Inspection on 06/05/05 for Tyrwhitt House

This inspection was carried out on 6th May 2005.

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

The inspector 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 6 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 11/12/07

Tyrwhitt House 24/09/07

Tyrwhitt House 11/05/06

Tyrwhitt House 06/09/05

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 Lisa Johnson Unannounced 6 May 2005 10.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Tyrwhitt House Address Oaklawn Road Leatherhead Surrey KT22 0BX 01372 841630 01372 841631 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ex Services Mental Welfare Society Mr Anthony John Letford Care Home 30 Category(ies) of MD Mental Disorder (30) registration, with number of places Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: MD Mental disorder ( 30) Date of last inspection 9 November 2004 Brief Description of the Service: Tyrwhitt is a large victorian house near Leatherhead. The home caters for exservicemen and women 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.The name of the registered provider is the Ex-Services Mental Welfare Society. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started at 10 am and finished at 4.15 pm and was the homes first inspection in 2005/2006. This visit was unannounced The first part of the inspection consisted of the inspectors talking to the manager of the home followed by a tour of the premises. The second part of the visit consisted of the inspectors talking to and having lunch with the Service users to gain their views of their life when they stay at Tyrwhitt House. The inspectors also spoke to members of staff and attended the homes staff handover. The inspectors looked at some of the documentation recorded in the house and these were the service users guide, the admissions schedule for the house, and the statement of purpose, care plans, risk assessments, medication records and staff rota. What the service does well: What has improved since the last inspection? Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 6 There has been an improvement in the procedure for the controlled medications. Medication stock in the cupboard was checked and found to be correct. The home carries out checks and records how much medication is left. Ventilation has improved in the shower rooms and some deep cleaning has taken place. There has been some internal alterations, which have made more space, for example one being that the television and pool table room have now been separated. The home has recruited some more staff. 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. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 & 4 Information provided by the home enables service Users to make an informed decision about admission to the home. EVIDENCE: The home has a detailed statement of purpose in place and a copy was provided to the Commission for Social Care Inspection. The statement of purpose gives clear information about the facilities, care and activities and support that the home offers. A copy of the service user guide was available to all Service Users accessing the service and his was evidenced in each individual’s room. The home provided evidence that each service user has an assessment prior to admission and a care plan is produced. The home offers only short-term treatment and the length of stay varies from between one and three weeks up to a maximum of six weeks in a year. There is a clear admission statement and a copy of the homes admission schedule was inspected which covered the period from 9-29th may2005. The home is registered for thirty beds, but on three occasions in May 2005 it was found that the capacity would be thirty-one. This means the home is not complying with its conditions of registration in respect of the number of service users accommodation. Therefore action is required to rectify this situation. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Individual care plans are in place and are detailed in information particularly focusing on mental health needs and therapeutic treatment and services Service users are involved in making decisions about their lives and provided with assistance where required. EVIDENCE: Evidence was available to show that service users individual plans reflected assessed needs Service users stated that staff were approachable and helpful And they felt that staff were willing to listen to any concerns that they may have. Although generally the service Users only stay at the house for short stays they felt that they were involved in some aspects of decision-making and regular service user meetings are held. However some Service users didn’t always feel that they could influence decisions made by senior management. Individual risk plans were examined and were included in the service users plan. Plans are agreed in consultation with service users who sign their agree plan. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12,13, 14, 15, 16 &17 The home is able to demonstrate that service users are given opportunities for stimulation through meaningful activities and leisure pursuits. EVIDENCE: As well as therapeutic sessions there was evidence that detailed activity plans were in place and they were displayed on notice boards in the home. On the day of the inspection a number of Service users had gone on an outing to the bluebell railway. The home has it own vehicle and service users have an opportunity to visit local amenities, such as attending the local town centre. Some of the Service Users attend the local Queen Elizabeth College to undertake courses and to attend the gym. There are number of activities available in the home for service users to access during their stay. Television and videos, Pool table, library, Computers, arts and crafts woodwork and cooking are available at the activities centre. On discussion with service users they were happy with the activities available. One Service user stated “I feel relaxed when I come here, I feel I can face the world again when I go home”. Another Service User said, “Coming here is like home from home”. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 11 There were a number of compliments and thank you cards seen on display at the home from both service users and relatives. However some service users spoken to were not happy that they were now not allowed to use the electrical tools in the workshop due to health and safety restrictions and they felt restricted by this. The inspectors spoke to the homes facilities manager who said this is being looked at and a requirement has been made that a report on the outcomes of the health and safety report is made available to the Commission For Social Care Inspection on completion. Service users stated that they were happy with the choice of meals available. On service user stated “I can help myself to snacks and drinks which are available throughout the day”. Lunch was observed being served and there was a choice of a hot meal and sandwiches. Fruit and yoghurt was available for dessert and the meal was presented well. The tables were laid with tablecloths and flowers and condiments were available. The service provides a group, which supports wives or partners of service users. