Inspection on 11/12/07 for Tyrwhitt House

This inspection was carried out on 11th December 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tyrwhitt House 11/12/08

Tyrwhitt House 24/09/07

Tyrwhitt House 11/05/06

Tyrwhitt House 06/09/05

Tyrwhitt House 06/05/05

Tyrwhitt House 09/11/04

Tyrwhitt House 27/05/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Tyrwhitt House Oaklawn Road Leatherhead Surrey KT22 0BX Lead Inspector Kenneth Dunn Unannounced Inspection 11th December 2007 10:00 DS0000013365.V353260.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000013365.V353260.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000013365.V353260.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tyrwhitt House Address Oaklawn Road Leatherhead Surrey KT22 0BX 01372 841634 01372 841601 cmth@combatstress.org.uk 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) Ex Services Mental Welfare Society Mr Anthony John Letford Care Home 30 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (30) of places DS0000013365.V353260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th September 2007 Brief Description of the Service: Tyrwhitt House is a large detached Victorian property located on the outskirts of Leatherhead Surrey. The service is operated by the registered charity Combat Stress the Ex Services Mental Welfare Society. The home caters for ex-servicemen and women (veterans) with a mental health need, primarily post traumatic stress disorder. The home is set in extensive grounds and has ample car parking. There are 30 single bedrooms, kitchen, servery, dining room, a main lounge, smoking room and an equipped activities department There are no fees charged directly to the veterans or their families, where the veteran is in receipt of a war pension a charge of £106.00 per day is made to the awarding body. DS0000013365.V353260.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to inform this year’s key inspection process; to review findings on the last inspection (September 2007) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion. The inspection process took just under six hours, and involved meeting with the registered manager, nursing and therapy staff and the veterans. Mr Kenneth Dunn and Mrs Mary Williamson of the CSCI conducted the site visit. The inspection also involved a full tour of the building including bedrooms and all the communal areas, and the examination of a range of records. Random selections of veteran’s files were selected for case tracking. The inspectors would like to thank the veterans and staff for their time, assistance and hospitality during this visit and the service users, staff and relatives who participated in the surveys. What the service does well: What has improved since the last inspection? The service has undertaken a schedule of redecoration and recarpeting, phase one has been completed and phase two is expected be finalised on the 31st of March 2008. The construction work in the dining room has been completed and the veterans can enjoy eating in a more convivial and appropriate atmosphere. DS0000013365.V353260.R01.S.doc Version 5.2 Page 6 Health and safety issues highlighted by the previous site visit have been actioned to improve the safety of the veterans and the staff. The cleaning contract has been reviewed and new provisions have been introduced to ensure that the overall cleanliness of the service continues to improve. The use of communal rooms as ad hoc storage areas has been stopped and theses areas have been cleared and returned to their original use. 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. The summary of this inspection report can be made available in other formats on request. DS0000013365.V353260.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000013365.V353260.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 & 2 was assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to allow the veterans to make an informed decision about the service. All veterans are assessed using multidisciplinary assessments in order to allow the manager and the clinical team to identify and respond to their needs and aspirations. EVIDENCE: The Inspector sampled the homes Statement of Purpose and Service User Guide both documents were compliant with the elements of the National Minimum Standards. The statement of purpose contained sufficient information as to allow the veterans to make clear decisions as to the appropriateness of a stay at Tyrwhitt House for the individual. The inspector made a random sample of veteran’s files, which have previously been judged compliant with the elements of the National Minimum Standards, please refer to the previous inspection report 24th of September 2007. The random sample demonstrated that in the pre admission and assessment process at the service continues to be of a good standard. DS0000013365.V353260.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7and 9 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The veterans are involved in decisions about their lives, and play a central role in planning the care and support they receive. EVIDENCE: The inspector made a random sample of the veterans care plans, which have previously been judged compliant and met the National Minimum Standards, please refer to the previous inspection report 24th of September 2007. The care plans are person-centred and designed to enable health, personal and social care needs of each veteran to be addressed. Where limitations are in place, they were well documented and risk assessments are completed covering the individual, their activities and environments (on and off site), and consent forms. The records sampled confirm that the plans are reviewed regularly to respond to any changes in the needs of the individual. They focus on how the veterans DS0000013365.V353260.R01.S.doc Version 5.2 Page 10 can develop their skills and interests, and the therapeutic needs of each person. DS0000013365.V353260.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The veteran’s benefit by the support they receive to make choices about their life style, and to develop their life skills. Social, educational, cultural and recreational activities are seen as a high priority and are designed to raise individuals’ aspirations. EVIDENCE: Standards 12, 13, 15, 16 and 17 had previously been judged compliant and met the National Minimum Standards, please refer to the previous inspection report 24th of September 2007. The veterans are provided with a range of recreational, therapeutic and social activities. The service has developed a series of therapies to encourage and enable the veterans to engage with the rehabilitation offered at Tyrwhitt DS0000013365.V353260.R01.S.doc Version 5.2 Page 12 House. The veterans can join relaxation therapy, counselling, and trauma therapy groups to asset them to re-intrograte into their local communities. In addition to the therapeutic activities the service also encourages the veterans to participate in a number of social activities. A programme of activities was displayed on the veteran’s notice board and included swimming, boat trips and visits to historical sites. There was a positive relationship demonstrated between the staff and the veterans and there appeared to be genuine respect and positive interaction between them. The inspector received very mixed reviews from the veterans in respect to the meals provided by the service. One veteran stated that the food was not of a good quality while another one felt it was the best food he had since leaving the army, the majority of veterans asked felt that the food was of a good overall standard. DS0000013365.V353260.