Inspection on 29/08/08 for Tynefield Court

This inspection was carried out on 29th August 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tynefield Court 18/10/07

Tynefield Court 13/02/07

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 09/11/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Tynefield Court Blakeley Lane Egginton Road Etwall Derby DE65 6NQ Lead Inspector Steve Smith Unannounced Inspection 29th August 2008 09:30 Tynefield Court DS0000002169.V371275.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.V371275.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.V371275.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.V371275.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 18th October 2007 Brief Description of the Service: Tynefield Court Care Home is a home with 40 places that provides both nursing and personal care. The home cares for older people, as well as young adults with physical disabilities. It 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. The 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 Manager, on 29 August 2008, stated that the weekly fees ranged between £360.00 and £560.00 and are dependent on the needs of the person. Additional charges are made for hairdressing, chiropody personal newspapers and toiletries. Details of previous inspection reports can be found at the Home, or on the Commission for Social Care Inspection’s website: www.csci.org.uk Tynefield Court DS0000002169.V371275.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 the service experience Adequate quality outcomes. The focus of inspections, undertaken by the Commission for Social Care Inspection (CSCI), is upon outcomes for people and their views of the service provided. This process considers the Home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. This inspection visit was unannounced and took place over a period of approximately 7.5 hours. In order to prepare for this visit we looked at all of the information that we have received, or asked for, since the last key inspection of the Home, which took place on 18 October 2007. This included: The ‘Annual Quality Assurance Assessment’ (AQAA). This is a document completed by the Registered Providers of the Home that focuses on how well outcomes are being met for people using the service. What the service has told us about things that have happened in the service. These are called ‘notifications’ and are legal requirements. The previous ‘Key Inspection Report’, and the results of any Other Visits that we have made to the service in the last 12 months. Relevant information from Other Organisations, and what Other People have told us about the service. Surveys returned to us by people using the service, from the relatives of those staying in the Home, and from the staff working in the Home. For this inspection of the service the Commission’s Residents questionnaire (a ‘survey’ mentioned above) was sent to 10 people staying in the Home, and 9 were returned. Ten questionnaires were also sent relatives, with the peoples staying consent, and 2 were returned. Ten questionnaires were also sent to staff, and 9 were returned. During this visit to the Home ‘case tracking’ was used as a system to look at the quality of the care provided. This involved the sampling of a total of four peoples records, being a cross-section of people staying in the Home. Discussions were held with those people, if they were able, together with a Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 6 number of others, about the care and services the Home provided. Their care plans and care records were also examined, and their private bedrooms and communal facilities were seen. Discussions were also held with any relatives that were visiting during this visit to the Home. In addition, discussions were held with the Manager of the Home about its general operation. Discussions were also held with staff about the arrangements for peoples care, and also about the staffs recruitment, induction, deployment, training and supervision. What the service does well: What has improved since the last inspection? What they could do better: The following issues were found to be still outstanding from the visit made to the Home in October 2007: Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 7 People staying in the Home had not been shown their plans of care, or have the opportunity to comment upon them. Radiators needed to be unguarded in peoples bedrooms. Care staff needed to receive regular supervision. Mandatory training had not been provided for all staff in First Aid and Infection Control. The Registered Providers had not been ‘visiting’ the Home on an unannounced monthly basis, to discuss its operation with those staying, with staff and to assess the condition of the Home. The following issues were new issues found to need addressing as a result of this visit to the Home. Staff had not received training on dealing with anger and aggression, in line with Safeguarding Adults from abuse. The rear exterior to the Home had not been maintained at a good standard, and the gardens also required attention. In a number of bedrooms the curtaining had come away from the curtain track. The heating system in the Home needed considerable repair or urgent replacement. New staff to the Home not received copies of the General Social Care Council’s code of conduct and practice. Quality Assurance issues had not been fully addressed. 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.V371275.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.V371275.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): Standards 1 & 2 (Adults 18-65), and Standards 1 & 3 (Older People). Standard 6 (Older People) is not applicable in this service. