Inspection on 13/02/07 for Tynefield Court

This inspection was carried out on 13th February 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tynefield Court 29/08/08

Tynefield Court 18/10/07

Tynefield Court 10/02/06

Tynefield Court 29/09/05

Tynefield Court 08/12/04

Tynefield Court 16/06/04

Tynefield Court 10/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Tynefield Court Blakeley Lane Egginton Road Etwall Derby DE65 6NQ Lead Inspector Janet Morrow Key Unannounced Inspection 13th February 2007 02:00 Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 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 Tynefield Court DS0000002169.V329728.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 and Care Homes for Adults 18 – 65*. 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. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tynefield Court Address Blakeley Lane Egginton Road Etwall Derby DE65 6NQ 01283 732030 01283 734550 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) Tynefield Care Limited Mrs Shirley Hall Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (13), Physical disability (27) of places Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 27 places for younger PD aged 18 years and over included in the total above 13 places for OP aged 65 years and over included in the above total Date of last inspection 10th February 2006 Brief Description of the Service: Tynefield Court Care Home is a 40 bedded home that provides both nursing and personal care. The home cares for older people, as well as young adults with physical disabilities. The home is purpose built and resident’s accommodation is located in three single storey wings, with central communal areas. The home has 36 single and 2 shared rooms. A total of 27 rooms have en-suite facilities, 10 of which also have en-suite showers. Tynefield Court Care Home is located outside the village of Etwall. The site also accommodates a children’s nursery and a number of bungalows for independent living. Information provided by the service in 2006 stated that the fees ranged from £330 – £505 per week. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over two days for a total of ten hours. Care records and staff records were examined. Eleven of thirty residents currently accommodated were spoken with. Four residents surveys were received during July and August 2006. Three members of staff were spoken with. Three visiting professionals were contacted by telephone following the inspection visit. A partial tour of the building was undertaken. The manager was not present at the inspection visit so the nurse in charge assisted throughout the inspection. The findings of the inspection were discussed with the new providers, who had taken over responsibility for the service in November 2006. A complaint received in December 2006 at the office of the Commission for Social Care Inspection and written information supplied by the home in June 2006 informed the inspection process. What the service does well: What has improved since the last inspection? A greater range of activities was being organised by the home and residents spoken with appreciated the efforts being made in this area. Some aspects of medication administration procedures had improved although there continued to be a need for greater consistency. The new providers were implementing a plan for upgrading the accommodation and nine bedrooms had been decorated since December 2006. Communal Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 6 space provided a specific activities room and a smoking lounge for those residents who wished to smoke. What they could do better: The response to outstanding requirements needs to be addressed in a more timely manner. Several requirements were outstanding from the previous two inspection reports. However, timescales have been extended further to allow the new providers the opportunity to comply with all the requirements in this report. Assessments for prevention of pressure sores, continence and falls must be available on all care records and risk assessments must be available for all activities that pose a potential risk to residents. There should be regular residents’ meeting to ensure residents have the opportunity to participate and be involved in the decision-making in the home. The information on staff files must comply with the Care Homes Regulations 2001 and include all the information stipulated in Schedule 2. This means a Criminal Record Bureau (CRB) check and Protection of Vulnerable Adults (POVA First) check must be in place for all staff, including those recruited overseas. This has been raised as an issue at previous inspections and an immediate requirement notice was therefore issued to commence this process. Ongoing efforts need to be made to ensure that staff receive formal supervision on a regular basis. Although staff receive induction and foundation training, the staff team need to be trained to the required level of National Vocational Qualifications. All staff should also received additional training in relation to direct care and new staff must receive training in adult protection. Mandatory training in health and safety areas, such as food hygiene and infection control, must be kept up to date. The qualified staff need to improve their practice in relation to the administration of medication. This needs to be more consistent to ensure that all records are accurate and medicine stocks held correspond with the written record. Handwritten medication administration record (MAR) charts should be signed and dated by two people and there should be consistency in recording the amount of medicine received on handwritten charts. A risk assessment of all radiators must be undertaken and guards fitted where necessary and refurbishment of bedrooms and identified areas should continue. All bedrooms should have lockable storage space provided. Information for residents, such as care information and service information, should be provided in other formats to enable comprehension, for example on audiotape and in other languages. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 7 Quality assurance processes must be implemented and views from a range of different people such as residents, relatives and visiting professionals should be obtained. 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. