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Inspection on 21/09/06 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 21st September 2006.

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

The home provides a pleasant comfortable and welcoming environment, residents are relaxed and settled, there are sufficient staff` to enable them to spend time with residents. Interactions observed between staff and residents were respectful, friendly and relaxed. Residents spoken with commented that " staff are very caring" "There`s always enough staff they`re very willing". "I`m quite happy here, there are some things I like, and some I don`t". Residents are encouraged to retain independence and their routines are flexible and in keeping with their own preferences, they report "staff would help if I asked, but I don`t need any at the moment". The home has supported the development and training of the kitchen staff who provide freshly cooked nutritious and varied menu choices, residents were complimentary of the portion sizes, variety and quality of the food on offer, the home were able to evidence regular surveys seeking residents views on meals provided. The home has surveyed residents to develop an active and varied range of activities. Visitors and residents reported that communication in the home was good.

What has improved since the last inspection?

A shower has now been installed for residents use. All care staff have now received adult protection training. The adult abuse policy has been amended to give greater clarity to reporting procedures. The home has made a clear separation in the recording of complaints and incidents. The garden gate is now being locked to provide additional security. Arrangements have been made for the independent assessment of the homes environment by an occupational therapist. Plans are underway for the upgrade of the library.

What the care home could do better:

Minor improvements are needed to improve systems already in place within the home, these are: Care plans would benefit from some consistency in the level of detail recorded on each, and in the manner in which plans are reviewed by individual staff` and how this is reflected on care plans. Handwritten changes on MAR sheets should be dated. Residents in receipt of PRN medications would benefit from the development of individual PRN guidelines to aid consistency of administration by staff. The home need to actively investigate why delays are occurring in the receipt of POVA first checks, risk assessments should be developed where POVA checks have not been returned and staff are employed in the home. Staff files would benefit from inclusion of current photographs. The home should make sure all written references have been received as a direct response to a request from the home and are addressed to the home manager. The home should make clear within fire records maintained that monthly tests of the fire alarm also incorporates visual checks of fire equipment and emergency lighting. The home will need to review the current accident recording system to ensure this is compliant with H&SE requirements and the DPA 1998.

CARE HOMES FOR OLDER PEOPLE Tynwald Residential Home For The Elderly Tynwald Residential Home For The Elderly Hillside Street Hythe Kent CT21 5DH Lead Inspector Michele Etherton Unannounced Inspection 21st September 2006 09:25a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tynwald Residential Home For The Elderly Address Tynwald Residential Home For The Elderly Hillside Street Hythe Kent CT21 5DH 01303 267629 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) The Alice Butterworth Charity Mrs Marie Elizabeth Rose Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (24) of places Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with a diagnosis of DE(E) are restricted to 3 whose DOB are 17/01/1919 and 30/04/1920 13th April 2006 Date of last inspection Brief Description of the Service: Tynwald was established as a charitable trust to provide residential care to twenty-four 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 homes 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. Fee levels for this service range from between £305 - £320 per week Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection-involved analysis of information and documentation received about the home including a pre-inspection questionnaire completed by the manager. The views of residents, relatives and Health and social care professionals have been sought through pre-inspection survey questionnaires, and responses received have contributed to the compilation of this report. An unannounced site visit was also undertaken as part of the inspection process and took place on 21st September 2006 between 9:25 am and 4:35 PM. During the course of the site visit, a tour of the premises was undertaken and time was spent in speaking with and observing individual residents and staff. A range of documentation was viewed during the course of the visit including care plans, assessment information, MAR charts, complaints, accident records, the fire book, staff recruitment, and some staff training and supervision records. All findings were discussed with the manager at the end of the site visit. Four recommendations for improved practice were made as a result of this visit. During the course of the site visit the inspector spoke privately with 7 residents and observed a number of others during a tour of the premises, four members of staff in addition to the manager were spoken with, feedback from these interviews has been incorporated into the report. The site visit highlighted that the home is maintaining a good to excellent standard of compliance within all outcome groups. All residents observed presented as relaxed and settled, they spoke positively of the home and staff with comments ranging from “This is the only home I’ve ever seen that lives up to what it says” “It’s a lovely environment” “there’s nothing we want for” “There’s always enough staff, they’re very willing” What the service does well: The home provides a pleasant comfortable and welcoming environment, residents are