Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 20/10/05 for Tyspane Nursing Home

Also see our care home review for Tyspane Nursing Home for more information

This inspection was carried out on 20th October 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Some residents appreciated that staff had a sense of humour, describing them as `polite but cheerful`, and `jokey, lovely girls`. Someone who had had been at the home some time said they could see an improvement in the home, and were satisfied with the situation at the home now. Another person, who had lived at the home some time, said `Things are better now`. Residents have opportunities to undertake a variety of activities and events, both within the home and in the surrounding community. The meals provided are good, catering for individuals` needs and preferences. The home is adapted to promote residents` independence, and there are good standards of cleanliness. There is an ongoing programme of refurbishment and improvement of the environment. Residents benefit from good staff recruitment practices, and a very active approach to staff development. Health and safety matters are well attended to. Staff felt there is good team-working, and support from senior staff.

What has improved since the last inspection?

There is evidence that more residents (or their representative) are being involved in planning their care. And care plans are more detailedAspects of medication systems have been improved. Staff have had training regarding protection of vulnerable adults, reporting of abuse, etc. A kitchenette has been created in the first floor lounge for younger adults, with appropriate adaptations. Some bedroom carpeting and furniture have been renewed. A treatment room has been provided, and a new fire panel has been fitted.

What the care home could do better:

Social and recreational needs of prospective residents were not as well described as other needs, though were more fully assessed after admission. In order to assure prospective residents the home can meet their needs, these should be included in assessments prior to admission. There is a good care planning system in place. However, some care plans (including evaluations of care) need more detail to ensure needs are identified, and that staff are fully informed of residents` needs and how to meet them. For example, by recording social needs and monitoring residents` weight regularly. Medication systems are generally well managed, but medication in unlocked facilities must not be left unattended. Action has been taken to try to protect residents from abuse. However, staff should be made familiar with local written policies. Staff must be managed so as to ensure residents` safety and overall wellbeing. And staff training should include different communication skills and some other topics specific to current residents` needs. Measures are needed to ensure residents` personal monies kept by the home are correctly managed.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Tyspane Nursing Home Lower Park Road Braunton North Devon EX33 2LH Lead Inspector Ms Rachel Fleet Unannounced Inspection 20th October 2005 09:50 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.V253435.R01.S.doc Version 5.0 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.V253435.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tyspane Nursing Home Address Lower Park Road Braunton North Devon EX33 2LH 01271 816600 01271 812409 tyspane@barchester.com 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) Barchester Healthcare Homes Limited Mrs Susan Dawn Harris Care Home with Nursing 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.V253435.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That 11 places are provided for service users with a physical disability. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 19/6/2000 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 That the registered provider will provide a temporary quiet area for the OP service users from the 16 October 2003 and that a new permanent quiet area will be provided by the 30 April 2004. The total number of service users shall not exceed 69 in total. 4. 5. 6. 7. 8. Date of last inspection 9th June 2005 Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 5 Brief Description of the Service: Tyspane Nursing Home is registered for 69 service users within the categories of old age (58 places) and physical disability (11 places), which includes adults aged 18-65years. Barchester Healthcare Homes Limited owns Tyspane. It is a purpose built twostorey home, in a residential area of Braunton relatively near to the town centre facilities. These include shops, a library, and public houses. There is a regular bus service to the larger town of Barnstaple. Most bedrooms are for single occupancy only, with en suite facilities. However, three rooms can be used as shared rooms if requested. There are 2 lifts giving access to all areas of the home. The home has lawned areas at the front, and a car parking area at the rear. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors Dee McEvoy and Rachel Fleet were at the home for seven hours. There were 64 residents initially, one being discharged home during the day; six were younger adults. The inspectors spoke with 14 residents in some depth, as well as meeting others around the home. CSCI comment cards were returned by four residents and three relatives/visitors. The inspectors also spoke with one relative and 12 staff - care assistants, administration staff, etc. - and looked at documentation. Six care plans were checked – for two younger adults and four older adults with a range of needs. Finally, findings were discussed with Sue Harris. All residents spoken with were generally happy with the care. Positive comments were made about Sue Harris, the manager – including “Sue is superb”, and “The manager listens, and is helpful”. What the service does well: What has improved since the last inspection? There is evidence that more residents (or their representative) are being involved in planning their care. And care plans are more detailed. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 7 Aspects of medication systems have been improved. Staff have had training regarding protection of vulnerable adults, reporting of abuse, etc. A kitchenette has been created in the first floor lounge for younger adults, with appropriate adaptations. Some bedroom carpeting and furniture have been renewed. A treatment room has been provided, and a new fire panel has been fitted. 