Inspection on 13/07/06 for Tyspane Nursing Home

This inspection was carried out on 13th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tyspane Nursing Home 28/05/09

Tyspane Nursing Home 08/06/07

Tyspane Nursing Home 20/10/05

Tyspane Nursing Home 09/06/05

Tyspane Nursing Home 23/02/05

Tyspane Nursing Home 03/06/04

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Poldhu

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Didsbury Court Rest Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Tyspane Nursing Home Lower Park Road Braunton North Devon EX33 2LH Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 13th July 2006 10.30 X10029.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 Tyspane Nursing Home DS0000026726.V293587.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 and 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. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tyspane Nursing Home Address Lower Park Road Braunton North Devon EX33 2LH 01271 816600 01271 818302 tyspane@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited 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) Mrs Susan Dawn Harris Care Home 69 Category(ies) of Old age, not falling within any other category registration, with number (58), Physical disability (11) of places Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 19/6/2000 That 11 places are provided for service users with a physical disability. That from 16 October 2003 when a room becomes available in the new designated wing it can only be occupied by a person who falls within the service user category of physical disability (PD) and when a room becomes available within the remainder of the establishment then it can only be occupied by a service user falling within the category of service users, old age, not falling within any other category (OP). That all service users who were accommodated with the service user category of PD as at 16 October 2003 who do not have a bedroom within the new designated wing will be offered a room when one becomes available before the room can be offered to any new potential service users. That all service users who were accommodated with the service user category OP as at 16 October 2003 who do not have a bedroom outside the new designated wing will be offered a similar room when one becomes available before the room can be offered to any new potential service users. As at the 16 October 2003 the home accommodated 58 service users with the service user category of OP which is 6 over the current maximum registered number for this category of service users. The National Care Standards Commission and future successor regulatory bodies will not seek to enforce the breach of this condition of registration subject to the registered provider using his best endeavours to achieve the transition within one year and not admitting any new service users in contravention of the conditions contained in this certificate of registration The total number of service users shall not exceed 69 in total. 4. 5. 6. 7. Date of last inspection 20th October 2005 Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 5 Brief Description of the Service: Tyspane Nursing Home is registered for 69 residents who may need nursing care, within the categories of old age (58 beds), and physical disability (11 beds for adults below retirement age i.e. ‘Adults 18-65’). The home does not offer intermediate care. It is a purpose-built, two-storey home, in a residential area of Braunton. It is relatively near the town centre facilities (including shops, a library, and public houses) and coastal areas. There is a regular bus service to the larger town of Barnstaple. The home has its own transport. Most bedrooms are for single occupancy only, and all have en suite facilities. Three rooms can be used as shared rooms if requested. There are two lifts giving access to all areas of the home. The home has a large lawned area at the front, and a car parking area to the rear. The home is owned by Barchester Healthcare Homes Limited. Weekly fees at the time of the inspection were £274 - £1517.56. These did not include the cost of theatre outings (a contribution is requested), taxis/transport, magazines/newspapers, toiletries, sweets, stationery, hairdressing and chiropody - which are all charged at cost price. Inspection reports produced by the Commission (CSCI) about the home are kept at the reception, in the home’s entrance hall. Prospective residents may also request a copy. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. There were 60 residents at the home on the day of this unannounced inspection. A CSCI pre-inspection questionnaire had been returned by the home. Completed CSCI surveys or comment cards were also returned from three residents, four care staff (some new, some longer serving, some day staff, some night staff), and eight community-based health or social care professionals. The inspectors, Dee McEvoy and Rachel Fleet, met at least 20 residents around the home. Some residents were too frail to give their views but the inspectors spoke with 11 residents (both men and women, including two younger adults) in some depth, as well as speaking with one visitor, 11 staff (including care/nursing staff, the chef, domestic staff and maintenance man), as well as the registered manager and her deputy, during the eight hours spent at the home. Staff files, minutes of meetings, quality assurance material, kitchen records and other records relating to health and safety were seen. The inspection incorporated ‘case-tracking’ of six residents, including a younger adult, a wheelchair user, frail or bedbound residents, new residents and a respite service user. