Inspection on 08/06/07 for Tyspane Nursing Home

This inspection was carried out on 8th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tyspane Nursing Home 28/05/09

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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Fairfields Country Rest Home

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Poldhu

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Trevaylor Manor

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 8 June 2007 9.40 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.V345090.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.V345090.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.V345090.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 13th July 2006 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, and there are smoking restrictions. It is a purpose-built, two-storey home, in a residential area of Braunton. It is Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 5 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 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 (which are all charged at cost price), hairdressing for men and women (costing £5 £26), chiropody (£13 per session), and visitors’ meals (£3.80 for lunch, £3 for tea). 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.V345090.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. There were 63 people living at the home on the day of this unannounced inspection. A CSCI pre-inspection questionnaire had previously been returned by the home, as well as some of our surveys. Of 20 CSCI surveys sent to residents, five were returned completed (three being completed by their representative, two completed with help from the home’s activities coordinator), with a note on another saying someone had declined to complete it. Of ten sent to care staff, two were returned. And of ten sent to communitybased health or social care professionals, none were returned. We met at least 20 people who lived at the home. Some were too frail to give their views and one did not wish to speak with us, but we spoke with 13 of the 20, as well as speaking with two visitors and 11 staff (including care or nursing staff, and ancillary staff, singly or in groups), as well as the registered manager, during the seven hours spent at the home. The inspection included ‘case-tracking’ of six people, including younger and older adults, men and women, a wheelchair user, someone frail who was cared for in bed, people with mental health needs, people with complex health needs, a privately-funded person, someone who self-medicated, new residents, and someone staying for respite. This involved looking into their care in more detail by meeting with them if possible, checking their care records and other documentation relating to them (medication sheets, personal monies records kept by the home, etc.), talking with care staff, and observation of general care these people received. We also looked at the accommodation provided and service areas such as the kitchen and laundry. Staff files, minutes of meetings, quality assurance material, kitchen records and other records relating to health and safety (maintenance and servicing records, etc.) were seen. We ended the visit by discussing our findings with Mrs Sue Harris, the registered manager. Information gained from all these sources and from communication with the service since the last inspection is included in this report. We have not received any complaints about the home since the last inspection. What the service does well: A relative said, “For me, the staff are excellent and nothing is too much trouble.” During our inspection, we found peoples’ needs are assessed well before they move into the home, to help ensure it is a suitable place for them to live. Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 7 Multidisciplinary working and better record-keeping ensures that peoples’ health needs are met, promoting their wellbeing. Peoples’ rights to privacy, choice and control are respected, promoting their dignity. They have various opportunities for fulfilment, to improve the quality of their lives. This is helped by keeping links with peoples’ families, friends and the community around the home, so people benefit from supportive and interesting relationships. Catering arrangements meet peoples’ preferences, as well as their social and medical needs. They benefit from a well kept and accessible home. Staffing arrangements within the home promote the care and safety of people living at the home, supported by good levels of basic staff training and good recruitment practices. The manager has the knowledge and experience to ensure the home is run well, with a variety of quality assurance arrangements that enable people at the home to influence the service’s development. This includes attention to peoples’ concerns or complaints. Good systems and practices used by the home protect people from abuse. What has improved since the last inspection? What they could do better: When asked this question, one person replied, “There’s absolutely nothing wrong with this place.” A staff member suggested more staff would improve the way the care home works, so that they had more time to spend with people. Prospective residents’ rights would be better protected if they received confirmation that the home can meet the needs identified before their admission. Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 8 There must be fuller information for staff about some peoples’ care needs particularly by involving each person (or their representative) in planning their care whenever possible - to avoid inconsistencies in care and a risk that people may not receive all the care they need or would like. Some medication practices need improvement, to ensure peoples’ safety. Development of staff knowledge and skills regarding equal opportunities and diversity would help ensure people living at the home are properly supported and enabled. Health and safety matters are generally well attended to, although use of certain equipment must be reviewed, to fully protect the welfare of everyone at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tyspane Nursing Home DS0000026726.V345090.