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 & 20 At the time of this inspection the service users personal and healthcare needs were being adequately met. EVIDENCE: A comprehensive care plan is available for each service user, which covered in detail all aspects of health, personal and social care. The service provides a multidisciplinary approach to care at Tyrwhitt house. Therapeutic interventions are implemented based on assessment and the wishes of the clients such as counselling, occupational therapy, and group work and art therapy. The care plan is drawn up with the key worker and service user. The service liaises with the local GP if any of the service users should acquire any physical illness while staying at the home. A staff handover was observed and detailed information was handed over. It was evident that the staff had a good knowledge and understanding of the needs of the service users. The mediation records were inspected and accurate records were maintained. A record was kept of currently prescribed medication, some of the clients staying in the home administer their own medication and records were maintained based on risk assessments. The controlled drugs cupboard was inspected and stock was correct. A clear audit trail is now in place with weekly stock checks implemented. A Separate book, which is used by the service for stock checks in the home, was observed to have tippex on it and this practice must be stopped immediately. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 A complaints policy is in place. Service Users feel that the home manager and staff team listens to their views. EVIDENCE: The homes complaints procedure is available in the service user guide. The inspector’s spoke to the service users who stated they knew who they could approach if they had any concerns to discuss. Concerns were raised to the inspector in respect of not being able to access the electric tools in the activities room due to health and safety issues. From observation on this visit there was good rapport between staff and service users and staff were acting with respect. Service users stated that they really looked forward to their stay at Tyrwhitt house. Service users are given an opportunity to complete a form to inform the manager and the provider of the home how they found their stay. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 &30 The environment is appropriate to the needs of the service users and some progress in improving communal space had been made. EVIDENCE: Redevelopment of office and communal space has been completed. There is now a separate game and television room as well as another separate living room. This has created space to extend some of the office space. There is now a combined reception / nursing office near the main front door. However it was concerning that the reception windows were being kept open when staff are in the office making it difficult for staff to discuss confidential information. This situation must be reviewed. The home was clean and some deep cleaning had taken place in one of the shower rooms. However there is still some mould around the seals of the shower and the shower curtain needs replacing. Service users are able to bring personal belongings when they visit the house and have their own room. Specialist bathing and hoist facilities are available if required. Fire instructions are displayed around home but the fire door of the television room was found not to be shutting properly and a requirement was made that Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 15 this is urgently actioned. Furniture was found to be in good condition, but it was recommended that the armchairs in the television room be recovered. The home has extensive gardens and grounds, which are being maintained in good order. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 & 35 The staff team work positively with service users and have the necessary skills to support the service users in the home. EVIDENCE: The staff rota was examined and was found to be satisfactory. The service has recruited some new permanent staff that had been working in the home as agency staff. Due to the nature of the service that the home provides there is always a qualified mental health nurse on duty. Some of the care staff spoken to have completed NVQ Staff were clear about their responsibilities and evidence was available that staff have the opportunities to attend training to develop their skill. These range from mandatory training such as to training in managing aggression and counselling. As well as nursing and care staff the home employs therapists achieving a joint approach to the needs of the service Users. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40,41, 42 The home was observed to be running well with good interactions observed between the home manager staff and service users. EVIDENCE: The manager holds nursing and management qualifications. The manager informed the inspectors that he had just received a visit from the Health and Social Care Advisory Service (HASCAS) and are awaiting the outcome of an audit that was carried out. Evidence was available that services users were informed about this visit and its purpose and asked if they would like to participate. It was recommended that a copy of this report be forwarded to the Commission For Social Care Inspection when this is available. Service user meetings are held in the home and a complaints policy is made available. Good interaction was observed between the manager, staff and service users. A health and safety risk assessment is available but the new facilities manager who has come in to post is updating it. A requirement has been made that the Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 18 outcome of this assessment is forwarded to the Commission for Social care Inspection. The requirement for other procedures other then fire is still to be implemented. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tyrwhitt House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 x H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4)(c) Requirement It was a requirement that the procedures to follow in the event of an emergency situation, other than a fire, must be reviewed and a programme of training implemented to ensure that all staff are aware of the action to be taken in such circumstances. (Previous timescale of 11 January 2005 not me) It is required that the booking schedule for admissions is reviewed. The practice of using tippex on records must cease. It is a requirement that the problem with mold in the base of the shower is attended to and that the shower curtain is replaced. It is a requirement that the function of the nurses office and reception is reviewed and to ensure that confidential information is maintained on the service users. An action plan is to be presented to CSCI providing details on the outcome of this review. It is a requirement that the fire door is repaired. Timescale for action 1 month 06/06/05 2. 3. 4. YA1 YA10 YA27 4(1)(c) Schedule 1 17(1)(b) 23(2)(b) 2 weeks 20/05/05 Immediate 06/05/05 1 month 06/06/05 5. YA27 23(2)(a) 2 months 06/07/05 6. YA42 23(4)(c)(i ) Immediate Page 21 Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA42 YA39 YA24 Good Practice Recommendations A copy of the health and safety audit is to be provided to the CSCI specifically in relation to the use of electric tools in the actvities room. It is recommended that a copy of the H.A.C.A.S. audit is provided to CSCI. Consideration should be given to recovering the arm chairs in the television room. Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Tyrwhitt House H58-H09 s13365 Tyrwhitt House v224456 060505 Stage 4.doc Version 1.30 Page 23 - 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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