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (medication sheets, etc.), talking with staff, and observation of care they received. Staff were also otherwise observed with residents for significant periods. The inspectors ended the visit by discussing their findings with Mrs Sue Harris, the registered manager, and her deputy Maria Coomber. Information gained from all these sources and from communication with the service since the last inspection is included in this report. The Commission has received two complaints about the home since the last inspection. Both were passed to the provider to investigate. One complaint related to adequacy of care of a resident who was admitted to hospital from the home with dehydration. This was partly upheld. The other was about a lack of basic supplies needed to provide personal care for residents and that staff did not answer call bells at the end of the night shift because they had to get residents up. This was not upheld, apart from where one room was found to be without some supplies. Action was taken promptly by the home to address the issues identified or to try to prevent them recurring. The inspectors followed this up during this visit. What the service does well: A resident said, “There is nowhere better.” Another said, “The food.” A community-based professional said someone who had respite at the home Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 7 found the activities and physiotherapy services good. Staff comments included caring for people well as individuals, meals, and entertainment. Prospective residents’ needs are assessed well, to try to ensure the home can meet the care needs of people who are admitted. Catering arrangements meet residents’ preferences regarding their dietary likes/dislikes, as well as social and medical considerations, promoting enjoyment of mealtimes and wellbeing. The environment is accessible, including to those with a physical disability; the accommodation is homely and well kept, with redecoration and refurbishment currently underway. Health and safety matters - including cleanliness and routine maintenance - are well attended to, protecting the welfare of everyone at the home. The staff as a team also have good knowledge and skills to ensure residents’ safety. Residents’ privacy is respected, promoting their dignity and rights. Regular and ‘ad hoc’ activities and arrangements provide opportunities for fulfilment, to enrich younger and older residents’ lives. This includes continued contact with residents’ families, friends and the community around the home, so residents benefit from supportive and interesting relationships. The manager has the knowledge and experience to ensure the home is run well, and run in the best interests of the residents. Complaints are listened to, with residents getting a satisfactory response to their suggestions, concerns or complaints. Various policies and practices are used to try to protect residents from abuse, including good recruitment procedures. A variety of quality assurance strategies are used to ensure that residents and staff can influence the service’s development. What has improved since the last inspection? What they could do better: Two residents said there was nothing the home could do better; one adding it was perfect. Staff comments included meal times, and provision of more “sliding sheets” for use at night, to move residents comfortably and safely in bed. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 8 Detail in some care plans must be improved to ensure consistency and delivery of appropriate care. There is good co-working with other professionals, which helps ensure many health needs are met; but other needs are less well addressed - which will affect the more vulnerable residents’ wellbeing. Staffing must be reviewed and staff deployed appropriately, to ensure residents’ rights to choice, good care and safety are promoted. Training and support for staff is adequate, but residents would benefit in the longer term if all staff had up-to-date knowledge and skills needed for caring for younger adults with physical disabilities. 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. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) 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 (The home does not offer intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Good systems are in place to ensure prospective residents’ needs are fully assessed, promoting the success of admissions to the home. EVIDENCE: All surveys from residents said they received enough information about the home before moving in so they could decide if it was right for them. And they had received contracts, which protects their rights. Each room has a copy of the home’s statement of purpose, to ensure that they can be aware of the services offered. The majority of residents spoken with were happy with their choice of home; several had visited before moving in or knew of the home Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 11 because they had lived locally before admission. Relatives had chosen the home for some residents. Comments from residents included, “ I am very happy here” and “Everyone here is kindness itself”. Staff surveys said they had not been asked to care for people outside of their area of expertise, suggesting the home admits people appropriately. Staff spoken with confirmed this, and said they were informed of residents’ needs before they are admitted. A resident confirmed the manager had visited them before their admission to assess their needs. The assessment format used is comprehensive, and two were completed with sufficient detail to enable staff to develop care plans and meet needs. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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 – 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There are systems in place for informing staff about residents’ care needs, but poor levels of detail in some care plans may lead to inconsistencies in care and a risk that some residents may not receive all the care they need. Multidisciplinary working ensures that most health needs are well met but some are only adequately addressed, which will affect vulnerable residents’ wellbeing. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 13 Management of medication is good, with practices in place that promote residents’ safety. There is good respect for residents’ privacy, with promotion of their dignity and rights. EVIDENCE: Care plans for two long-stay residents were good, reflecting the needs of the residents but the care plan for a resident staying for respite was less well developed and did not ensure that all aspects of health, personal and social care needs were identified and planned for (- refer to standard 3). Three other care plans did not have much to inform staff about past interests, social needs, how to maintain their wellbeing, etc.; one staff also commented about a lack of social history provided for new residents, though another felt communication about needs and preferences was good. All care plans had moving/handling plans, to help ensure safe movement or mobilisation of residents. Some residents were aware of their care plan; others were not and could not remember being consulted. Most reviews were regular and recent, but generally consisted of a date and signature, with no detail of or reflection on care provided. Most health care needs are well addressed, and residents said they got the medical support they needed, including specialist help. Two residents described how their health had improved since moving to the home. A resident said the doctor had been consulted when they began having falls. Records showed input from health professionals such as psychiatrist and nurse specialists. Surveys from community-based health or social care professionals said the home works in partnership with them, and specialist advice was incorporated into care plans. The home employs a physiotherapist; one resident living on the younger adults unit said this was a very valuable service. One resident was at risk of dehydration and urinary tract infection, but goals for daily fluid intake were not set, and their fluid intake record was not well kept. Staff confirmed the resident had had a drink that morning, but the record once completed showed total fluid intake had been poor. A complaint since the last inspection included concerns about adequate fluid intake. One resident on a soft diet, which suggested they had special dietary needs, did not have a nutrition risk assessment in their care records. A care plan indicated a resident should be weighed monthly, but they had not been weighed since March 2006, and weight was not reflected in evaluations of the care plan. Use of potential restraints (such as bedrails or wheelchair lapbelts) was recorded if used, including the resident’s view where possible. But one seen did not include time limits for using a lapbelt; time limits should be indicated, to minimise risk to the resident’s welfare caused by restriction of movement. Care records lacked detail for one resident with a skin wound, with little evidence of monitoring its progress, etc. A resident said they got their medication at the right intervals; two others were generally satisfied also. Relevant community-based professionals thought Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 14 residents’ medication was appropriately managed, as found at the inspection. There is safe storage. Disposal of some unwanted medicines is satisfactory; the manager is looking into disposal of controlled drugs, to ensure safe procedures are in place in the long term. Medication administration charts were looked at for three residents; where hand written entries are made, two staff sign and date to ensure accuracy and accountability. One chart had not been completed where medication was due on some occasions; this was brought to the attention of the nurse and the manager. Medicines with a limited shelf life once open had been dated to ensure efficacy. The residents spoken with, with the exception of one, were full of praise about the care and attention they received, although some acknowledged the pressures staff were under at times (also referred to elsewhere in this report). They confirmed staff respected their privacy, saying they were respectful, polite, helpful and kind. During the inspection, they attended to residents in a respectful, sensitive and responsive manner, many interactions demonstrating that staff had a good understanding of individuals. Community professionals said they could have privacy with residents. The manager has taken steps, since the inspection, to ensure residents’ privacy is maintained when they are using one bathroom with a door that opened into a hall area. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for fulfilment, to enrich younger and older residents’ lives. Good links are maintained with residents’ families, friends and the community around the home, helping to ensure residents benefit from supportive and interesting relationships. There is adequate promotion of choice and control for residents, but these rights are sometimes affected by limited staff availability. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 16 There are good catering arrangements that meet residents’ tastes, as well as their social and medical needs. EVIDENCE: Residents’ surveys said there was usually or always activities arranged by the home that they could take part in. Several residents described the activities co-ordinators as “fantastic” or “marvellous”. They said a programme of events was delivered to all bedrooms. They enjoyed outings, pantomimes and Old Time musicals, regular swimming, fetes, quizzes, Bingo. A number of residents enjoyed the regular church service, held during the inspection. The activities co-ordinator and her assistant work very hard to provide a varied and interesting programme of activities for residents, but were keen to develop further activities, particularly for evenings and weekends. A staff said that a resident who didn’t want to leave their room was happy for staff to leave the bedroom door open so they could hear the musical entertainments, etc. from their room. Younger adults are able to take part in age and peer appropriate activities. The inspectors were told that the kitchen on the younger adults unit was “rarely” used, but that this will be developed to enable residents to increase independent living skills. One resident had their own computer. Residents said their visitors were made to feel welcome at the home, one saying their spouse was invited to have lunch with the resident when visiting. One resident said they enjoyed “the frequent bus trips”, which are to local places of interest, local shops and other amenities. On the day of the inspection, the home had organised a coffee morning for 15 friends of a younger resident. One younger adult praised the manager for enabling them to achieve their goal and described how they had been supported to make personal decisions. Information about ‘Age Concern’ services was outside the dining room, and there is a file of information on advocacy services, which is brought to the attention of prospective residents. Discussions with some residents indicated