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.V345090.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 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. There are systems are in place to ensure peoples’ needs are assessed well before they move into the home, promoting the success of their admission. The rights of prospective residents would be more fully protected if they received confirmation that the home can meet the needs identified. EVIDENCE: The majority of residents spoken with were happy with their choice of home. Comments from people included, “ It’s lovely here - everyone is so kind”. Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 11 Four surveys from people who live at the home said they had enough information about the home before they moved in. One said the nurse who had shown them around answered all their questions. Another added, “Very happy with it.” Information about the home, including the home’s statement of purpose and Service User Guide, was also seen in bedrooms. The manager said this information was also offered to people who came to look around; she said people often stayed for a meal, with their accompanying relative or friend, when deciding whether or not to they would like to live there. She confirmed information could be provided in large print if needed. We looked at care needs assessments for five people, undertaken by the home’s senior staff before people were admitted. All were comprehensive, with enough detail to enable staff to develop plans of how they would meet the needs identified. Assessments have been improved since the last inspection. For example, besides finding out what practical help people needed daily, they now included peoples’ ability or capacity to make decisions for themselves, and whether they had an ‘advance directive’ (or living will) about their future care. One seen for someone admitted for a respite stay included the person’s particular wishes for privacy, contact details for other care professionals supporting them, as well as a Social Services care plan. Staff confirmed they were informed about planned admissions and could read the person’s care plan before they moved in, so they knew what care they would need in advance. Prior to admission, the home confirms details such as fees and admission date, but does not confirm in writing whether or not people’s identified health and social care needs can be met at the home. Doing so would promote peoples’ rights. Tyspane Nursing Home DS0000026726.V345090.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. There is improved information for staff about peoples’ care needs. A lack of involvement of some people receiving care and inadequate detail in some care plans may lead to inconsistencies in care, as well as a risk that some people may not receive all the care they need or would like. Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 13 Good multidisciplinary working and improved record-keeping ensures that peoples’ health needs are met, promoting their wellbeing. Medication is adequately managed, although some practices need improvement to ensure peoples’ safety. There is good respect for peoples’ privacy, with promotion of their dignity and rights. EVIDENCE: We looked at care plans / care profiles for six people. Each included a broad range of needs. Some people said they had agreed that a relative should be involved in the drawing-up and review of their care plan, on their behalf. Other care plans did not show that residents or their representatives had been involved or told of any changes to their care. At the recent residents/relatives’ meeting, minutes show senior staff talked about care profiles and invited people to discuss their care. Four surveys from people who live at the home said they always got the care and support they needed; the fifth said ‘usually’. Care plans outlined peoples’ general needs, and a great improvement was noted since the last inspection in the information for staff as to how needs should be met. However, some still did not include much detail about communication, mobility and certain behavioural needs, for example. One plan of care intended to ‘promote a sense of wellbeing’ in relation to management of “physical and verbal aggression”, said the person’s behaviour was to be monitored but did not say how staff might minimise any aggression. Review dates were recorded at least monthly. Although some care plans and daily notes included evaluations of care, not all did. So it was not always clear how appropriate or helpful care was, or to what extent the aim of the care had been achieved. A risk assessment was seen that had been written for someone who preferred not to have help from anyone but who was at risk of falling. This ensured their wishes were respected as much as possible yet also that they were not neglected and got help needed to ensure their welfare. When asked if staff were vigilant about peoples’ health, one person agreed, saying their blood pressure and weight were measured regularly (this was also reflected in other peoples’ care notes). Frail people seen in bed looked comfortable and cared for, with mouth care and hair care having been attended to, etc. The home monitors dental and sight checks to ensure people get the healthcare they are entitled to, and chiropody is arranged according to people’s needs. Care records showed advice was sought promptly from GPs Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 14 and mental health staff. Allied professionals were supporting staff to meet someone’s changing needs whilst multidisciplinary reviews were carried out about how best to care for them in the longer term. Staff said a first aider always went on the minibus outings so that