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. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 8 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.V253435.R01.S.doc Version 5.0 Page 9 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): OP3/YA2 There are good systems for assessing prospective residents’ needs. But they are not always used fully, creating uncertainty as to whether needs can be met if some are not known before admission. The home does not offer intermediate care. EVIDENCE: Prospective residents are invited to visit the home for lunch or coffee, and encouraged to look around. The manager also visits prospective residents at their home or in hospital where possible, to assess their care needs. Barchester staff in other parts of the country will assess prospective residents’ needs if living ‘out of county’. One recently admitted resident said that they had settled well: “It is a great relief to be here. I have no worries.” Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 10 There is a comprehensive pre-admission assessment tool. Written information had also been obtained from the previous carer in one case. However, the quality of the assessments was inconsistent - for example, allergies were not routinely recorded, and other sections had been left blank. In some, information on social activities and personal histories were not as well described as other needs. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 11 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): OP 7, 8 & 9 / YA 6, 9, 19 & 20 There is an individualised care planning system in place. However, the level of detail in care profiles (i.e. care plans) lacked consistency, with a potential that some residents’ needs may not always be met. The health needs of residents are generally well met, with evidence of good multi-disciplinary working taking place. Regular recording of residents’ weight would strengthen nutritional monitoring. Safe management of medications is compromised by one area of poor practice. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 12 EVIDENCE: Residents spoken with were generally happy with the care, and the relatives/visitors’ comment cards indicated they were also satisfied. Some care plans/care profiles were excellent, with regular reviews and good guidance for staff, particularly for meeting personal care needs. Some had less information, however. Four care plans had limited or no information regarding residents’ personal histories, social care needs and preferred activities. One diabetic care plan did not include action to be taken if blood glucose levels were low or raised, or what was an acceptable level for that individual. The plan for a resident with communication difficulties did not include the strategies staff said they were using. Wound care plans did not routinely include measurements or descriptions of wounds, although Sue Harris was already taking action to address this, in trying to obtain appropriate measuring tools, etc. Some evaluations were very reflective, and care assistants had recorded very valuable observations. Others were brief, not showing whether care was appropriate or successful in meeting needs. Risk assessments had been written, but some needed more detail, and regular review. For example, where a resident’s wandering was causing concern, no triggers, times, or how staff might manage this behaviour other than “observe” were given; or where bedrails had been fitted, what was creating any risk of falling was not noted, nor guidance on time limits for use of restraints such as lapbelts or bedrails. Five residents spoken with were aware of their care plans. A relative said they had been formally consulted; although it was over a year ago, they felt they had since spoken regularly with staff so could have raised any issues if they wished to. Health professionals’ support is recorded - from urology nurse specialists and mental health professionals, for example. One staff acts as the diabetic liaison nurse, the home working with the diabetic nurse specialist. One diabetic resident said they were confident staff could manage their condition. A care assistant said they were informed about those on special diets. Weights for two residents had not been routinely monitored. A front sheet on medication administration charts had the resident’s photo, any allergies, etc.; the charts were appropriately kept. Controlled drug records were well kept, and correlated with stock held. No issues were found relating to self-administration of medication by residents. Two staff were involved when warfarin-related results were phoned through from GPs, to ensure information was accurately received. The drugs trolley was seen open and unattended during the inspection. This was discussed with the nurse doing the medicines at the time, with regard to unsafe practice. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 13 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): OP 12 & 15 / YA 11, 12, 14 & 17 Residents benefit from a varied programme of activities, which takes into account individuals’ needs and preferences. The meals in the home are enjoyed, with choice and variety offered, and special dietary needs attended to. EVIDENCE: Comment cards and residents spoken with said the home provided suitable activities. A relative/visitor’s comment card included ‘The entertainment organisers are never ending trying to find something for everyone to do’. Activities staff are employed for 45 hours a week, with some event taking Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 14 place seven days a week. Records kept by the activities co-ordinator state which activities are offered and if residents prefer not to join in. However, these are not related to individual care plans to ensure that recreational interests and needs are fully met. When asked what the home does well, one younger adult said activities were generally good, and “They work hard”. The resident had enjoyed regular swimming sessions, occasional drives and a recent fishing trip. A letter from a relative expressed their satisfaction and said that improvements had been seen because of access to ‘hydrotherapy’. During the inspection, a multi-denominational service was held at the home. Staff spoken with also identified activities as something the home ‘does well’, but pointed out that outings are limited to six people when the home has over 60 residents. The