relaxed and settled, there are sufficient staff’ to enable them to Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 6 spend time with residents. Interactions observed between staff and residents were respectful, friendly and relaxed. Residents spoken with commented that “ staff are very caring” “There’s always enough staff they’re very willing”. “I’m quite happy here, there are some things I like, and some I don’t”. Residents are encouraged to retain independence and their routines are flexible and in keeping with their own preferences, they report “staff would help if I asked, but I don’t need any at the moment”. The home has supported the development and training of the kitchen staff who provide freshly cooked nutritious and varied menu choices, residents were complimentary of the portion sizes, variety and quality of the food on offer, the home were able to evidence regular surveys seeking residents views on meals provided. The home has surveyed residents to develop an active and varied range of activities. Visitors and residents reported that communication in the home was good. What has improved since the last inspection? What they could do better: Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 7 Minor improvements are needed to improve systems already in place within the home, these are: Care plans would benefit from some consistency in the level of detail recorded on each, and in the manner in which plans are reviewed by individual staff’ and how this is reflected on care plans. Handwritten changes on MAR sheets should be dated. Residents in receipt of PRN medications would benefit from the development of individual PRN guidelines to aid consistency of administration by staff. The home need to actively investigate why delays are occurring in the receipt of POVA first checks, risk assessments should be developed where POVA checks have not been returned and staff are employed in the home. Staff files would benefit from inclusion of current photographs. The home should make sure all written references have been received as a direct response to a request from the home and are addressed to the home manager. The home should make clear within fire records maintained that monthly tests of the fire alarm also incorporates visual checks of fire equipment and emergency lighting. The home will need to review the current accident recording system to ensure this is compliant with H&SE requirements and the DPA 1998. 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 DS0000023596.V306490.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 The overall quality of this outcome group is excellent. This judgment has been made using available evidence including a visit to the service. Residents have access to an excellent range of information about the home prior to admission, to help inform their decision making and make clear the terms and conditions of their stay. Residents seeking admission to the home benefit from a detailed assessment of their needs to ensure these can be met; these are reviewed regularly. Prospective residents and/or their families are provided with opportunities to visit and view the home prior to admission. The home does not provide an intermediate care service EVIDENCE: The home provides a comprehensive information pack to prospective residents that include information about the home and the terms and conditions of residence. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 10 Residents reported through direct discussion and survey feedback that either they or their family members had received the pack prior to their admission. The home operates a robust system of assessment for both prospective residents, and those existing residents needing re-admission following hospitalisation. Residents spoken with confirmed they had received an assessment of their needs prior to admission. An excellent range of assessment information completed by the manager was viewed during the visit; it was noted that this is not routinely completed in ink, the manager was reminded that for legal reasons this should always be the case and had agreed to ensure this is implemented immediately. The manager and the Trustees of the home have a clear understanding of the limitations of the service and actively seek interventions from health and social care professionals where needs can no longer be met within the home. Discussion with three relatives/friends visiting during the site visit confirmed that they or the client had visited prior to admission. A prospective resident was noted viewing the home at the time of the site and was observed receiving a pack of information about the home, and being advised by a staff member as to its contents. The home offers occasional respite when a long term vacancy arises until this bed is filled, but does not offer a formal respite service or an intermediate care service and is not resourced to do so Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Care plans provide an adequate level of information to reflect needs and inform staff, these would benefit from some consistency in the degree of information recorded and how reviewing of care needs is reflected. Service users are supported and enabled to access routine and more specialised healthcare. Medication administration within the home is managed in a safe manner. Service users feel their privacy and dignity is upheld by the attitudes and practice of staff EVIDENCE: Three care plans were selected to view. These provided an adequate level of information in respect of care needs, dependencies and risks; there was evidence of regular updating. Staff spoken demonstrated a good understanding of individual resident needs, and felt well informed of changes. Care plans would benefit from some consistency in the level of detail recorded by individual staff, as this varied, as did the manner in which the reviewing of Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 12 care plans was reflected in the plan itself, these issues were discussed with the manager and are recommendations for improvement. Residents interviewed spoke positively of the home, feeling that their care needs are