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, and 20 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that the veterans receive is based on their individual assessed needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Standards 18, 19 and 20 had previously been judged compliant and met the National Minimum Standards, please refer to the previous inspection report 24th of September 2007. Tyrwhitt House remains dedicated to the concept of the promotion and reinforcement of the veteran’s independence and to maximise their privacy and guarantee their dignity. The staff develops a treatment plan in conjunction with each individual at the point of admission to the home. There is a multi disciplinary approach to care and the veterans have access to a range of health professionals for example occupational therapy, relaxation therapy, counselling, anger and anxiety management, trauma therapy and DS0000013365.V353260.R01.S.doc Version 5.2 Page 14 group work. The veterans are supported to complete a full health questionnaire and emotional needs risk assessments are undertaken. The service operates a robust set pf policies and procedures for the safe handling, storage and administration of all medications. DS0000013365.V353260.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a fully accessible complaints procedure in place. The recording of complaints has been improved and staff training in safeguarding adults has been strengthened. EVIDENCE: A full set of policies and procedures are in place to ensure that any complaints received will be treated uniformly and within a set time and framework. The registered manager informed the inspector that there has been two complaints reported to him since the previous inspection visit, both are still active and are being investigated by the appropriate bodies. The CSCI have not been informed of any complaints since the previous inspection of the home. The home has an up to date copy of the Surrey County Council Multi Agency Safeguarding Adults Policy. In meetings with the inspector, staff invariably confirmed their commitment to challenge and report any abuse, should it occur. The inspector was provided with evidence of the training that has been undertaken by the service in respect to protection and safeguarding adults. The training matrix demonstrated that over 85 of all staff have received full adult protection training, the service has organised a mop up training session, which will occur on the 20th of December 2007 to ensure that the remaining 15 complete their training schedule. DS0000013365.V353260.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is now well maintained and offered the veterans a comfortable and clean environment to live in. EVIDENCE: The service has undertaken a schedule of redecoration and recarpeting. The inspector was informed that because of the overall size of the service the schedule of works has had to be split into two phases. Phase 1, which included the redecoration and re carpeting of areas such as the main entrance, Dining room and dining corridor, the games room, nurses station and so on. The inspector was informed that phase 2 would be embarked upon during January 2008 with an estimated completion date set for 31/03/2008. There has been a concerted effort to ensure that the levels of cleaning and hygiene have been improved throughout the service. The manager informed the inspector that the service management and the cleaning contractors are DS0000013365.V353260.R01.S.doc Version 5.2 Page 17 now working more closely to ensure that the cleanliness and hygiene levels stay at a high level. DS0000013365.V353260.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 were assessed during this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The professional staff are trained, skilled and in sufficient numbers to support the veterans, and to support the smooth running of the service. Recruitment practices require to be strengthened. The training in mandatory areas has remained an issue. EVIDENCE: A staff team that comprises of professional therapists and qualified nurses and the care team support the veterans. The professional teams are in sufficient number and in training and qualifications as to offer appropriate support to the veterans. The recruitment practises within the service however still remains an area of concern. A random sample of four staff files demonstrated that the service has still to implement a requirement from the previous inspection report date 24th of DS0000013365.V353260.R01.S.doc Version 5.2 Page 19 September 2007, requiring that the staff files contain all of the relevant documents as detailed in Schedule 2 of The Care Homes Regulations 2001. As a consequence the veterans could be at risk from abuse because there is no proof that members of staff are who the claim to be. The service has also failed to ensure that all mandatory and core training has offered and completed by staff, again this was a requirement from the previous inspection report. DS0000013365.V353260.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 41 and 42 were assessed during this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The veterans benefit by the management and administration of the home, which are based on openness and respect for its service objectives. A quality review is undertaken at the end of every stay at the service. There are failures within the record keeping and implementation of policies and procedures in the home. EVIDENCE: The processes for managing the home are accessible, transparent and there are clear lines of accountability within the home. DS0000013365.V353260.R01.S.doc Version 5.2 Page 21 The responsible individual carries out monthly quality visits (regulation 26) and copies of the report are made available to the Commission for Social Care Inspection. All veterans are requested to complete an exit questionnaire to feed back to the provider on how they felt that there time and treatment went at the service. During discussions with the registered manager and the responsible individual it was felt that the exit questionnaire was a good tool for the service to gage the levels of satisfaction the veterans felt that there stay at Tyrwhitt House and the therapy they received while resident at the service. However the questions were very heavily loaded towards the technical therapeutic benefits of the service and did not include the veterans families or any other significant others involved in the individuals treatment. It was felt that the service should develop the tool using a more holistic approach covering the care, support and environment. The collation and storage of information at the service still remains a issue as was mentioned on page 17 of this report and page 27 of the previous CSCI report dated the 24th of September 2007, staff file have still major gaps and omissions in them. DS0000013365.V353260.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X DS0000013365.V353260.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19(4)(5) Schedule2 Requirement Timescale for action 25/01/08 2. YA23 13(6) The registered person must ensure that all gaps of employment on staff application forms are explored and detailed. (Previous requirements 11/10/07 not met) The registered person must 21/12/07 ensure that the CSCI are notified upon the full and final completion of all staff undertaking up to date training in safeguarding adults. The registered person must 21/01/08 ensure that all staff working at the service receives all mandatory training. (Previous requirements 11/10/07 not met) 3. YA35 13(6) DS0000013365.V353260.R01.S.doc Version 5.2 Page 24 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 DS0000013365.V353260.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000013365.V353260.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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