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 (Adults 18-65) and 3 and 4 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was inconsistency in obtaining the necessary assessment information on admission, which had the potential for care needs to be missed. EVIDENCE: Four residents’ care records were examined and showed that assessment information was received from external professionals and the home also conducted their own assessment and background information prior to admission. However, there were inconsistencies in ensuring that all available information was collated; for example, on one file there was no risk Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 10 assessment for pressure areas or continence although these were referred to as areas of need in other documentation and on another file there was no falls risk assessment although this was also referred to as an area of need. A residents’ guide was available in each bedroom that provided comprehensive information and one resident spoken with stated that they had been able to view the home and discuss their needs prior to admission. However, none of the information provided was available in any other format than written English. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 (Adults 18-65) and 7, 14 and 33 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Greater efforts were required to ensure that residents participated fully and made decisions about life in the home. EVIDENCE: Four care files were examined and all had a care plan available that covered a wide range of needs including social and dietary information. One file had very specific information on dietary needs from external professionals. Residents spoken with stated that the home dealt well with their dietary requirements. There was a risk assessment available on all four files for moving and handling. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 12 However, there was limited information on other risk areas, for example in relation to falls and travelling safely outside the home. There was limited evidence available to show that residents were fully participating in decision making in the home. For example, there were no residents meetings taking place on a regular basis and there was no evidence on care files, such as a signature, to indicate that care needs had been fully discussed. However, those residents spoken with stated that they were able to decide on personal issues and make choices although this was sometimes limited in relation to their physical needs and safety. Reliance on staff to participate in certain activities, for example, going out, shopping etc meant that there were restrictions on how often this could occur. Residents who smoked asked staff to purchase cigarettes for them when necessary and those residents spoken with were satisfied with this arrangement. Those residents able to go out alone purchased their cigarettes independently. One visiting professional spoken with stated that the new owners had been ‘open to suggestions’ and appeared keen to continue meeting specialist needs. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 14 12, 13, 15 16 and 17. (Adults 18-65) and 10, 12, 13 and 15 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-managed meals and a range of varied activities enhanced residents’ quality of life. However, contact with the community needed improving to ensure that residents had a wider range of options available. EVIDENCE: Comments from residents and staff and observation during the inspection confirmed that the routines within the home were flexible. Staff were observed providing support and assistance as required, whilst encouraging independence. Residents made good use of the communal areas as well as their bedrooms. Residents stated that generally staff respected their privacy and dignity and this was observed during the inspection visit with staff knocking on doors prior to entering bedrooms and speaking to residents in an appropriate manner. There was a good rapport observed between the residents and staff and residents commented that staff were ‘very good’. Residents spoken with confirmed that visitors were welcome at any time and that they were encouraged to maintain links with their friends and families. This information was well recorded in the files. Some residents living at Tynefield Court made good use of motorised scooters to access the amenities in the local village. However, those residents who relied on staff assistance to go out stated that visits out of the home were limited. All residents spoken with stated that access to more activities in the community would be beneficial. Activities in the home were being organised by a specific member of staff on a regular basis. This included arts and crafts activities and games. All residents spoken with stated that they had enjoyed this and one resident praised the staff for their efforts in arranging the activities. A regular music and movement session also occurred. A smoking room was available for those residents who wished to smoke. Individual preferences were being taken into account; for example one resident stated that the home had discussed with them the possibility of installing a computer and internet access in their room. A brief tour of the kitchen was undertaken as part of this inspection. Catering staff demonstrated good knowledge about individual residents’ needs and special diets. Menus were examined and showed that residents were offered a choice and variety of meals, and observation of the lunchtime meal supported this. Levels and storage of food stocks were satisfactory and included items for special diets such as low sugar options for desserts, jams etc. All residents Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 15 spoken with during the lunchtime period stated that they enjoyed the food. One resident with a special diet stated that they were ‘well fed’ and another stated that the meals were ‘very good’ and that their special diet was well catered for with enough variety and specific items being available on request. A visiting professional stated that specialist dietary needs were well catered for. Dietary information was recorded on individual care files. One resident spoken with suggested a more proactive approach to information about meals; for example, having an up to date menu on display and being informed in advance of the choices available each day. Two residents surveys returned prior to the inspection stated that they ‘always ‘ enjoyed the meals and two said they ‘sometimes’ enjoyed the meals. