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Inspection on 03/01/06 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 3rd January 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

Residents were seen relaxed, cheerful and comfortable with staff, who were observed interacting with residents with attentiveness, respect and good humour. Comments from the residents spoken with included: "they`re all nice, the carers"; "staff will do anything to help"; "I`m well satisfied, here." Flexible routines are promoted in the home, with residents saying, "you`re free to get up when you want"; "I get up when I like, definitely". A varied, nutritious diet is provided in the home. Residents spoke positively about the meals provided, confirming that choices are offered, with alternatives always available when asked for. Visitors said they are always made welcome, and that their visits are encouraged by the home. A good system is in place to monitor whether there are sufficient night staff on duty.

What has improved since the last inspection?

Care plans based on the pre-admission needs assessment are available for residents at the time of admission. Risk assessments with regards to individual residents are in place. Hand written entries on MAR charts are signed and countersigned by two staff to ensure accuracy; and medication no longer required is being returned to the pharmacy.Two toilets have been upgraded and new carpets have been provided in the bedrooms of two residents.

What the care home could do better:

Whilst staff know what action to take in the event of any allegation or suspicion of abuse, staff would benefit from training in issues relating to adult abuse and the protection of residents. The written policy and procedure on adult abuse requires some amendment regarding reporting arrangements. Complaints and incident records need to be made separately to preserve confidentiality.