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. All new people moving to the Home were appropriately assessed prior to their admission, so that they and their families were reassured that their needs would be met. EVIDENCE: The Registered Providers statement of purpose and Residents Guide were reviewed during this visit to the Home. The Residents Guide was found to be a satisfactory document, providing satisfactory information for a person staying in the Home. Both documents were well constructed and copies of the Residents Guide were found in each person’s bedroom visited. However, the Residents Guide stated that Residents Meetings were held monthly, but the Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 10 Manager said that these meetings no longer took place. The complaints procedure, contained within the Residents Guide, failed to give the address and telephone number of the Commission. It also failed to provide information on how contact could be made with the local Social Services Dept and Heath Authority. People who completed the Commission’s questionnaire commented very little on the admission process. However, they all said they were happy with being in the Home, and two people wrote – ‘I think it is a lovely place. All the staff are wonderful, and if you want anything it is all sorted out’ – and – ‘I like the home.’ Staff, in the main, commented very positively on the information provided to them on peoples needs, in their questionnaires, by writing such things as – ‘We have a full handover at the beginning of our shifts, and there is full information about each resident in their care plans’ – and – ‘Good handovers are done by RGN’s (Nurses), and care plans are clear.’ However, one member of staff felt that information provided at handover meetings was not always good. This person said – ‘It depends who is on duty.’ When new people were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting that person, copies of which were seen. The Manager also assessed all people sponsored by Social Services Depts. This was confirmed by the Annual Quality Assurance Assessment completed by the Manager; she wrote – ‘Residents are given a full assessment prior to admission to the home, by the Manager, either by meeting the client at their home or in hospital. Preferably the client spends some time at Tynefield Court, either for the day, or for a meal, or over night. Relatives are also welcome. A preadmission form is completed prior to admission’ Tynefield Court DS0000002169.V371275.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): Standards 6, 7, & 9 (Adults 18-65) and Standards 7 & 14 (Older People). The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. The staff ensured that peoples needs were met, allowing for their differing abilities. They also enabled people to take risks, ensuring that the risks were appropriate to their abilities. EVIDENCE: Four records of people staying in the Home were examined, or case tracked, to ensure that suitable records were being maintained. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 12 Detailed full care plans were seen in each of the four files looked at. These plans of care were updated at intervals by nursing staff. Two had been updated in 2007, one in 2006 and one in early 2005. The files did not contain formal six monthly reviews of care, which is the time scale suggested by the Commission for these reviews. Two people staying in the Home said that they had not been offered the opportunity to read their care plans. One said – ‘I never knew that I could see it.’ Satisfactory risk assessments on each person staying were seen. The files showed that good records of medical events affecting each person were kept, but not of social events. Entries were made when significant medical events occurred. As a result, in all four files looked at, complete months went by with no record being made of any kind, medical or otherwise. Peoples records were easy to read, and all of the files were well organised. Staff said that they encouraged people staying in the Home to make decisions about their daily lives, although those decisions were in the main only about events within the Home itself. Two people spoken with said that they managed their own money, although on occasions relatives helped with this. Staff said that they encouraged people to tackle problematic areas in their lives (‘areas of risk’). This in the main was related to activities within the Home, and staff were seen doing this. For example, encouraging people to walk unaided along the corridors, and to manage their own meal at meal times. The Manager had recorded in the Annual Quality Assurance Assessment that – ‘(We) have regular reviews with Service Users with their Care Managers. (We) evaluate care plans monthly. (We) have good relationships with Care Managers (from Social Services Depts) and other specialist professionals. (We) encourage clients to make decisions about their lives. (We) encourage clients to manage their own finances. (We) encourage clients to be as independent as possible, assessing risks and allowing them to live their lives as normally as possible, without undue limitations.’ Tynefield Court DS0000002169.V371275.