Inspection on 28/05/09 for Tyspane Nursing Home

This inspection was carried out on 28th May 2009.

CQC found this care home to be providing an Good service.

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.

Other inspections for this house

Tyspane Nursing Home 08/06/07

Tyspane Nursing Home 13/07/06

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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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tyspane Nursing Home Lower Park Road Braunton North Devon EX33 2LH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Tyspane Nursing Home Lower Park Road Braunton North Devon EX33 2LH 01271816600 01271818302 tyspane@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 69 Number of places (if applicable): Under 65 Over 65 58 0 old age, not falling within any other category physical disability Additional conditions: 0 11 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 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 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. 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 Care Homes for Older People Page 4 of 28 potential service users. 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). The total number of service users shall not exceed 69 in total. Date of last inspection Brief description of the care home 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, and there are smoking restrictions. 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 double rooms if requested. There are two lifts giving access to all areas of the home. There is a large lawned area with some seating at the front of the home, with other paved or grassed areas and car parking areas elsewhere around the home. Barchester Healthcare Homes Limited owns the home. Weekly fees can be obtained from the home. They do not include the cost of theatre outings (a contribution is requested), taxis/transport, magazines/newspapers, toiletries, sweets, stationery (which are all charged at cost price), hairdressing for men and women, chiropody, and visitors meals. Inspection reports produced by the Commission about the home are kept at the reception, in the homes entrance hall. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in May 2009 and lasted approximately seven hours and involved two regulation inspectors. The focus of the inspection was to gain the views of the people who live at the home and individuals were spoken to during the inspection and care practice observed throughout the day. We also spent time talking to staff including two trained nurse, 8 care staff, one cook and one office staff. We spent time looking at some of the key documents including plans of care, assessments, staff recruitment files, records relating to medications and individuals finances. This helps us to understand how well the home is run. The home had been notified that a review of the home was due and had been asked to Care Homes for Older People Page 6 of 28 complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the inspection 6 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 7 people living at the home, and from 6 staff. Their comments and views have been included in this report and helped us to make a judgment about the service provided. What the care home does well: What has improved since the last inspection? What they could do better: Although we felt that overall the medication system was safe, we have made some recommendations to improve the system and make it more robust. Details of these can be found at the end of this report. The home is clean and well maintained however there are pockets of odour that need to be addressed. The home also needs to find space for equipment that is currently inappropriately stored in corridors. This may hinder the mobility of some individuals. Dressings also need to be stored safely and securely. We found one persons dressing on the floor in their bathroom. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tyspane has good systems in place for ensuring individuals needs are fully assessed before they are admitted to the home Evidence: We looked at the pre admission assessment information for four individuals two of whom were new to the home. The individual files contained detailed information about the persons personal and health care needs. One individual who had complex nursing needs had a full health care assessment, physiotherapist assessment and notes from the previous care provider. This enabled staff to have a good idea of the individuals needs and helps them to plan for care and support needs. Staff spoken to confirmed that they were made aware of pre admission assessment information usually prior or just before a new person moves into the home. Care Homes for Older People Page 11 of 28 Evidence: The home stated in their AQAA Prior to admission a senior member of staff will visit the prospective Resident and complete a pre-admission assessment. The assessment covers all the daily activities of living as well as the social and psychological needs.If a Resident is based out of area one of our sister homes will conduct the assessment on our behalf. Admission dates are agreed with the family and Resident to ensure the move is as stress free as possible. All rooms are prepared to a high standard and Residents are encouraged to personalise their room with their own possessions. If the room available is not of personal choice we endeavour to consult with Residents when another room is vacant. All permanent admissions are on a four week trial to enable the Resident to see if they are happy and feel that Tyspane can become their home. All respite admissions are invited to visit the home and have the same pre-admission assessment. Many of our respite Residents have now become permanent Residents. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are well planned and well met. Evidence: We looked in detail at six individuals plans of care and where possible this included talking to the individuals and/or their family member, speaking to staff and checking medication records of those individuals. This helps us gain a good picture of how well he home are meeting the quality outcome areas in this section. We found that plans of care are clearly set out and give staff good detail about how individuals personal and health care needs should be met. The plans included sections such as communication, hygiene, continence, moving and handling, tissue viability, nutrition, sleeping and hopes and fears for the future. Some areas of health care had been risk assessed using nationally recognised tools that allow the staff team to understand risks and put in place any measures to help prevent or minimise risks. Examples of these include the use of bed rails, the Waterlow risk assessment that assesses individuals risk of pressure sores, and MUST, a nutritional screening tool that Care Homes for Older People Page 13 of 28 Evidence: helps staff understand if an individual has additional needs in their dietary intake. One individual who we looked at had some pressure sores and we were satisfied that good records were maintained, including rationale for treatment, regular review of care plan re wounds and evidence that they have sought expert advice. Pressure relieving equipment was in place for this individual. Staff spoken to confirmed that the home had a good supply of equipment to ensure quality care and support is provided. A total of ten care and nursing staff were spoken to and we were impressed with their level of knowledge and understanding of the individuals they care for. They agreed that the plans of care provide them with good clear information. One individual is subject to a deprivation of liberty authorization. This means that they have had their mental capacity fully assessed and this has included a best interests assessment. We found that although there were some restrictions to ensure the person did not wander out of the building, staff showed a great deal of Patience and understanding during the inspection with this individual who at times became quite distressed and disorientated. Staff walked with them, sat and talked and offered comfort. The family member who was visiting said that what they were most impressed with was the fact that staff understood that a hug or a cuddle was important in calming the person down and that they did this on a frequent basis. We also found another individual where the Mental Capacity Act was used when the individual was making a decision which would adversely affect them re pressure sores. Their competence to make the decision was established and the decision had been honoured. Surveys returned and individuals spoken to during the inspection said that they were very happy with the care and support they received. Three visiting relatives praised the level of commitment from staff. One family have expressed concerns about the care provided and their concerns have been directed to the registered provider. We could not find any issues with the care, support and records relating to the individual concerned on the day of the inspection. The palliative nurse was spoken to following the inspection as we were aware that the home work closely with the palliative care team. She stated that Tyspane was Very caring, are pre emptive and all calls to us are appropriate. The home doesnt like to fail. There is no complacency. She said she had no concerns at all about the provision of health care at the home. The medication system and records were checked during this inspection. We were Care Homes for Older People Page 14 of 28 Evidence: informed Boots MDS had only just introduced and told there were some teething problems. Staff have received training in BOOTS medication system but staff have not had any other medication training in recent years, and this should be addressed, and their competencies checked on a regular basis. Medications were properly and securely stored including controlled drugs and those which needed fridge temperatures. Continual temperature monitoring is in place. Medications are kept on first and ground floors. Two separate sets of keys are in operation and so system is fully accountable. We commend the fact that all movement of medications is double signed, all information, which might change prescription, heard by two trained staff before accepting the change e.g. over the phone re antibiotic or INR re warfarin. We found that the medication records were well maintained and kept orderly. There is a stock control system and also a quality control system in place, the home and through reg 26 visits, that check on this. Overall we felt that the medication system was safe but have made some recommendations to improve practice and ensure that medication systems are fully robust. The home employ a physiotherapist for two days per week and any ongoing exercise plans are followed up by the two activity coordinators. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers an excellent range of activities to suit the needs of most individuals. Evidence: The home has one paid activities coordinator who works 48 hours per week and one volunteer who does similar hours. Together hey have worked hard to ensure that there is a range of activities both in house and off site such as swimming and shopping trips. Of the six surveys returned 5 had ticked always to the question are there activities arranged by the home that you can take part in. One person did tick never to this question. Comments included the activities organiser works very hard to please everyone and I love all the activities they do here, it keeps us busy and active. The AQAA states The routines of daily living are flexible and based on person centered approach to care. Residents have the opportunity to enjoy varied activities, social contact both internally and externally and the opportunity to express their own choices throughout. Tyspane has its own minibus with outings several days of the week and Residents have said they look forward to our Mystery tours. We have our weekly activities sheet that provides our Residents with all the planned activities for the week, these are delivered to their rooms. Religious preferences are catered for as are cultural Care Homes for Older People Page 16 of 28 Evidence: or life choices. We have a church service every two weeks and there are weekly visits from the local churches giving holy communion to our Residents if this is there preference. Good links are maintained with Residents families and the community surrounding the home, visitors are always welcome to Tyspane at any time