that staff were not always able to support residents’ rights to make choices. Staff said people were asked about their preferred bedtime and rising time on admission, although one resident said they couldn’t get up when they wanted and had to wait to get up. More able residents felt that they could make decisions and choices on a daily basis, but three commented that they thought this was not the case for less able residents. Barchester Healthcare Ltd. has a new ‘Cooking with care’ initiative, which aims to provide a “nutritious and delicious” diet for residents. Residents’ surveys Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 17 said they usually or always liked the meals at the home. Most residents spoken with described the food as ‘good’ or ‘excellent’; one said it was ‘brilliant’, one said, “Some days it’s good, some days not so good”. Several praised the new chef for his efforts. Kitchen staff were aware of residents’ dietary needs and preferences. Special diets such as diabetic, gluten-free, soft or pureed are catered for. All residents spoken with said there was always a choice; several said they could request things that were not on the menu. The lunchtime observed did not give rise to any concerns. Tables were set nicely before the meal; staff sat with some residents, giving unhurried assistance. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good attitude to complaints, with residents getting a satisfactory response to their suggestions, concerns or complaints. There are good safeguarding policies and practices in use, to try to protect residents from abuse. EVIDENCE: Residents’ surveys said they always or usually knew who to speak to if they weren’t happy - one adding they were “always given a sympathetic hearing”. All residents spoken with reflected this; they felt that their concerns would be listened to and acted upon by the manager. No complaints were raised during the visit. The complaints record kept by the home showed complaints were resolved in partnership with complainants, with appropriate investigations undertaken. One complainant spoken with was now very satisfied with the home. The written complaints procedure seen at the reception desk has now been amended to include contact details for the local CSCI office, since these were missing. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 19 Residents felt safe at the home and generally well cared for. Staff surveys said staff had been told not to accept gifts or money from residents, and said they were aware of adult protection procedures. Nursing staff and care staff spoken with had received adult protection training, although one said this was part of the care course they were doing, which wouldn’t necessarily include local procedures. They could describe various types of abuse and how they would deal with any concerns. The manager said information had also been included with each staff’s payslip recently, ensuring everyone got it. One staff said they were confident the manager would act to deal with any allegation of abuse if she were told about it. The manager has informed relevant authorities, including CSCI, when there have been allegations of abuse. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good, accessible, well-maintained and homely accommodation. Systems are in place to promote good standards of hygiene, protecting residents’ wellbeing. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home is generally well maintained and adapted environment for residents, with various aids and facilities such as level access, passenger lift and grab rails. Several residents using wheelchairs were seen to manoeuvre themselves independently around the home. Residents spoken with were happy with the general environment and their personal accommodation. A resident said there was a homely atmosphere. One bedroom needed some re-painting, but this to be attended to shortly as part of a rolling programme of refurbishment. Residents confirmed minor repairs are done promptly, one noting this is also so at weekends if necessary. Rooms seen were personalised with pieces of furniture, pictures and other sentimental and personal items. Lounges are provided within the younger adults’ wing on the first floor and on the ground floor. There are good views from the home - the gardens were looking lovely, and some residents told the inspector that they particularly enjoyed the gardens, even though some chose not to sit outside to use them. One staff survey said air conditioning would be appreciated. This was in place by the time of the inspection. Areas used by residents looked clean, orderly and were generally free of unpleasant odours, with residents confirming this was always or usually so. One bedroom was odorous, and the manager said she would get this addressed, once she was aware of it. Flooring in one sluice was damaged, which would affect ability to keep it clean. The manager said this is due to be replaced this financial year, and also that some bathrooms are to be refurbished during the rolling programme. Domestic staff spoken with had received relevant training, and said that they had the equipment and materials to do their work properly. The laundry is well equipped and organised. A staff member working in this area was aware of the system to use to maintain infection control. One resident felt the laundry service was particularly good, they said, “Everything comes back fresh and nicely ironed”. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Poor staffing arrangements within the home are affecting the care and safety of a number of residents. The staff as a team have good knowledge and skills to guide practice and ensure residents’ safety. Residents are protected by the home’s good recruitment policies and practices. Training and support for staff is adequate, but longer term meeting of residents’ needs, including changing needs, would be better ensured if all staff had up-to-date knowledge needed for caring for younger adults with physical disabilities. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 23 EVIDENCE: All residents spoke highly of the staff; comments included, “They work so hard”, “Staff are wonderful here” and “I can’t praise all staff enough”. A relative didn’t voice any concerns about care of the resident they were visiting. A bedfast resident on the ground floor said staff popped in regularly, didn’t rush and were very gentle when giving care. Another resident on this floor, when asked what the home did well, said, “The care, within the limits of the staff”, feeling there were not enough staff given the dependency of some residents and for contingencies. Three residents said they could get prompt attention from staff, but felt that less vocal and less able residents had more difficulty. Residents’ surveys said staff were always or usually available when they needed them. However, when residents and staff on the first floor were asked what could be improved at the home, the majority spoken with said ‘staffing levels’. Residents described waiting for attention, as also noted by community-based professionals; one resident said they ring their bell and “just lie back and wait”. The home and CSCI have, since the last inspection, received complaints that included slowness in answering call bells. In some cases, residents said staff switched off their bell, saying they would be back ‘in a minute’, which could be anything up to 20–30 minutes. Two residents on the first floor said that staff had no time for a chat and were always busy. Staff said they often felt frustrated at not being able to spend more “quality” time with residents; one felt more residents had confusion, and thus needed more time from staff. On the day of the inspection some residents on the first floor were still being assisted to get up, washed and dressed at 12.45pm. The inspector was unable to speak with care staff until lunchtime. Staff told the inspector that up to 22 residents on the first floor needed the support of two staff for personal care and safe moving and handling. One night staff survey said they didn’t feel they had enough support to do their job well. This was because they felt staffing levels at night were inadequate, saying there were three staff to care for 39 residents. They also said time was wasted looking for colleagues around the rooms, suggesting indicator lights outside rooms could quickly identify where staff were. The manager said that at least one staff is rostered to start work at 7am - earlier in the day than the rest of the morning staff - to help residents wanting to get up then. She also said an extra staff member is on duty in the evenings until 8.30pm, to help with this busy time of day. Of recent accidents, more had occurred on the first floor. One resident ‘casetracked’ during the inspection on the first floor did not have an adequate fluid intake. Two staff working on the ground floor during the inspection said they worked on both floors over time and didn’t mind where they worked, but both indicated that working on the first floor was more demanding. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 24 Senior staff said the day of the inspection was not a typical day, and that the day before had been different, with time even for some staff training. They also said staff had some choice as to where they worked, and did not always choose the lower floor, tending to rotate weekly instead so they remained familiar with all the residents and their needs. The pre-inspection questionnaire indicated that just over a quarter of care assistants have a recognised care qualification, with another quarter working towards it (some having almost completed it). There is always a minimum of two nurses on duty, to supervise care. The manager checks each nurse’s registration status yearly, with the regulatory body, to ensure they are still allowed to practice as a nurse. Community-based professionals said staff demonstrated a clear understanding of residents’ needs. Staff surveys showed appropriate recruitment procedures were followed, with staff files well kept. Information in four files showed initial police checks and other required information is obtained before staff start working at the home; all had previous care experience. The manager confirmed new staff are supervised until the full CRB disclosure is received. Residents’ surveys said they usually or always received the care and support they needed. A resident commented, “The nursing staff are well trained and the rest of the staff are very attentive and loving.” Staff surveys said all had had an induction. One newer part-time staff said they had not had supervision; the manager said everyone would be getting their annual appraisal in due course. Staff felt the home provided plenty of relevant training, although some is attended on “days off”; a part-time staff said they were offered as much training as other staff. There has been some general training for staff around the needs of younger adults since the last inspection regarding one medical condition and communication. Some staff said that there is no “separate” staff group for the younger adults, who might develop specialist skills in caring for these residents. The manager said there is a core group who do always work with the younger adults when on duty. She also said that staff work individually with the employed physiotherapist and with occupational therapists from the primary healthcare trust, to learn more specifically about individual residents’ needs and how to meet them. She agreed to record this training in future, so as to have an overview of specialist training, training needs of the team, etc. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has good knowledge, skills and experience to ensure the home is run well. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 26 There are good quality assurance arrangements in place, ensuring that residents and staff can influence the service’s development. Good systems and practices used by the home protect residents’ financial affairs. There is good attention to health and safety matters, protecting the welfare of everyone at the home. EVIDENCE: The manager has the Registered Managers Award, is a Registered General Nurse, and has managed the home for three years. She has kept up-to-date on various health and safety topics, and safeguarding of vulnerable people. She is undertaking a course on dementia, along with other staff, which includes environmental considerations. She confirmed she has regular formal supervision with her manager. All residents and staff spoken with spoke highly of the manager and her interpersonal skills. She was described as approachable, supportive, and very helpful; a resident said “She has time for you, and has a lot of patience”. The majority of staff asked felt valued by her. She operates an ‘open door’ policy and residents and staff have free access to her. The manager is well organised, and all the information required to undertake this inspection was readily available. A notice outside the dining room informed of an imminent residents’/relatives’ meeting. The manager said she asks residents individually in advance if there is anything they wish her to raise on their behalf. A resident said these meetings were usually about information-sharing rather than ‘complaining’. Satisfaction questionnaires, which have been sent to residents recently covered various areas such as food, activities and staff. Responses seen were generally positive; results will be collated into a report for residents - the manager discussing results at future residents’ meetings - and other interested parties. One resident said the home was run as a partnership between residents and the staff, rather than ‘run for the staff’. Staff spoken with said there were always sufficient supplies or stocks of items needed to care for residents properly. Personal monies records were computerised and well kept. No personal monies are kept at the home now – residents being billed in arrears instead, with payments made by the home initially. A monthly invoice or statement is sent to each person, or their ‘Power of Attorney’. If they have a query about transactions recorded, receipts can be viewed or copies sent on request; some were checked as part of the inspection. Receipts are given to residents if they give money into the office or had money returned to them; two staff signed these. Money handed in is paid into a bank account used solely for residents’ Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 27 monies. The administrator said records were audited by staff from headquarters; although it was not clear how frequently this was to happen. The provider’s representative has sometimes carried out checks, on their monthly unannounced visits that are required by regulation. Health and safety within the home is well managed. Staff felt it was a safe working environment and confirmed they had had relevant updates, with the training programme seen including various aspects. Satisfactory servicing and maintenance records were seen, including gas and electricity safety certificates and for the call bell system. On the day of the inspection an outside contractor was visiting to test the water for Legionella. The maintenance person has received training necessary to undertake his responsibilities, and is well organised, keeping clear records of maintenance undertaken. He confirmed that window restrictors were fitted to all first floor windows to prevent falls and these are checked regularly. Fire safety was good, with equipment serviced and checked regularly. A resident said the fire bells had been tested that morning. Hot water temperatures are controlled to prevent scalding. A new kitchen is being fitted in a few weeks and the home is well prepared for the inevitable disruption this can cause. The standard of hygiene in the kitchen was good; fridges and freezers were clean, tidy and regular temperatures are kept to ensure safe storage of food. Senior staff were fully aware of new food hygiene legislation. Exposed central heating pipes were seen in one toilet, which might present a burn hazard if some one fell against them when the heating was on. The manager said these would be included in the current refurbishment programme. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 28 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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) & (2) Requirement (a) Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. The registered person shall (b) keep the service users plan under review; (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users plan; and (d) notify the service user of any such revision. This should also include evaluations that are sufficiently detailed as to identify when the care plan needs revising. Timescale for action 15/08/06 Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 30 2. OP8 12(1) The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. Including that individuals’ care plans are sufficiently detailed regarding nutritional screening, any hydration needs, monitoring & description of any wounds, and use of potential restraints. 15/09/06 3. YA33 18(1)(a) You must, with regard to the size 31/08/06 of the home, the number & needs of the residents, ensure that at all times suitably qualified, competent & experienced persons are working at the care home in such numbers as are appropriate for the health & welfare of residents. This is especially regarding adequate staffing levels to ensure residents’ safety and overall wellbeing. Previous timescale of 31/01/06 not met. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 31 4. OP27 18(1)(a) You must, with regard to the size 31/08/06 of the home, the number & needs of the residents, ensure that at all times suitably qualified, competent & experienced persons are working at the care home in such numbers as are appropriate for the health & welfare of residents. This is especially regarding adequate staffing levels to ensure residents’ safety and overall wellbeing. Previous timescale of 31/01/06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP14 Good Practice Recommendations It is recommended you should include individuals’ social care needs in their care plans. It is recommended you should conduct the home so as to maximize service users’ capacity to exercise personal autonomy and choice, by ensuring there are sufficient staff to enable this. It is recommended all staff receive equal opportunities training, including disability equality training, and other training specific to younger adults’ needs, so that service users’ joint needs are met by appropriately trained staff, staff fulfill the aims of the home and meet the changing needs of service users. 3 YA35 Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. Tyspane Nursing Home DS0000026726.V293587.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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