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): Standards 12, 13, 15, 16 & 17 (Adults 18–65) and Standards 10, 12, 13 & 15 (Older People). The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 14 Peoples preferred lifestyles were respected by the Home, and people were given a wholesome and appealing diet in pleasant surroundings, that enhanced their wellbeing. EVIDENCE: Staff said that they encouraged people to take part in regular activities. They said that the Home provides an Activities Coordinator, who works approximately 6 hours a week, across 2 days. The Activities Coordinator was said to organise arts and craft events, cooking, bingo, entertainers such as singers to visit the Home. Trips to the shops were also organised. Staff said that the provision of a mini bus would enable people staying in the Home to get out more often, which was also requested by those spoken with in the Home, and by some of those completing the questionnaire. Those staying in the Home confirmed that the Activities Coordinator provided the above activities and also added that she arranged games, such as dominoes, draughts and skittles. One person completing a questionnaire wrote that they often found the activities were aimed at the older people on the Home. This person requested activities for those of a younger age. Staff said that the Manager assisted people with benefit entitlements. To help people staying in the Home maintain links with the local community, staff said that people were occasionally encouraged to go to local events such as ‘well dressings’. It was said that some people attend church and that ministers/vicars visited the Home. Staff said that barbeques were organised, and fish and chip nights and pub nights were also arranged. Those staying said that they were enabled to vote in local and national elections, with a postal vote or being taken to the polling station by staff, which was also confirmed in the Manager’s Annual Quality Assurance Assessment. Staff said that they were unable to take people out in the evening, as staffing levels at that time of day did not allow for this. People were encouraged to maintain links with family and friends, when this was found to be important to the person staying in the Home – ‘Yes, and I can always see them in private’ – said one person, and another said – ‘When my family comes we go to my room.’ In the Annual Quality Assurance Assessment the Manager had said – ‘(We) always welcome friends and relatives, with no restrictions on visiting. A private lounge is available for Service Users and their families. Families are also involved in social events.’ People spoken with said that staff knocked and wait to be invited in to their bedrooms – ‘Staff always use the correct procedure, I jump on them if they don’t do it!’ – and – ‘Staff always knock and wait to be invited in, but sometimes they forget.’ Staff were able to confirm they did this with able Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 15 people, but would knock and enter the bedrooms of those who were unable to respond to the knock. People also said that they had a key to their bedroom doors and could choose when to use it. They also said that their mail always came unopened; a delivery was made to someone during this visit to the Home. People also said that they had unrestricted access to the home and its grounds, on person said – ‘Staff take me out around the grounds.’ The rules on smoking was understood by those staying, and a smoking room was available. Meals were provided by staff. One person staying in the Home said that - ‘You can have your meal in the dinning room, or your bedroom if you are unwell.’ People staying in the Home said that a choice of meal was provided at breakfast, dinner and tea time. During this visit staff were heard asking those staying in the Home what they wanted for dinner, out of the choices available. Both those staying and the staff were clear that if someone needed assistance to manage their meal staff would only assist one person at once. In the Annual Quality Assurance Assessment provided by the Manager she had written – ‘(We) provide a good choice of food, which is well presented.’ Tynefield Court DS0000002169.V371275.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): Standards 18, 19 & 20 (Adults 18–65) and Standards 8, 9 & 10 (Older People). The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Peoples personal needs were well met, ensuring that their privacy, dignity and independence were maintained. The system of administering medication was good, and ensured peoples medication needs were met. EVIDENCE: People staying in the Home with mobility difficulties said that they always ensured that staff helped them in the way they wanted – ‘I always make sure that staff do it my way’. They also said that they were able to get up and go to bed at times of their own choosing. People also said that they were able to choose their own clothes and style of appearance – ‘I choose my clothes, Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 17 although staff always suggest.’ People staying in the Home said that, if they wished, they could choose which member of staff aided them with their daily tasks. One person said that they received assistance from specialist workers such as physiotherapists. Staff also said that in individual personal records peoples routines of likes and dislikes were recorded, for those who could not easily communicate their needs, so that staff were aware of them and always followed them. In the Annual Quality Assurance Assessment the Manager had written – ‘(We) provide a high standard of care to a wide range of clients with complex needs. (We) promote privacy and dignity. (We) allow Residents choice and are flexible in planning care. (We also) have good relationships with other professionals and specialist support.’ Those living in the Home were supported to maintain good health. When staff and a person staying in the Home judged it appropriate, the responsibility for managing medication was passed from staff to the person themselves. Should a GP need to visit the Home, they saw the person staying in the Home in private, although supported by staff, with the person’s agreement. During this visit to the Home the Medication Administration Record sheets were examined and all was found to be very well managed and maintained. In the Annual Quality Assurance Assessment completed by the Manager she had written – Screening and health checks take place. Residents are support to managed their own medical conditions and are assessed to self-medicate if appropriate. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 18 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): Standards 22 & 23 (Adults 18–65) and Standards 16 & 18 (Older People). The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Complaints made to the Registered Providers or Manager were addressed to meet peoples needs. The protection policies and procedures provided meant that people staying in the Home were well protected. EVIDENCE: People staying in the Home, who were spoken to, were aware of the complaints procedure. One said that they had used the procedure and were satisfied with the outcome – ‘I have complained, and complained to the Manager.’ The Commission had not received any notice of complaint since the last inspection of the Home in October 2007. Good procedures were seen for both written and verbal complaints. The Registered Providers complaints procedure detailed that all complaints would be responded to by the Registered Provider or Manager within at least 28 days. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 19 One complaint had been formally raised since the last visit to the Home. This was examined and found to have been dealt with appropriately. In the Annual Quality Assurance Assessment the Manager had written – ‘(We) have a complaints procedure in place. (The) Manager listens to staff and clients regarding concerns and views (and) responds accordingly. Complaints are responded to within 28 days. No one is victimised for complaining, complaints are used constructively.’ The Registered Providers had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy, which staff spoken with were aware of and said that training had been provided. The Registered Providers had copies of the Public Interest Disclosure Act of 1998, and of the Dept of Health’s policy called ‘No Secrets’ available in the Home. The Manager confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. Staff said that they understood that people staying in the Home might, on occasion, show anger and aggression, and that they knew how to respond. However, they said that they had not had training on how to formally deal with these situations. The Manager said that a policy was available to staff stating that they could not benefit from peoples wills, however, the staff spoken with were not aware of this policy. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 20 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): Standards 24, 25, 26, 27, 28, 29 & 30 (Adults 18-65) and Standards 19, 20, 21, 22, 23, 24, 25 & 26 (Older People). The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. The Home was, in some areas, inadequately maintained, providing people staying in the Home with a poor environment. EVIDENCE: A tour was made of the public areas of the Home, and permission was obtained to visit a number of the bedrooms of the people staying in the Home. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 21 The Home was pleasantly decorated throughout, and the lounges and dining room were pleasant to sit in, and were provided with appropriate items for those staying. People spoken with said that they were happy with their bedrooms and the lounges within the Home. In the questionnaires completed by those staying in the Home all said that the Home was always kept fresh and clean – ‘The cleaners do a wonderful job’. The bedrooms seen provided limited space and provision for each person, although those spoken with were satisfied with their bedrooms. The Registered Providers had provided appropriate furnishings in all locations seen during this visit. Toilets and bathrooms were easily available to all people staying in the Home and were clearly marked. The Home had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. In the Annual Quality Assurance Assessment completed by the Manager she had written – ‘Service Users are assessed and given a room that is suitable for their needs. Privacy is respected. The Home is the Service Users home, it is kept clean, comfortable and warm, and has a homely and friendly atmosphere. We abide by their wishes as much as possible. We make no restrictions regarding visiting. We encourage Service Users to personalise their bedrooms with their own furnishing and belongings. (We have) no odours, which is often commented upon by visitors.’ However, the following issue were observed during the visit to the Home : Outside of the conservatory was a seating area, which was inadequately maintained. Tall weeds were seen growing through the gravelled pathways. The cedar wood finish to the outside of the home, in this area, was flaking badly. The tables had not been cleaned for some time and so were stained with tea and coffee. At the front of the Home the lawns had been recently cut, but the garden areas were extremely over grown with weeds and had obviously not been tended for a very long time. Radiators in peoples bedrooms did not have covers to safeguard those staying in the Home. Down one of the corridors radiators had been removed from the walls, which, come the autumn and winter, will probably leave the Home cold for those staying there. Radiator piping was found to be leaking in a number of places around the Home. However, the Manager said that the heating system was due to be replaced before the autumn. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 22 The carpeting around the nurses station was badly stained. The smoking room had apparently been decorated during the past 12 months, but already it was looking poorly maintained. The curtaining was not appropriately attached to the curtain track, there were no pictures on the walls and the ceiling was very discoloured. In many bedrooms the curtaining was not appropriately attached to the curtain track to provide a neat finish. Tynefield Court DS0000002169.V371275.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): Standards 32, 34, 35 & 36 (Adults 18-65) and Standards 27, 28, 29 & 30 (Older People). The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Overall, appropriate staffing was provided, which met the needs of people staying in the Home. EVIDENCE: At the time of this visit the Manager said that less than 50 of care staff had the appropriate qualification to work in the Home (NVQ level 2 in Care). However, in the Annual Quality Assurance Assessment the Manager had written – ‘More staff have enrolled to do NVQ training.’ Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 24 The staffing level provided for the four week period beginning 28 July 2008 was reviewed. This showed that more than adequate levels of staffing were being provided. The records of two new staff employed during the past 12 months were examined to see whether the Manager had obtained all relevant information about them, and it was found that all relevant information had been obtained. One member of staff spoken with was able to confirm that she had been given a copy of the General Social Care Council’s code of conduct and practice when she started to work at the Home, however, the second member of staff was unaware of this. Both staff were able to confirm that they had been given copies of the statement of the terms and conditions under which they were employed. The Manager said that all new staff would be provided with induction and foundation training, which was confirmed by staff at the time of the visit to the Home. Staff spoken with said that they received approximately 3 days paid training each year. All staff also had an individual training and development assessment and profile. Two members of staff spoken to were asked whether they had received regular supervision from the Manager or other senior nurses in the Home. They both said that no supervision was provided, on a formal basis. This was needed to ensure that the Manager was aware of the needs of her staff and of the people staying in the Home, and made plans to meet those needs. This was later confirmed by the Manager. In the Annual Quality Assurance Assessment the Manager had written – ‘(We) need to provide more formal supervision.’ Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 25 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): Standards 37, 39, 42 & 43 (Adults 18-65) and 31, 33, 35 & 38 (Older People). The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 26 The management arrangements at the Home were not sufficiently robust to ensure that residential and nursing care were maintained at a positive standard. EVIDENCE: The Manager of the Home had been in post for many years, but did not hold an NVQ level 4 qualification in Management. However, she did hold a nursing qualification. The Registered Providers visited the Home often, one of them being present during this visit. However, they did not complete the documentation to show that they had carried out the monthly unannounced ‘visit’ of the Home, or provided the written report on these ‘visits’ to the Manager, as required by Regulation 26. The Manager was not able to show an annual development plan for the Home, which reflected the aims and outcomes for people staying there. However, surveys had been undertaken, and published, of peoples opinions of the operation of the Home. Residents Meeting were no longer being held, although had been held regularly in the past. The opinions of peoples families and friends, and of GPs and District Nurses etc, were obtained, via questionnaires, on how well they all thought the Home was achieving goals for those staying, although the results had not been published. The training provided for all staff was examined. This showed that the training required by law, for all staff, on Moving and Handling, Fire Safety and Food Hygiene had been provided. Training for the majority of staff was needed on First Aid and on Infection Control. This was also confirmed by the staff spoken with during the visit to the Home. The Manager was able to say that in addition to the mandatory training required, training had been provided on Adult Protection and Whistle Blowing, Huntington’s Chorea, PEG feeding, Parkinson’s Disease, and Multiple Sclerosis The Manager was also able to confirm that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. She also confirmed that, with the assistance of the Fire Service, fire safety notices were posted in relevant places around the Home. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 X 4 X 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 2 43 2 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tynefield Court Score 3 3 3 X DS0000002169.V371275.R01.S.doc Version 5.2 Page 28 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 YA6 Regulation 15(2)(a) to (d) Requirement Peoples plans of care must be shown and discussed with those staying in the Home who are able to understand them, and include any comments requested by the relevant Resident. This is to ensure that each person’s needs are accurately described and addressed by staff. (This issue is outstanding from the inspection report dated 18 October 2007) All staff must receive training on dealing with anger and aggression, in line with Safeguarding Adults from abuse. This is to ensure that all staff are aware of how to safeguard people staying in the Home. At the rear of the Home, by the conservatory, the garden area and cedar wood panelling on the rear of the building must be improved, to maintain the Home at a good standard. DS0000002169.V371275.R01.S.doc Timescale for action 24/10/08 2. YA23 Reg. 13(6) 31/12/08 3. YA24 Reg 23(2)(b). 