and we organise events to which they are invited. Residents are encouraged to remain independent and to pursue outside activities such as Bridge or Oasis Club. Within Tyspane Residents can choose to have their own hairdresser or chiropodist should they prefer or they may use our hairdresser in our recently refurbished salon. Residents have the choice to get up when they wish and retire when they wish, this enables promotion of Residents rights ensuring they have choice and control of their lives. Our Activity Coordinator ensures she visits our frailer Residents regularly if they wish for One to One sessions. We observed some group activities that included sing along and board games. One person said that they loved seeing the coordinators dogs, that this gave them a great deal of pleasure. Visiting families that we spoke to said that they could visit when they wished and that they were made welcome and offered refreshments. The home offers a good choice and range of meals. People we spoke to and those who returned surveys said that they did get a choice of meals each day and that it was well presented and hot. We observed meals being served in two areas of the building and staff served and offered support as needed in a kind and respectful manner. Meal times were not rushed and people said they could choose where they ate their meals. The cook confirmed that special diets are catered for and that individuals likes and dislikes are recorded and taken into consideration. The menu plans show that a wide choice and variety is offered and the meals appear to offer individuals a well balanced and nutritious diet. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views and concerns are listened to and acted upon Evidence: Tyspane stated in the AQAA We welcome feedback and comments from our Residents and their families and this is shown by our Open Door Policy. We have a Mission, Vision and Values statement, which we believe in. We address any concerns, complaints in an appropriate manner and in accordance with Barchesters policies and procedures. We investigate fully and in a timely way and endeavour to work closely with the person concerned for a resolution.The complaints procedure is displayed at reception and throughout the home and is available to all. All staff receives training in the Protection of Vulnerable Adults and are aware of the need to protect our Residents. Staffs know the procedures to follow should they wish to raise a concern.We are fully up to date with the new safeguarding policies provided by the local authority and C.S.C.I. We have made referrals as and when necessary with reports being forwarded to the relevant bodies. We aim to ensure Residents have life choices and will conduct risk assessments to evaluate any risk identified with a particular choice such as one Resident choosing not to be disturbed at night. We checked the complaints information held at the home and were satisfied that all complaints logged had been investigated and responded to appropriately. We are aware that at the time of writing this report there is one complaint being looked at that Care Homes for Older People Page 18 of 28 Evidence: concerns the care given to one individuals. We checked this persons records and spoke with the continuing health care assessors who reviewed the individual earlier in the year this included gaining the views of all stakeholders including the family. We are satisfied that the individuals current needs are being well met by the home. We are unable to comment on any past concerns. Staff who completed surveys and those asked during the inspection said they had received training in understanding what abuse was and what they should do if the suspect abuse happening. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tyspane provides a well maintained pleasant and homely environment for individuals. Evidence: During this inspection we looked at all communal areas and some of the individual bedrooms. We were impressed by the homely feel of communal areas, that despite being a very large home, they had achieved a homely feel by ensuring that furniture was placed in small groups. Although the home is kept clean to a high standard, there were still pockets of odour in some areas of the building. The manager said they are looking at addressing this with refurbishment of some carpets and looking at deep cleaning on a more regular basis. One area that could be improved is storage for equipment. The corridors appear littered with hoists and unused wheelchairs. We also found dressing being stored in one persons en suite, some had become wet, and this was considered a possible health and safety risk. The manager agreed to move the dressing immediately. We also thought that individuals would benefit form having hand rails in corridors. There is none present and this does not help promote independence of those who are able to walk without aids, but may need to steady themselves. Individual bedrooms appear personalised and all have en suits. Some people told us Care Homes for Older People Page 20 of 28 Evidence: that they liked their bedrooms and that they had been able to bring in items of furniture and their own personal belongings. The laundry meets requirements and the home use specialist dis-solvable bags so that soiled linen is not touched and does not contaminate clean linen. We saw staff using gloves and aprons appropriately and staff confirmed that there was equipment available to ensure they could do their job safely. The AQAA shows us that the building is well maintained and that policies and procedures are in place to ensure goos infection control. The home and gardens are wheel chair accessible and the gardens are well maintained and provided people with a pleasant area to sit. In answer to the question what has improved in the last 12 months the home said the following in their AQAA Our Health and Safety Committee is very pro-active in ensuring the safety of our Residents and staff. Our fire training has become more robust with regular fire drills encompassing scenarios and training in the use of the ski pads. The patio on the right hand side of the lounge has been refurbished and a ramp created allowing access to our beautiful gardens. We have redesigned the layout in the laundry to encompass a new store cupboard for the chemicals which meets all the Health and Safety requirements. We have introduced fresh flowers in all communal areas these are supplied to us free from Salisburys. These give great joy to our Residents. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and supported to do their jobs. Evidence: The home has sufficient numbers of staff on duty for the current needs of the people who live there. Normally they have two trained nurses and between 6 to 8 care staff downstairs and 7 to 9 care staff upstairs per shift. In addition the have two activity coordinators, four cleaning staff one laundry person, one chef and two kitchen assistants. They also have a full time maintenance person and employ a physiotherapist two days per week. Comments from people who we spoke to and those who returned surveys said that staff were available to meet needs, although three health care professionals who returned surveys said that they felt the service could be improved with more staff. One made the comment that the call bells appear to ring for long periods. This was not the experience we noted. We found that although staff were busy throughout the day, individuals were given support and care in a timely fashion. We were impressed with the level of kindness and patience shown to individuals by staff throughout the day. Staff training usually covers all aspects of health and safety, although this has fallen a little behind due to one of the training coordinators being off sick. Since the inspection Care Homes for Older People Page 22 of 28 Evidence: taking place however the manager has updated us, and says that all training is now back on track and has either been completed or is planned in. The home has over 50 of staff who have achieved or are working to wards National Vocational training in care. Staff recruitment files were checked and these showed that the home make sure all checks and references are in place prior to the new member of staff commencing employment. This helps to safeguard individuals who live at the home. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tyspane is well managed and run in the best interests of the people who live there. Evidence: The home has a new manager who is in the process of registering with CQC. She had only been at the home for three weeks at the time of the inspection, however she is experienced and qualified and we have been impressed with her level of engagement in the inspection process and keeping CQC informed of progress at the home. The home have good quality assurance processes in place to ensure the views of individuals who live at the home, their families and other stakeholders are all able to make their views known. This helps to plan for improvements in the quality outcomes for people. We saw that regular meetings are held for staff, for people who live at the home and for their families. We also saw that surveys are used to gain views. The registered provider ensures that they visit monthly and provides a report on what has been audited. Care Homes for Older People Page 24 of 28 Evidence: The AQAA stated We have a comprehensive Statement of Purpose and Service Users Guide detailing all aspects of our service and how to raise any concerns or complaints. At Tyspane we have an Open Door Policy this enables Residents and their Relatives to have immediate access and enables us to deal with matters immediately. Barchester Healthcare also conduct external Satisfaction Surveys involving Residents, Relatives and Professionals, the most recent one in December 2008, a letter detailing the results is to be sent to the Residents and there will be letters at the reception for Relatives. An action plan will then be formulated and discussed with our director. The results were discussed at the February 2009 Relatives and Residents meeting. We meet every three months with Residents and Relatives where there is an open forum and exchange of views and ideas; we have several Residents who prefer not to share their views with others and prefer to see us privately through the Open Door Policy. At Tyspane we record all our concerns and complaints and work with the individual Resident or Relative to resolve any issues. We have located at Reception our compliments and Thank You Book and copies are also located in the staff room. We have extensive Care Profiles which are formulated with the involvement of the individual Resident and Relative, these are reviewed monthly by the Registered Nurse and are formally reviewed six monthly with the Resident and relevant personnel to ensure the wellbeing of the individual. We have a strong activities team within Tyspane providing a wide range of activities. We have weekly Activity sheets detailing all the Weeks activities and our team discuss regularly with the Residents what further activities they would like introduced. We involve our Residents in planning their minibus outings and these can take place several times a week. It is often not decided the location of the trip until the residents are consulted on the minibus. The AQAA also gives us information to show how the home ensures safe working practices via training and policies and procedures. We saw that all new staff have an induction programme that meets national standards. We checked the system in place for ensuring that any personal monies kept is safe and accountable, and found that a good audit trail is available and records well maintained. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The manager or designated person should see the prescription forms to check them against the items which were ordered and also to have sight of the only documents that is signed by the prescriber, which is in accordance with the Royal Pharmaceutical society guidelines for care homes 2003. Externally administered medicines, such as lotions and creams, should also have a record of by whom and when they were administered. Nursing staff should receive update training in the handling of medicines to a level pertaining to their role and responsibilities. The home needs to consider how it can ensure that equipment is stored safely and is not in the way of individuals in communal corridors. 2 9 3 9 4 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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