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 Julian Graham Announced Inspection 3rd January 2006 09:30 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.V262829.R01.S.doc Version 5.1 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.V262829.R01.S.doc Version 5.1 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.V262829.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with a diagnosis of DE(E) are restricted to 3 whose DOB are 26/02/1916 and 17/01/1919 and 30/04/1920 12th August 2005 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. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 09.30 and lasted around six hours. The majority of the time was spent talking with residents and staff. Lunch was spent with the residents. Two senior staff, the cook, kitchen assistant and one of the domestics were spoken with, and two care staff were interviewed in private. Time was spent with the manager and the chairman of the trustees. A District Nurse, two relatives and a representative of one of the residents were also spoken with. Some parts of the premises were viewed, and some paperwork looked at. What the service does well: What has improved since the last inspection? Care plans based on the pre-admission needs assessment are available for residents at the time of admission. Risk assessments with regards to individual residents are in place. Hand written entries on MAR charts are signed and countersigned by two staff to ensure accuracy; and medication no longer required is being returned to the pharmacy. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 6 Two toilets have been upgraded and new carpets have been provided in the bedrooms of two residents. 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 DS0000023596.V262829.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 the following standard(s): 3 Arrangements for assessing prospective residents’ needs are good. EVIDENCE: Two staff are involved in all pre-admission assessments, with records showing that comprehensive information is collected to assist the home in determining whether the person is suitable for admission. This information is translated into brief initial plans of care, prior to the development of more substantial care plans as the home gets to know the persons better and becomes more familiar with their needs. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 the following standard(s): 7,8,10 Care plans are clear and consistent providing staff with the information they need to meet residents’ needs. Residents are being treated with dignity and their privacy is respected. EVIDENCE: The kardex system of care planning is in place in the home, and a wide range of information to assist staff in providing the care residents need is contained in this document. In addition to the basic care plan outlining the action needing to be taken by staff to meet residents’ needs, in the areas of personal cleansing, social activities for example, there are assessments in place with regards to minimising the risk of pressure areas, moving and handling and other identified risks, such as falling out of bed. There was evidence of regular care plan review. Clear records are being maintained of when residents see their GP, the District Nurse and other health care professionals. Any concerns regarding the health of residents are noted, and suitable observation and direct action is taken. One entry read, for example, “ x is not quite herself this morning. Please observe.” A visiting District Nurse was spoken with, who referred to Tynwald as “one of Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 10 the best.” Staff alert her to any concerns promptly and follow any instruction given well. Fluids are readily available to residents throughout the day, and exercise sessions are taken up by most of the residents at least twice a week. All residents spoken with said that staff are very respectful to them and this was observed during the visit. Medication was not examined in detail on this inspection. However, staff were seen following safe procedures regarding the receipt of medication into the home, and MAR charts were in order. Medication no longer in use is being returned to the pharmacy for disposal, which was a requirement from the last inspection. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 the following 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. Maintaining contact with relatives and friends is encouraged. EVIDENCE: Residents who were spoken with said they are satisfied with the social and leisure activities on offer, and that there was enough to do. Some said they preferred not to join in any group activity, and that this is respected. The Activities Coordinator works two full days a week, and provides a range of activities’ including arts and crafts, taking residents to the shops and so on. On the day of inspection, residents were seen having a manicure. Foot spa and massage sessions were provided later in the afternoon. Several relatives and a representative were spoken with, all of whom confirmed they are made welcome when they visit, and feel satisfied with the care and service provided. One commented on the “friendly atmosphere.” Staff who were interviewed were clear that residents have rights to make choices in their lives, and gave examples of how this is being promoted in the home. These included being able to rise and retire when they like. Residents confirmed that the routines are very flexible, with one resident, for example, saying she sometimes prefers to have her meals in her room, and staff are happy to arrange this for her. One resident said that she likes to get up at 5 in the morning, and that the night staff assist her to do this. With one exception, comments from the residents Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 12 about the food were very favourable, with words such as “excellent” and “couldn’t be better” often used. One resident, in a comment card given to the inspector, was not satisfied with the food. This was discussed with the manager, who said the home is trying very hard to meet the needs and wishes of this person in this regard. Since the last inspection, there has been consultation with the residents regarding their preferred time of the last meal of the day. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 the following standard(s): 16,18 Residents know their complaints will be listened to and acted upon. Arrangements for protecting residents from abuse are satisfactory, although staff would benefit from training on abuse and the protection of residents. EVIDENCE: Examination of records showed that residents’ complaints are being taken seriously and handled appropriately. These records must be made separately, however. Residents said that they feel confident that staff would listen to them attentively if they were ever to have a concern or wanted to complain, and that suitable action would be taken. Both of the care staff who were interviewed privately, and one of the domestic staff who was spoken with, knew the action to take in the event of any allegation or suspicion of abuse, although they had not had any training on this matter. Training for staff on abuse is a requirement of this report. The policy on abuse also needs some amendment to ensure clarity regarding the need for all allegations of abuse to be reported to the relevant authorities without delay. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 the following standard(s): 19 The standard of the environment is generally very good. EVIDENCE: A brief tour of the premises was undertaken. The property is being maintained in a comfortable and homely way. Residents said they are very happy with their rooms, with those few that were seen on this occasion looking attractive and individually personalised. As recommended at the last inspection, two of the toilets have been brightened up, and the carpets in two rooms have been replaced. The premises was clean and hygienic and one resident said it is “plenty warm enough.” Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 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): 27,28,30 The deployment and number of staff is sufficient to meet the needs of the residents. Staff are well qualified and trained. EVIDENCE: Staff turnover remains very low, in turn providing continuity and consistency of care. Staff said there are no times when they are rushed, with one saying “you can’t rush the residents”. Residents said that staff respond to their needs, including when they need to ring the call bell, without delay. This indicates that sufficient staff are being deployed. The manager is closely and very efficiently monitoring the number of times residents need assistance during the night. This helps to ensure that there is the right number of night staff available. An ongoing training programme for staff is provided to enable them to maintain and develop their skills, and the majority either have a NVQ or will be commencing the training very shortly. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 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 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): 31,33,36,37,38 Residents are benefiting form a well run home. EVIDENCE: The manager, who is well qualified and experienced, is continuing to provide clear leadership and direction, to which both residents and staff are responding. Staff said the manager is very approachable, and that they feel very supported in their work. Staff confirmed that they receive regular formal supervision with either the manager or a senior member of staff. The manager is herself being well supported by the chairman and the other trustees who visit the home on a regular basis. The chairman has agreed to include within the minutes of the trustees’ monthly meetings, an account of the visits made by the trustees, including whether any problems were identified, to satisfy the requirements of Regulation 26. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 17 Resident feedback surveys continue to be undertaken on an annual basis, and a summary of the most recent one was seen. The manager was able to demonstrate the action taken to address issues that emerge from these surveys. Residents meetings are also held four times a year. Records seen were in good order. The pre-inspection questionnaire showed that appliances and systems are checked and serviced at required intervals. Environmental risk assessments and COSHH assessments were seen on the day of inspection. No obvious health and safety hazards were noted on this visit. Staff have recently completed a safety compliance course, and receive updated moving and handling training from the manager each year. Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 18 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x x STAFFING Standard No Score 27 3 28 4 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x x 3 3 3 Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 19 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. 1. 2. 3. Standard OP16 OP18 OP18 Regulation 17 19 13 Requirement Timescale for action 03/01/06 Complaints and incident records to be kept separately. All staff to receive training on 03/04/06 abuse. Abuse policy and procedure to be 17/01/06 amended to ensure clarity regarding reporting procedures. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tynwald Residential Home For The Elderly DS0000023596.V262829.R01.S.doc Version 5.1 Page 20 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.V262829.R01.S.doc Version 5.1 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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