managed appropriately, this view was shared by relatives spoken with during the site visit and survey feedback received from residents, care managers and relatives. Care plans viewed provided evidence of regular contacts by individual residents with a range of health professionals; this was confirmed in discussion with residents who spoke of access to routine and more specialised health appointments. Survey feedback from local GP’s and district nurse feedback indicated an overall view that the health care needs of residents are being met, the home undertakes assessment of risks in respect of skin viability, nutrition, falls and continence upon admission and this is kept under review, the district nurse indicated the home are quick to seek interventions as problems arise. Resident’s weights are recorded regularly. Feedback from GP’s surveyed indicated their view that medication within the home is being managed appropriately. A lunchtime medication round was partly observed during the visit and administration was undertaken satisfactorily. “Everything is done for you here, it’s a relief that they’re doing my medication” Medication Administration Records (MAR) sheets viewed indicated that medications received are being appropriately recorded on the sheets, codes used correctly and handwritten changes are being signed for by the relevant staff member, these should also be dated and this is a recommendation. The home has introduced basic medication profiles, and staff were noted explaining to some residents why they receive the medications they do. Residents in receipt of PRN medications would benefit from the development and implementation of Individual PRN guidelines to ensure consistency of administration by staff. Storage of medication is being undertaken in a satisfactory manner, improvements to the security of the medication trolleys was discussed with the manager and consideration should be given to the routine securing of both trolleys to the wall when not in use, in keeping with Pharmaceutical guidance. Staff’ were observed during the course of the visit chatting to service users, making themselves available and providing support where needed. Service users thought that staff understood their needs and supported them in a manner that was respectful and dignified. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 13 Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The overall quality of this outcome group is excellent. This judgment has been made using available evidence including a visit to the service. Resident’s views are listened to in the development of a varied range of activities. Residents are supported and facilitated to maintain links with family and friends and to exercise control and choice in their daily lives. Residents are consulted about the menus provided and benefit from a varied, nutritious range of cooked meals, in keeping with their needs and preferences EVIDENCE: Feedback from resident discussions and survey responses indicated overall satisfaction with the level of activities provided. The home independently surveys residents regularly to obtain their views about the service and activities provided. A monthly plan of activities is in place and each resident is provided with a copy of this timetable to access those activities that appeal to them. One resident reported that they had recently baked flapjacks, and also that armchair exercise classes had now restarted, the product of some gardening activities were also noted around the home. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 15 “There are lots of activities each week” “Nothing we want for here” “I’m quite happy here, there are some things I like and some things I don’t” “I haven’t really felt like doing much” Four relatives /friends were met with during the visit, residents and visitors reported that they found visiting flexible, relatives are made to feel welcome and the manager advised that visiting relatives can take a meal with their relative if they wish for a small charge. Two’ Religious services are held regularly by representatives’ from the community. The home takes a limited role in residents finances preferring the resident or their family to maintain control; the home does undertake to securely store small amounts of personal allowance money for some residents and records are in place to evidence income and expenditure of these monies. Service user spoken with confirmed that they had brought some of their own possessions and small items of furniture with them, the home maintains records of residents personal possessions where these are known to the home, and provides advice to residents and their families in respect of additional insurance cover if needed for more valuable items. Residents have lockable facilities within their rooms. The home has invested in the training of its kitchen staff team. Four weekly menus are in place and residents receive a choice of their main meal. The home undertakes to survey residents regularly to obtain their views about food quality and variety. Residents reported through survey responses and discussion at the site visit an overall level of satisfaction with the menu range and quality of food provided in the home. “Food is very good, too much for me” “We get a choice” “Food is perfect, no one will die of malnutrition here” Mealtimes are relaxed and are taken in a pleasant dining area; residents’ were excellently supported throughout their lunch by the presence of two care staff and two kitchen staff. Water dispensers are located around the home for service users to help themselves to drinks and staff’ were also noted reminding some residents to drink fluids, a small kitchen is available for residents assessed as able to make drinks and snacks for themselves. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Residents know their views will be listened to and acted upon and appropriate records of this are maintained. The home promotes and protects the safety of service users through it policies and practices EVIDENCE: The home has addressed a previous requirement to separate out complaints from incidents and this was evidenced in those records viewed at the site visit. Survey responses from residents and relatives indicated that residents know how to make a complaint and feel confident about doing so; residents reported in discussion that they had no complaints but had occasional gripes. They universally found staff approachable and were confident of being listened to. Complaints information is made available to all residents in their initial admission packs. Complaints information within the home has been updated to reflect the change of address for the local CSCI office. Minutes of trustees meetings viewed confirmed that all care staff have now received adult protection training. Three staff interviewed confirmed they had received training, a fourth staff member recently in post has not received specific but had covered some of this within initial induction. Staff spoken with Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 17 demonstrated a good understanding of adult protection issues and how this can be reported, three of the longer serving staff were aware of the local AP protocols. The home will need to ensure that adult protection features as a routine refresher course for all staff. A previous inspection requirement to amend the Adult abuse policy and procedure to clarify reporting procedure’s, has been addressed. Residents spoken with reported that they can do pretty much what they want and that there are few restrictions in place except those for their own safety. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Service users benefit from living in a safe comfortable and homely environment, they are enabled and facilitated to express their taste and interests within their own personal space and are assured that the home is maintained to a good standard of cleanliness, décor and furnishings. EVIDENCE: During a tour of the premises all communal areas, a sample of bathrooms and toilets, the laundry and three resident bedrooms with permission were viewed in addition to the gardens. The home was observed to be clean, tidy and odour free. The garden is very pleasant and accessible; consideration will need to be given as to whether decorative tiling on an exterior patio needs to have some remedial action to make this more even for residents to walk on. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 19 “Its lovely environment” “My room is okay” “It’s the only home I’ve ever seen that lives up to what it says” Pre-inspection information and copies of Trustees meetings minutes provided by the home indicated there is an ongoing programme of upgrading and repairs. The Manager advised that she works to a 5 yr plan for upgrading. The communal spaces viewed are furnished to a good standard with a comfortable range of domestic style furnishings and chairs in a range of sizes, there is a mix of utility and antique furniture, some carpets in hallways showed signs of staining here and there, the manager advised that they have a carpet shampooer which is used to tackle spillages etc. There are an adequate number of toilets and bathrooms, residents can choose from a shower or bath; several bathrooms have Parker baths to support residents in undertaking their personal care safely and comfortably. Arrangements are underway for an independent OT assessment of the premises to identify any shortfalls in equipment or highlight any accessibility issues. Bedrooms are a mix of small and large, none have en-suite facilities. Residents can bring with them furniture and furnishings if they wish or this can be supplied from a store of items owned by the home. Residents spoken with confirmed they had brought in items of their own and felt this enabled them to settle better. Each bedroom viewed is individually furnished and reflective of the specific tastes and interests of the rooms resident. The home is well lit within personal and communal spaces by a range of domestic lighting. Residents have access to natural light and ventilation through a mix of windows and French doors many of which were open during the site visit as the weather was dry and warm. The home is centrally heated. Emergency lighting is in place and tested regularly. The home undertakes checks of the hot water system for Legionella. Residents reported through discussion and survey feedback that the home is always kept very clean which they appreciate. Paper towels, liquid soaps and hand gels were noted in all washrooms, toilet areas and bedrooms viewed. The laundry area is small but discussion with staff indicated that they find it adequate to support the residents’ needs. Residents reported that they were satisfied with the laundry service, and always had clean clothes available to put on daily. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 20 Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Residents’ receive support from satisfactory levels’ of competent, qualified staff’ The home operates a comprehensive recruitment procedure that would benefit from minor improvements to ensure it is sufficiently robust to protect residents. A staff’ training programme is in place. EVIDENCE: Staffing levels are satisfactory for the current dependencies and numbers of residents. Residents reported that staff were always available, and spoke positively of staff support. “Always enough staff, they’re very willing”. “Staff would help if I asked, but I don’t need any help at present” “Staff are very caring” “staff are always approachable and very caring towards my father” Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 22 Staff spoken with said they felt relaxed and unrushed and that staffing was sufficient and flexible enough to allow them to spend time with residents. At times of increased pressure through resident illness staff reported that additional staffing cover is provided over a short-term period, thus enabling staff to spend extra time monitoring clients who are unwell. The home has demonstrated a commitment to the learning and development of staff and has achieved a 75 achievement rate for qualified NVQ2 and above qualifications. Three staff files were viewed. The Home routinely seeks two written references on all staff and supervises