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 (Adults 18-65) and 8 and 9 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents health needs were generally met but lack of consistency in medication administration records and care records had the potential to compromise care. EVIDENCE: Four residents’ care files were examined and showed that access to health professionals was made available. They also showed that specialist services were also requested on a regular basis. Those residents interviewed also confirmed this and stated that the staff at the home helped them to sort out Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 17 specific health needs. Personal support was offered sensitively and one resident interviewed stated that they were ‘well looked after’ and one survey stated that staff were ‘very, very good’. All four resident surveys returned stated that they ‘usually’ or ‘always’ received the medical and care support they needed. Visiting professionals were satisfied with the level of support offered; one praised the manager and staff stating that they understood specialist needs well and provided a good service for residents with specific problems and that their impression of the home was ‘favourable’; a second stated that staff were able to communicate well in reviews and had the necessary information available and that they were ‘quite impressed’ with the service offered and a third commented that the home implemented agreed strategies well to deal with specific problems. There continued to be some information lacking on care records, although improvements had taken place since the last inspection in February 2006. For example, there were inconsistencies in recording residents’ wishes regarding death. This information was recorded on some but not all files seen. Although continence assessments had been introduced, one file examined did not have one in place although this was recorded as a need. Assessments for risk of pressure sores and nutritional assessments took place but the results of these were logged at various points within the care plan. Recording these on a chart would locate the information more easily and would also give a quick reference point to determine changes over a period of time. Four residents’ medication administration record (MAR) charts were examined. There had been improvements following requirements made at the last inspection in February 2006 as all four charts were signed appropriately where medicines had been administered and the amount of medicine received was being recorded on all pre-printed MAR charts. However, the amount of medicine received had not been recorded on handwritten MAR charts. A random sample of MAR charts showed that the majority of handwritten charts were signed by two people, although there were three records seen where this had not occurred. Photographs to aid identity of residents were incomplete and some had the wrong room number attached. This must be updated and must be accurate to minimise the risk of errors occurring. One MAR chart examined showed that the actual amount of medication given for a variable dose was not being recorded consistently. This was raised as an issue at the previous inspection in February 2006. Medication was stored appropriately. A refrigerator was in use and its temperatures were recorded daily and were within safe limits. Systems were in place for the recording and destruction of medication. Records of controlled medicines were in place and two people signed the register appropriately. However, one controlled medicine had not been destroyed although it was no longer in use and the record for another medicine Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 18 did not have the residents name identified. Temazepam stocks were examined and one resident’s record did not correspond with the amount of tablets in stock i.e. there was one tablet more than the record stated. Discussion of administration practices occurred with the nurse in charge who confirmed that most medicines were not left with a resident; this only occurred if specifically requested by the resident and then staff observed at a distance to ensure that the medicine was taken. Care staff interviewed also confirmed that they closely observed residents to ensure medicines were taken. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) and 16, 18 and 35 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were handled objectively and comprehensive adult protection procedures ensured residents were protected from abuse. EVIDENCE: The complaints procedure was clear and was included in the individual handbook displayed in each resident’s room. It stated that complaints would be dealt with in twenty-eight days. Residents spoken with were aware of the complaints procedure and the majority were confident that their concerns would be listened to and acted upon. One resident stated that they were not confident that issues could be raised and dealt with appropriately. All four residents’ surveys received stated that they ‘always’ or ‘usually’ knew how to make a complaint. The complaint record was examined and showed that complaints were responded to in writing. There had been one complaint received at the office of the Commission for Social Care Inspection since the last inspection in February 2006. The issues raised had been responded to in writing to the complainant. Issues raised concerned the price charged for Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 20 cigarettes, night staff sleeping on duty, wooden floors being a fire risk and food for special diets. These issues have been discussed in other sections of this report and were not upheld on this inspection visit. The home had its own policy on adult protection and also had a copy of Derby and Derbyshire Local Authority Social Services adult protection procedures. Staff spoken with were aware of their responsibilities in the event of an allegation. Senior staff had received training in safeguarding adults but newer members of staff had not. The written information supplied by the home stated that there had been no protection of vulnerable adults (POVA) referrals in the previous twelve months. Money was kept in safe keeping for a number of people living at the home. The person in charge at the time of this inspection did not have access to the personal monies. One resident spoken with stated that their personal finances were dealt with appropriately and they were confident that these were managed properly. The written information supplied by the home stated that resident’s personal money was deposited in a separate bank account. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30(Adults 18-65) and19, 20, 24 and 26 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tynefield Court provides a comfortable and safe environment for residents, although ongoing refurbishment would further enhance the quality of the accommodation offered. EVIDENCE: Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 22 Tynefield Court was clean, tidy and free from odours at the time of this inspection. The new providers stated that they were in the process of redecorating all the bedrooms and stated that nine bedrooms had been decorated since December 2006. The main corridor had also been decorated. There were repairs being made to a leak that had occurred and the central heating system was also being checked during the visit. A log was kept where staff could identify repairs that were needed and a maintenance person was employed for ongoing repairs. Some areas of the building needed refurbishing; for example, some corridors had scratched paintwork and the smoking lounge also needed re-painting. Two residents stated that they wanted their bedrooms refurbishing and the new providers stated that they planned to re-decorate all the bedrooms over the next few months. Four bedrooms were viewed. Residents had been encouraged to personalise their bedrooms with their own furniture and belongings. One resident spoken with stated that the providers had discussed with them the use of a computer in their bedroom and access to the internet. Not all bedrooms seen had lockable storage space provided. Residents had access to a number of communal areas, including a separate smoking lounge. This lounge, and the dining room, had a wooden floor. There was no evidence seen to suggest that either of these areas were a fire risk and they had not been raised as such in the last Fire Officers visit in January 2006. The laundry facilities were viewed. No issues about the laundry service were raised during this inspection. The laundry was neat and tidy and information was available on infection control procedures. Cleaning materials were stored securely and there was comprehensive product information available to comply with the Control of Substances Hazardous to Health (COSHH). Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 (Adults 18-65) and 27, 28 29, 30 and 36(Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were sufficient staff to ensure that residents’ needs were met but additional staff training would enhance the care provided. Recruitment procedures were not comprehensive enough to ensure residents were fully protected. EVIDENCE: Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 24 Discussion with residents, staff and the person in charge supported that staffing levels were adequate to meet the needs of the current resident group. The staff group was relatively stable, although the written information supplied by the home indicated that there was some turnover of staff, due to staff recruited from overseas returning home. Staff rotas supplied with the written information from the home showed that there were two qualified nurses on duty during the day-time shifts and one at night with seven or eight care staff on the day time shift and four care staff in the evening and at night. This was consistent with the numbers seen during the inspection visit. The complaint raised with the Commission for Social Care Inspection alleged that night staff were sometimes asleep on duty. The written response to the complaint stated that the manager had investigated and found no evidence of this. This issue was discussed with the manager on her return from leave following the inspection and she stated that all night staff had been interviewed regarding the allegation. Discussion with the person in charge during the inspection indicated that no further progress has been made towards meeting the requirement for 50 of care staff being trained to National Vocational Qualification (NVQ) level 2 or equivalent. The written information provided by the home stated that four members of staff had achieved this qualification, which meant that only 25 of care staff were qualified. Four staff files were examined and showed that not all the information required by Schedule 2 of the Care Homes Regulations 2001 was in place. This included Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks and two written references. For example, three files did not have a CRB or POVA First check from this country, although police checks from the country of origin were available. An immediate requirement notice was therefore issued to commence the process of obtaining CRB checks and POVA First checks. Two files had only one written reference. There was also no evidence of a work permit in the file for one staff member recruited from overseas. One file did not have an application form in place. There was evidence of identity, such as passport and birth certificate, on all the files examined. There was a process for induction being introduced for new staff by the new providers. However, previous staff had not completed the induction document in three of the staff files seen, although staff interviewed confirmed that they spent a week with experienced staff when commencing employment at the home. One newer member of staff had completed training in only two of five mandatory training areas in health and safety (moving and handling and fire safety), although first aid was booked for March 2007. Although health and safety courses were arranged, care staff did not undertake food hygiene training and not all staff had undertaken all five areas of health and safety training. This was raised as an issue at the last inspection in February 2006. One food hygiene certificate was out of date for a member of the catering staff. Staff spoken with stated that there were other training courses available Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 25 related to care issues, such as Huntington’s Disease and promoting continence. However, there were a number of areas where training had not occurred such as loss and bereavement, visual and hearing loss awareness and dementia that would be beneficial to staff. Supervision documents in staff files were not completed but staff spoken with confirmed that senior staff carried out direct observations of care practice, although formal supervision on a one to one basis did not take place. This has been raised as an issue at previous inspections. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 (Adults 18-65) and 31, 33, 35 and 38 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to health and safety training and quality assurance were necessary to ensure that the home was run in residents’ best interests. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager has been in post for eighteen years, and was an experienced qualified nurse. However, she had not yet enrolled on NVQ Level 4 in management. The manager’s approach was praised by visiting professionals spoken with; one stated an understanding of specialist needs was ‘cascaded by the manager’ to the staff and another stated that there was ‘always a consistent response’ from the manager. New providers had taken over the company in November 2006 and were keen to promote quality assurance policies but as yet had not implemented any procedures. They stated that they were planning to undertake surveys of residents, relatives and visiting professionals on an annual basis. They were aware of their responsibility under Regulation 26 of the Care Homes Regulations 2001 to undertake monthly monitoring visits. They also stated that they were intending to establish residents’ forums to ensure that residents were involved in the decision making process of the home and to hold more regular staff meetings. Staff spoken with stated that they would like the opportunity to meet together more often. The new providers had prioritised certain areas of work such as re-decoration of bedrooms, improving the menus, increasing activities and re-fitting the serving area of the dining room. The written information supplied by the home stated that regular safety checks occurred. For example, gas safety had been checked in March 2006, water safety in May 2006 and the electrical wiring certificate was issued in September 2003. Mandatory health and safety training for staff occurred but some of this was out of date on the training records seen. For example, the food hygiene certificate for a member of the catering staff was dated 2002 and care staff did not undertake this training although they were involved in the preparation of light snacks and drinks where necessary, and one member of staff spoken with had not undertaken infection control training. This was raised as an issue at the previous inspection in February 2006. There had been no progress on risk assessing radiators and the person in charge was not aware of any radiator guards being provided since the last inspection in February 2006. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 X 42 2 43 X 3 2 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tynefield Court Score 3 3 2 X DS0000002169.V329728.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 14(1)(a) Timescale for action Continence assessments must be 30/03/07 completed for all residents with an identified need. (Previous timescales of 31/12/05 and 30/04/06 not met.) A record must be kept of all 31/03/07 medication received into the home. (Previous timescales of 31/12/05 and 31/03/06 not met) Where a variable dose is 31/03/07 prescribed the actual dose administered must be recorded (Previous timescale of 30/11/05 and 31/03/06 not met) The information required in 16/02/07 Schedule 2 and 4 of the Care Homes Regulations 2001 relating to staff must be maintained for all staff. This includes staff recruited from overseas. Previous timescale of 31/03/06 not met. Now immediate. All staff must receive formal and 30/04/07 informal supervision on a regular basis. (Previous timescales of 31/12/05 30/06/06 not met) A quality assurance system for 31/03/07 DS0000002169.V329728.R01.S.doc Version 5.2 Page 30 Requirement 2. YA20 13(2) 17(1)(a) Sch 3 13(2) 17(1)(a) Sch 3 17(2)Sch 4 19(1)(4) 3. YA20 4. YA34 5. YA36 18(2) 6. YA39 24 (1) Tynefield Court 7. 8. YA42 & YA35 YA42 13(6) 18(1)(2) 13(4) 9. YA2 14 (1) 10. YA9 13 (4) (c) reviewing the quality of care and nursing must be established (Previous timescales of 31 March 2004 and 31/03/06 not met) All staff must receive mandatory training in food hygiene and infection control. A risk assessment of all radiators must be undertaken and guards fitted where necessary (Previous timescales of 31 May 2004 and 31/03/06 not met) There must be assessment information obtained on admission to establish individual care needs, particularly in relation to preventing falls and pressure sores. There should be risk assessments in place for all daily activities that involve risk-taking. 31/03/07 31/03/07 31/05/07 30/04/07 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. 2. Refer to Standard YA1 YA7 Good Practice Recommendations Information provided to residents should be available in a variety of formats such as large print, different languages, audiotape etc. There should be evidence on files, such as a signature, to demonstrate that care needs have been discussed and residents are involved in making decisions about their lives. There should be regular residents’ meeting to ensure participation and involvement in decision-making in the home. Ongoing efforts should be made to engage residents in social and community activities. Menus should be on display each day and residents DS0000002169.V329728.R01.S.doc Version 5.2 Page 31 3. 4. 5. YA8 YA13 YA17 Tynefield Court 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. YA19 YA20 YA20 YA20 YA21 YA24 YA26 YA28 YA32 YA35 YA37 advised of choices available in advance. Charts for recording nutritional and tissue viability scores should be used to aid location and establish any patterns or changes. The photographs of residents should correspond accurately with their room number to aid identification when administering medicines. Consideration should be given to recording Temazepam in the controlled drugs register to ensure accuracy of recording and correspondence with stocks held. Two people should sign and date all handwritten medication administration record (MAR) charts. Residents’ wishes at the time of severe illness or post death must be recorded in the files. Scratches to paintwork in the corridors should be repaired. All bedrooms should have lockable storage space provided. The smoking lounge should be re-painted. 50 of care staff must be trained to NVQ Level 2 or equivalent. A wider range of training courses applicable to direct care should be arranged for staff. The manager must enrol on a course leading to an appropriate management qualification. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. Tynefield Court DS0000002169.V329728.R01.S.doc Version 5.2 Page 33 - 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. 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