manager said everyone is offered the opportunity to go out, however. One younger resident said that the mix of older and younger adults was difficult at times; he said, “It is difficult to strike up a conversation at times”. Facilities for younger adults are being further developed to provide separate areas for the two age groups, however. Residents’ comments cards said they liked the food provided. Most of those spoken with said that the food was generally good, offering a choice. Of those asked, one resident said that supper could be “boring” with a limited choice. A relative/visitor’s comment card included ‘The food is as good as any restaurant that I have visited’. The atmosphere is the dining room was congenial, with a buzz of conversation over the meal. Staff were seen to offer discreet assistance where needed. Meal choices were made at the time of the meal. Special diets are provided - for example, diabetic or vegetarian. Menus are available and these were balanced and varied; however, one resident said that they were not always accurate. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 15 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): OP 18 / YA 23 Action has been taken to try to protect residents from abuse, neglect and selfharm. However, residents would be better protected if all staff were familiar with local policies. EVIDENCE: Residents spoken with said they felt safe in the home; comments included “The staff are very good”, “The staff are friendly” and “The majority of staff treat me with respect.” Residents’ comment cards indicated that they knew who to speak to if they were unhappy with their care. A visitor said staff were always prepared to listen to queries and requests. Three relatives/visitors’ comment cards said they could visit residents in private. Four of the five care staff spoken with had received adult protection training, but four of the five said they had not seen the home’s policy and procedures. However, the manager said these policies, etc. had been presented in the training sessions. All recognised their responsibility to report any concerns, as did the member of the housekeeping staff. One knew people external to the home who could be contacted if they had concerns. Risk assessments had been completed for the use of bedrails, with consent for their use being obtained. Appropriate action had been taken regarding a recent allegation, including contacting other agencies. Inventories for residents’ property are being introduced. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 16 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): OP 22 & 26 / YA 29 & 30 Residents have a home that is adapted to promote their independence, and that has good standards of cleanliness and hygiene. EVIDENCE: Following consultation with younger residents and an occupational therapist, a kitchenette has been installed in the first floor lounge in the area for younger adults –giving them the opportunity to develop daily living skills and general independence. Light switches, sockets and surfaces in the new kitchenette and switches in the adjacent lounge are accessible to wheelchair uses. Grab rails Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 17 and raised toilet seats are provided around the home. A resident and their visitor were pleased with the newly installed ramp at the main entrance. There is a dedicated team of cleaners, and the home was clean and free from odour on the day of the inspection. A relative felt the home was usually kept to a good standard of cleanliness. A housekeeper described correct infection control procedures. One staff member said she was to complete an infection control assessment shortly. The inspector was told that 15 were currently completing the training. Staff confirmed that disposable gloves were available. The laundry room has equipment with recommended programmes, and was generally well organised. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 18 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): OP 27 - 30 / YA 31- 35 There is an appropriate skill mix of staff, who care about meeting residents’ needs. But management of those employed needs review, to ensure residents’ needs are met by current staff numbers. Residents benefit from and are protected by the Home’s rigorous recruitment practices, and an active approach to training and supervision. EVIDENCE: On the day of this unannounced inspection, there were three nurses and twelve care assistants on duty in the first part of the day (another coming on duty at 11.30am), with the latter reduced to eight care assistants from 2pm, looking after 64 residents. The manager – a nurse – was also on duty, and there were separate housekeeping, administration and catering staff on duty during the day. The manager works in a supernumerary capacity and when she is away, the Deputy manager is supernumerary. The five comment cards from residents said they all liked living at the home and felt well cared for. Most residents spoken with said staff generally knew Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 19 their needs when they came to assist them, with new staff being less well informed. One resident said ‘ I think the staff work very hard and care’. One resident felt staffing levels were too low at meal times, there being a slow response to callbells because care staff were involved with meals. One said there were not enough staff to look after people as individuals, wanting more help to do their teeth regularly, for example. Two others said they just waited for their bell to be answered because they knew staff were busy. Two cited bedtime and being helped from the dining room as times when they had to wait for assistance, although in the latter case, they said the home was now trying to address this. When others were asked what could be improved, three residents said the staffing levels at times. One said they had had to wait for “up to 30 minutes on one occasion for assistance”. Staff spoken with recognised that the manager had improved staffing levels; one also felt there was a better skill mix too, with more staff having gained care qualifications and recruitment of more experienced individuals. But they also said occasionally there were only three staff on duty on the ground floor in the afternoon (which they felt was insufficient), and weekends were difficult at times as staffing levels were lower. Staff said they would like more quality time with the residents. All staff