those without a returned POVA first check, the home are aware of the need for POVA first checks to be in place and have systems in place for this to happen unfortunately delays in processing by their umbrella body are occurring and the home is recommended to investigate and rectify these delays, where staff have commenced work in the home so as not to allow the service to suffer through inadequate staffing, the manager must undertake a risk assessment for each individual worker concerned and how the judgement on risk has been reached including the levels of supervision put in place by the home. Staff recruitment files viewed generally contained a good range of information in excess of schedule 2 of the care homes Regulations 2001, they would benefit from the inclusion of an updated current photograph of each staff member on file, this is a recommendation, as is the need for the home to ensure all written references received are directed to the manager and home in specific response to a request. Staff spoken with confirmed access to a number of updates for core skills training and the home has training booked for M& H updates in October. Induction training was noted in staff files viewed and the home has implemented the new skills for care induction standards and workbooks. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 The overall quality of this outcome group is good. This judgment has been made using available evidence including a visit to the service. Residents benefit from the knowledge, skills and leadership of a committed and competent manager, they and staff feel listened to and feel confident that their views are taken account of. The home has made progress in developing quality monitoring of some aspects of service performance against expectations of service users, this needs strengthening and a drawing together of other quality monitoring in place within the home. Systems are in place to safeguard service users financial interests. Staff performance, practice and learning are monitored through formal supervision and appraisal. Systems. The home promotes and protects the health safety and welfare of service users. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager demonstrated an excellent understanding of standards and regulations and the new IBL process, she demonstrated a sound knowledge and competency, she utilises new technology and has demonstrated a commitment to her own and other staff’ professional development. The ethos within the home is one of inclusion and staff and residents reported feeling listened to. Staff and residents reported that they found the manager approachable and accessible. Opportunities are made available for them to express their views through resident or staff meetings. Residents are routinely surveyed in respect of service quality and all new residents receive a questionnaire asking them to comment on the admission process and seeking suggestions for improvements. “Communication is good here” Staff spoken with felt they were able to express ideas and these are sometimes taken up. The home has limited involvement in the finances of individual residents but takes responsibility for managing some personal allowance monies held on their behalf, systems are in place to record income and expenditure from these allowances and regular audits are undertaken. Possessions brought into the home by residents are recorded in their files. Staff spoken with confirmed they are in receipt of supervision sessions, the manager was undertaking annual appraisals on the day of the site visit and these were noted in staff files. The home has confirmed within the pre-inspection information provided that all servicing and checks have been undertaken. An updated fire risk assessment was noted. The fire book was reviewed and the manager confirmed that all tests and visual checks of fire alarm and fire fighting equipment are undertaken on a monthly basis although currently this is recorded only as the alarm system, it is recommended that the home makes clear what is being tested or checked and records this. A review of the accident book highlighted a low level of accidents generally for each client. Accident records are well recorded and in some detail, their current format is not in keeping with that required by the Health and Safety executive to comply with the Data protection Act 1998, and it is recommended that the Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 25 Home consider changing the accident-recording book to one approved by H&SE. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 3 3 X 3 3 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 3 Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Consistency is needed in the level of detail recorded in each plan. Consistency is needed as to the manner of reviewing of care plans and how this is was reflected in each individual plan. Handwritten changes to MAR sheets should be dated. Residents in receipt of PRN medications would benefit from the development and implementation of Individual PRN guidelines to ensure consistency of administration by staff. 3 OP29 Home to investigate and rectify delays in processing POVA first checks by the umbrella body Home to evidence risk assessment for individual staff commencing work without POVA returned and how the judgement on risk has been reached, Current updated photographs of staff to be place on DS0000023596.V306490.R01.S.doc Version 5.2 Page 28 2 OP9 Tynwald Residential Home For The Elderly 4 OP38 recruitment files, All written references to be directed to manager or home as result of a specific request for a reference. Home to make clear within fire book what tests and checks are being undertaken monthly and to ensure they are recorded. Home consider changing the accident-recording book to one approved by H&SE. Tynwald Residential Home For The Elderly DS0000023596.V306490.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Kent and Medway Area Office 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 DS0000023596.V306490.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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