maintained. There is evidence of appropriate infection control measures and planned maintenance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall the home is clean and comfortable. A major refurbishment of the kitchen is now completed and the home has had a thorough “tidy”. Peoples’ rooms are comfortable containing plenty of personal items. Some furniture in the bedrooms in the old house is looking rather tired. Communal spaces are attractively furnished and there are planned further refurbishment. There are gardens around the home that can be used by people on warm days. There is a planned program of redecoration and refurbishment and the manager was able to talk about further planned up-grades. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 15 Appropriate measures were in place to control infection including supplies of gloves and hand washing equipment. Tyndale Nursing Home DS0000043153.V362179.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 Quality in this outcome area is good. People who use the service have confidence in the staff that care for them. Rotas show that staff numbers are maintained. Above 50 of staff have NVQ qualifications. Recruitment systems are sufficiently robust to protect people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection in addition to the manager, the deputy manager Lin Whiston (registered nurse) was in charge of the daily care. She confirmed that she had undertaken recent professional up-dates and had others planned. Ms Whiston described how she put things “on the board” of interest to remind staff and worked with them to ensure standards in the home. Her team on the day of inspection comprised of six care assistants and domestic and catering staff. Duty rotas were examined and there appeared to be sufficient staff on duty to meet peoples’ needs. Staff spoken to said that there was always a real attempt to make sure that the home was not “short”. If it was necessary to use agency staff then staff known to the home were usually available. According to the AQAA in the past three months 78 care shifts and 30 nursing shifts have been covered by agency staff. The home has taken steps to recruit staff and it is hoped that the number of shifts needing to be covered will reduce. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 17 The home has a high proportion of staff with NVQs. At the time of the inspection 10 of the staff group have NVQ 2 or above and two are working towards the qualification. Training up-dates have commenced and the manager is compiling a year plan. Dates are available for Infection Control and Recognition of Abuse. 4 files were examined and showed recruitment practice that protected people. It is important to ensure that when someone is seeking work as relief or bank staff that a reference is obtained from the main employer. This is to ensure that people do not work excess hours and put people in the home at risk. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is adequate. The home is run in the best interests of the people who live there. There are systems in place to ensure the health and safety of people who live and work there. Management registration must be resolved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Carol Flowers is a qualified nurse who has been deputy at the home for some years. She was appointed as manager in January. She recently withdrew from the registration process but is intending to make a new application in September. It was evident that Mrs Flowers had taken action to address the requirements from the last inspection. She should continue with her professional Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 19 development prior to resubmitting for the CSCI registration process as discussed during the inspection. Staff and people who live in the home confirmed that she was approachable and easily accessible. People said “I would always talk to Carol if I was worried.” The quality assurance aspects of the home are continuing to develop. Some questionnaires have been completed by some people that demonstrated they were satisfied with their care and life in Tyndale. A comprehensive quality system is being developed. The home has not held staff or residents meetings recently but these are planned. The AQAA confirms that equipment is serviced and tested according to requirements. Records of maintenance of hoists and fire records were seen. These were up-to-date. There is a maintenance person employed and contracts are in place for major work. The manager is in the process of reviewing and up-dating all policies and procedures. Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 20 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 2 Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP36 Regulation 18(2) Requirement The registered person must provide appropriate supervision and appraisal to trained staff. (Carried forward from the previous inspection. Some work undertaken but still developing. ) Previous time scale 01/04/08 The care plans must indicate the involvement of the people in the home and where appropriate their representatives. There must be records of food provided to people in the home in sufficient detail to confirm satisfactory nutritional content and any special diets provided. Care plans include clear guidance regarding the prevention of pressure damage. When it is necessary to measure a person’s intake and output of fluids clear guidance is given in the care plan and actual measurements are recorded. The manager must pursue the registration process within the agreed time scale. Timescale for action 01/08/08 2. OP7 15(1) 30/06/08 3. OP37 17(2) 30/06/08 4. OP8 12 1(a) 30/06/08 5. OP31 8 (1) 01/10/08 Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 22 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.V362179.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tyndale Nursing Home DS0000043153.V362179.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!