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Inspection on 12/08/05 for Tynwald Residential Home For The Elderly

Also see our care home review for Tynwald Residential Home For The Elderly for more information

This inspection was carried out on 12th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

Residents said that no restrictions are imposed and that flexible routines are encouraged. They said that staff show them kindness and consideration and respect their privacy and dignity. One resident said staff "respect my dignity in every way". The home offers residents a range of activities to enable them to have a more interesting day, although residents are free to choose not to participate if they prefer. The home is good at consulting with residents, listening to their views and making changes accordingly to improve the service. Staff are given regular opportunities to attend training courses and broaden their knowledge and awareness, which is of benefit to the residents.

What has improved since the last inspection?

Requirements made at the last inspection have been met, including amendments to the medication and abuse policies and procedures. Electrical installations have been checked and serviced.The menus have been revised in line with suggestions from residents. The number of days cooked breakfasts are being provided has been increased to five or six.

What the care home could do better:

The home must ensure that care plans are available for residents new to the home. Any risks or hazards relating to individual residents must be assessed, with risk management strategies agreed and recorded. Unannounced Regulation 26 visits must be made each month and copies of the reports of the visits sent to the commission every month.

CARE HOMES FOR OLDER PEOPLE Tynwald Residential Home for the Elderly Hillside Street Hythe Kent CT21 5DH Lead Inspector Julian Graham Unannounced 12 August 2005 9:30 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tynwald Residential Home for the Elderly Address Hillside Street, Hythe, Kent, CT21 5DH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 267629 The Alice Butterworth Charity Mrs Marie Elizabeth Rose Care Home only 24 Category(ies) of Older People x 24; Dementia (over 65) x 3 registration, with number of places Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 01/11/04 Brief Description of the Service: Tynwald was established as a charitable trust to provide residential care to older people who have lived in the Hythe area, or have connections with Hythe. The Home is situated a short distance from the town centre where there are shops, health centres, churches, a library and other amenities. The Home provides personal care and support in a non-institutional setting. The Manager places great emphasis on encouraging residents to remain active and independent, and the services include a variety of activities and entertainment.All the home’s bedrooms are single, and there is both a shaft and stair lift. There is a choice of sitting areas, and an attractive and accessible garden. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 09.30, and took place over six hours. Twelve of the residents were spoken with, all of whom saying that they like living at Tynwald and find the staff kind and helpful. One resident said she finds the staff “so attentive and kind”. The hairdresser who comes to the home regularly said she feels the care provided is very good. Visiting relatives commented on the “nice atmosphere” and said they are kept informed of any changes to their relative’s health. Time was also spent with the manager and a carer was interviewed in private. The lunch time meal was shared with the residents. A tour of the home was undertaken including viewing the communal areas of the home, toilets and bathrooms and a number of bedrooms. Some records were examined, including medication records, a sample of care plans and risk assessments, a staff recruitment file and training records. What the service does well: What has improved since the last inspection? Requirements made at the last inspection have been met, including amendments to the medication and abuse policies and procedures. Electrical installations have been checked and serviced. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 6 The menus have been revised in line with suggestions from residents. The number of days cooked breakfasts are being provided has been increased to five or six. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,5 Arrangements for assessing prospective residents’ needs prior to admission are good. However, care plans based on these assessments are not available for residents at the time of admission. EVIDENCE: The case files of two residents admitted in June and July were viewed and comprehensive assessments of need were seen, enabling the home to judge the suitability of the persons for admission. It is recommended that the preadmission needs assessment form includes a section on hobbies and interests. There were, however, no care plans available for either of these persons, which is unsatisfactory. One resident said she was able to visit the home first before making a decision to move in. Other residents spoken with confirmed that prior to admission, the manager and other staff visited them in their own homes or in hospital to talk to them about their needs and whether the home would be suitable for them. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The care planning system is generally clear and consistent providing staff with the information they need to meet residents’ needs. Personal care is provided in a way that promotes residents’ dignity and privacy. EVIDENCE: Other than residents admitted to the home within recent weeks, plans of care detailing the action needing to be taken by staff to meet a wide spectrum of need are in place and are being regularly reviewed. These include eating and drinking, personal cleansing, mobility, vision, hearing and hobbies and interests. Dependency profiles are also in place and reviewed monthly. This enables the home to identify and monitor when there is a deterioration in health or ability and take speedy action when necessary. Residents said that the home arranges for them to see their GP or other health care professional when the need arises, and records are available in support of this. Some residents are preferring to make contact with their GP themselves. Residents are now being weighed on a monthly basis. All staff who administer medication have had training, and have recently been awarded a “Certificate in Safe Handling of Medication” following assessment by nurses. A senior staff member said that the training has helped increase her Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 10 understanding and that she now has greater awareness of some of the risks associated with the control and administration of medication. The system for handling medication was examined and arrangements are generally being safely managed. A resident said she always “gets my medicines on time”. Any handwritten entries on MAR charts must be checked and countersigned by a second staff member, and all medication no longer in use must be returned to the pharmacy for disposal. All the residents spoken with said staff respect their dignity and privacy, and knock on their bedroom doors and wait for an answer before entering. One resident said staff respects her privacy when bathing “in every way”. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Routines are flexible, and a range of interesting activities are provided. The meals are good and offer both choice and variety. EVIDENCE: Residents said there are no restrictions in the home, with one saying “you can do what you want to do.” Staff were clear that residents have flexibility of choice with regards how they spend their days, including choice of when they rise and retire. An Activities Co-ordinator visits the home twice a week, and engages residents in a variety of activities, including for example, manicure sessions and a foot spa. One of the care staff said there is time mainly in the afternoons to spend chatting with residents or in other social or leisure activities. Entertainers visit the home from time to time. The residents’ notice board referred to a forthcoming visit from the Community Church singers. Residents said that their friends and relatives are always made welcome. This was confirmed by some visiting relatives. One resident said that the tea time meals have improved. The manager said she has consulted all the residents individually and in a Residents’ Meeting regarding the meals provided and that the menus have been amended Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 12 accordingly. Menus were seen and looked very interesting, varied and balanced. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected EVIDENCE: Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25,26 The standard of the environment is generally very good. EVIDENCE: A tour of the communal areas of the home revealed good decorative standards, and a sample of bedrooms seen were very comfortable and attractive, with good evidence of residents being able to personalise their rooms and bring in small items of their own furniture and other possessions. The carpet in room 18 was looking rather tatty and “ridged.” The occupant of this room said she is hoping for this to replaced., and this is a recommendation of this report. Parker baths and another type of assisted bath are available. The manager said that the home is exploring the possibility of providing a shower room, a facility one of the residents said she would like. Toilets are generally satisfactory, although two were noted as needing redecorating and brightening up. The premises was clean, hygienic and free from offensive odours. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The deployment and number of staff is sufficient to meet the needs of the residents. Recruitment procedures are sound, offering protection to the residents. Staff are well qualified and trained. EVIDENCE: Care staff turnover continues to be very low, providing consistency and continuity of care for the residents. In addition to the manager, two care staff and a senior carer are on duty during weekdays. Kitchen and domestic staff are in addition to these staff. Residents said that care when needed is provided promptly and staff said they do not feel rushed. This would indicate that staffing numbers are sufficient to meet residents’ needs. The file of the most recently appointed staff member was viewed and provided evidence of sound recruitment practice being followed. The majority of the care staff have either completed or are in the process of undertaking NVQ training, which is a very good achievement. The manager is very proactive in organising and providing a range of in-house training for the staff, including moving and handling, and a there is a designated room for the purpose. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32,33,38 Residents are benefiting from a well run home. EVIDENCE: The manager is very experienced and well qualified and since the last inspection has achieved the Registered Manager’s Award. She updates her training regularly, and has undertaken courses recently on dementia and medication. A clear sense of leadership and direction is being communicated. Residents said that the manager and staff are very approachable and a friendly and welcoming atmosphere was noted. Staff said they feel supported. All the care staff have had their annual appraisal recently. The manager said that a senior staff member is taking a lead role in staff supervisions. Resident feedback surveys are undertaken on an annual basis. No obvious health and safety concerns were noted. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 4 3 3 x x x x 3 Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 18 no 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 7 Regulation 15 Requirement Timescale for action 12/08/05 2. 3. 7 9 13 13 4. 37 26 A care plan based on the preadmission needs assessment to be available for residents at the time of admission. Risk assessments with regards to 12/09/05 individual residents to be available. With regards to medication: a) 12/08/05 handwritten entries on MAR charts to be signed and countersigned by two staff. b) medication no longer required to be returned to pharmacy for disposal. Regulation 26 visits to be 12/09/05 undertaken and copies of the reports of the visits to be sent to the commission each month. 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 3 14 Good Practice Recommendations The pre-admission needs assessment form to include hobbies and interests. The time of the last meal of the day to be reviewed in H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 19 Tynwald Residential Home for the Elderly 3. 4. 5. 6. 19 21 24 consultation with the residents. Toilets to be upgraded as part of ongoing rolling programme of redecoration and refurbishment. The provision of a shower facility to be considered as planned. Carpet to be replaced in room 18. Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tynwald Residential Home for the Elderly H56-H05 S23596 Tynwald V226228 120805 Stage 4.doc Version 1.30 Page 21 - 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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