have the opportunity to undertake NVQ2, or higher, care courses. A third of care assistants have obtained such a qualification, and another 11 are currently undertaking it. Four care assistants have been accepted for nurse training. A former staff member has recently taken on a staff training and NVQ co-ordinator role. Five staff files were examined, including for care staff and ancillary staff. All files contained required information. A record was made of CRB disclosures seen on this occasion, signed and dated by the inspector; these can now be destroyed in line with data protection guidance. The home is keen to develop training opportunities for staff, and has allocated 12 hours a week for development and management training. Since the last inspection many staff have received in-house training on various subjects relating to the work they undertake, such as adult protection, pressure area care and other mandatory training; 16 staff had been given training relating to care of younger adults. The content of the training was discussed with the manager and it was agreed that further training, to include different communication skills and other specific issues, would be beneficial. Dementia and diabetes training are to be organised. Staff identified training as a strength of the home. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 20 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): OP 33, 35 & 38 / YA 8, 23, 39 & 42 Residents are involved in the running of the home, with evidence that their views are sought. There are insufficient safeguards to ensure residents’ personal monies are correctly managed. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 21 Satisfactory systems are in place to promote the safety and health of residents and staff. EVIDENCE: Four of the residents’ comment cards said the respondent did not wish to be more involved in decision-making within the home; one said they did. A resident said there were regular residents/relatives’ meetings, held at different times or days of the week to encourage attendance of a variety of people, with minutes available at the reception desk. But they were not aware of any ‘quality of care’ type surveys. A resident who chose not to go to residents’ meetings said they were still kept informed of topical matters. CSCI receives monthly reports on the conduct of the home, and a report on the review of quality of care is expected early in the new year – these being done on a yearly basis. Personal monies records were checked regarding four residents. Evidence of good practice included individually kept accounts and cash balances, receipts given to anyone depositing money with the home for safekeeping, and two signatures obtained for each transaction. There is an external audit of such records every few months, according to staff. The inspector found auditing of receipts and transactions was not easy because dates of entries on records did not correlate with the date of the transaction as shown on shop receipts, etc. Two accounts had inaccuracies relating to the running and final totals; the manager has since looked into this and confirmed records have now been corrected. Staff receive training on moving and handling, food hygiene, fire safety and infection control. A housekeeper said they had had training on safe handling of cleaning chemicals, etc. (‘COSHH’ training) from an external trainer recently. Records show that two care staff have first aid training, and the activities coordinator holds first aid and life support. A Health and Safety committee has been established at the home, a meeting being held during the inspection. A bulletin is produced and distributed to all staff to ensure they are aware of any issues. Many staff require Health & Safety training; training is booked for November 2005. The pre-inspection questionnaire showed maintenance of equipment, water, gas and electrical systems was up-to-date. No hazards were noted during the inspection. Residents did not raise any related issues. Staff said repairs were carried out quickly. The inspector was told that a recent fire inspection found satisfactory standards; a new fire panel has been installed. The manager had recently reviewed the fire risk assessment, and fire safety checks were recorded at recommended intervals. There was no overview kept of staff fire safety training, but the deputy manager said all staff were up-to-date, and staff asked said they’d received training recently. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 22 Restrictors were in situ where windows were checked at random. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 23 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 2 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 ENVIRONMENT Standard No Score 19 X 20 X 21 X 22 3 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 X 33 3 34 X 35 2 36 X 37 X 38 3 Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 24 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 YA20 OP9 Regulation 13(2) Requirement You must make arrangements for the safekeeping & safe administration of medication. This is especially regarding leaving the unlocked drug trolley unattended. You must, with regard to the size 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. Timescale for action 30/11/05 2 YA33OP27 18(1)(a) 31/01/06 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 Good Practice Recommendations DS0000026726.V253435.R01.S.doc Version 5.0 Page 25 Tyspane Nursing Home 1 2 3 4 5 6 Standard YA2 YA6OP7 YA19OP8 YA23OP18 YA35OP30 YA23OP35 You should include social interests, hobbies, religious and cultural needs as part of the pre-admission assessment for each prospective resident. You should include individuals’ social care needs in their care plans. You should include measurements & description of any wounds and monitoring of weight in regular nutritional screening, in individuals’ care plans. You should ensure staff are familiar with the home’s written policies and procedures relating to protection of residents. You should include in training communication and other issues specific to residents’ needs. You should ensure there is a clear audit trail to ensure each resident’s personal monies are correctly managed, with accurate records kept relating to transactions and balances. Tyspane Nursing Home DS0000026726.V253435.R01.S.doc Version 5.0 Page 26 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.V253435.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!