30/11/08 Tynefield Court Version 5.2 Page 29 4. YA24 Reg. 23(2)(d) The seating area outside of the conservatory must be kept clean and attractive. This is to ensure that these facilities are pleasant for people to use. The garden areas to the front of the Home must be regularly tended and be pleasant to look at, for those who live in the Home, and for those visiting. All bedrooms must be provided with appropriate curtaining attached to the curtain track to make the curtaining look attractive and neat. Risk assessments must be carried out on all radiators and guards provided where people are placed at risk. This is to safeguard those staying in the Home for being scalded. (This issue is outstanding from the inspection report dated 18 October 2007) Heating must be provided in all corridors to maintain the temperature at a suitable level throughout the year. The heating system must be adequately repaired before the autumn. If a new system is to be installed then this must be completed before the autumn to maintain a suitable temperature in the Home at all times. 24/10/08 Reg. 23(2)(a) Reg. 16(2)(c) 5. YA24 Reg. 23(2)(p) 30/09/08 6. YA34 Reg 18(4) All new staff to the Home must be given copies of the General Social Care Council’s code of conduct and practice. This is to ensure that staff are aware of the requirements of the General DS0000002169.V371275.R01.S.doc 24/10/08 Tynefield Court Version 5.2 Page 30 Social Care Council. 7. YA39 Reg 24(1) as amended. The Registered Providers and Manager must complete an annual development plan for the Home to ensure that all future needs of the Home are documented and eventually addressed. All staff must receive mandatory training in First Aid, and Infection Control. (This issue is outstanding from the inspection report dated 30 March 2007) The Registered Providers must ensure that the Home is visited on an unannounced basis, at least once each month in line with the requirements listed in Regulation 26. (This issue is outstanding from the inspection reports dated 18 October 2007) 31/12/08 8. YA42 Reg 18(1)(a) 31/01/09 9. YA43 Reg. 26(3) & (4) 24/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Residents Guide should contain up to date information for those staying in the Home. Information about Residents Meetings should be removed if they are not taking place, or Residents Meetings should held at the frequency referred to in the Residents Guide. The Residents Guide should also contain information for those staying in the Home on how to contact the Commission, the local Social Services Dept and local Heath Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 31 Authority. 2. YA6 Plans of care should be updated at regular interval, or at least reviewed and dated to show that the needs of the person had not changed over time. The Manager should complete formal 6 monthly reviews of care with Residents. Those attending the review should include the Resident, where possible their relatives and representative, and staff from the home. Care plans should include all events affecting those staying in the Home, including positive occasions such as social events Entries in peoples files should be made at least at weekly intervals of time, unless events require more frequent entries. 3. YA12 The Registered Providers should consider employing the Activities Coordinator for a longer period; for example 20 to 30 hours a week. This would ensure that the leisure and activity needs of those staying were appropriately met. Consideration should be given to providing a mini bus to allow those staying to be taken out into towns and on trips to places of interest. This would be beneficial to peoples welfare given the isolated location of the Home. Consideration should be given to providing activities that younger people in the home would enjoy. 4. YA13 Enough staff should be provided to allow staff to accompany those staying in the Home out from the Home in the evenings, to public houses and other places of entertainment. All staff should be reminded that it is the policy of the Registered Provider that staff are not able to benefit from or assist those staying in the Home in the making of their wills. Carpeting around the nurses station should be replaced. The smoking room needs to have the curtaining appropriately attached to the curtain track, pictures should Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 32 5. YA23 6. YA24 be placed upon the walls and the ceiling should be redecorated. 7. 8. 9. YA32 YA36 YA39 50 of care staff should be trained to NVQ Level 2 or equivalent. Supervision should be provided for all care staff in the home on at least a two monthly basis. Residents Meetings should be regularly held, to allow those staying in the Home to effect the way care was being provided. The results of the surveys undertaken of the views of relatives and friends of those staying, and of GPs, District Nurses, etc, should be published to inform all of the way the Home is operating. Tynefield Court DS0000002169.V371275.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V371275.R01.S.doc Version 5.2 Page 34 - 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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