help could be given if needed. Nutrition assessments were seen had been regularly reviewed; information in daily care notes about greater monitoring of someone’s food intake that day had been used then to update their care plan, so that all staff would be aware of their changed needs and the new care needed. Detailed wound assessment forms have been introduced since the last inspection; a completed one thus gave clear information on the state of the wound when last seen, and any changes in previous weeks. People who were asked were satisfied with how the home managed their medicines for them. Records clearly included whether or not people had any allergies, medicinal or otherwise. Medicines received by the home were recorded on medication administration sheets, which had peoples’ photos on to ensure medicines were given to the right person. The home carries out medication audits, and notified us of a recording error thus identified. A risk assessment was seen where someone was self-medicating, to ensure they could manage safely. The assessment had not been reviewed for some months, but the manager said this was to be done at an imminent care review meeting with the person concerned. There was no written record of what medication stocks had been given to the person or when, to ensure staff could properly audit all medication received into the home. Two issues relating to safe storage of medication were noted. One medication fridge’s thermometer showed -3°C, but when asked about this, staff read it as ‘3°C’. The probe was found to be in ice, hence the low reading. So although storage temperatures were monitored, as is good practice to ensure medications keep their effectiveness, this was not reliable. Also, rather than using the manufacturers’ information on medications’ shelf-life once opened, staff were mistakenly using the product’s expiry date to show when it should no longer be used, for safety reasons, after opening. People who were asked felt staff respected their privacy, with one adding staff did not cause them to feel embarrassed when helped with a bath. Staff were observed to knock and enter bedrooms in a way that reflected respect for peoples’ personal space. Personnel files were seen to include the home’s confidentiality policy, signed by each staff member to confirm they knew they should not readily share information about people living at the home. Tyspane Nursing Home DS0000026726.V345090.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. 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 peoples’ lives. Good links are maintained with peoples’ families, friends and the community around the home, helping to ensure people benefit from supportive and interesting relationships. There is good promotion of peoples’ rights through enabling them to have choice and control of their lives. Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 16 There are good catering arrangements that meet peoples’ tastes, as well as their social and medical needs. EVIDENCE: When we arrived, some people who lived at the home were at the entrance, looking forward to going on a ‘mystery tour’. Others confirmed there were outings in the home’s minibus most days of the week, with staff saying sometimes there were two in one day if lots of people wanted to go out. Two people were taken to a swimming pool weekly, at a centre for younger adults. Garden facilities have been improved since the last inspection visit, so people can sit outside in sun or shade, as reflected by care records. Information about planned events was seen in people’s rooms, which included weekend activities. One person referred to the information whilst speaking with us, to see when they could get a haircut from the visiting hairdresser. Someone with poor sight said they couldn’t read it, but did not want an alternative format; they said staff invited them to any planned events. They appreciated the regular multi-denominational services held at the home, although added that sometimes they missed it because staff would come to help them have a bath, etc. when it was due to take place. When we told staff this, they immediately said they would make a note in the person’s care plan and ensure staff did not do this. One staff survey raised concerns about recreation for people who stayed behind at the home whilst others went on the outings. The manager said the activities staff stayed behind to organise this. During the visit, a care assistant set up games in the main lounge, whilst some people were out. A relative of someone living at the home said they played the organ at the home, for others to listen to. Visitors were seen coming and going throughout the day, and were made welcome by all staff. People who lived at the home said this was usually the case. There were several people sat in their rooms, reading or listening to the radio and socialising in groups in various communal areas. One survey said the person concerned really appreciated weekly visits from their church. Five surveys from people who live at the home (or their representative) said staff listened and acted on what they say. One person, who said they enjoyed the time they spent relaxing in the bath, said staff had initially given them the choice of a bath or shower. People in their bedrooms all had call bells within reach, enabling them to get help when they wanted it. A lockable facility was seen in some rooms, so people did not have to hand valued possessions to Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 17 others for safekeeping but could keep them themselves. Risk assessments were seen that took account of individuals’ choices or preferences. Several people described the food as ‘good’ or ‘excellent’. One said, “Usually good,” and another said, “The best thing about living here is the food.” People confirmed there was always a choice and that they could request things that were not on the menu. The kitchen staff were aware of peoples’ dietary needs and preferences. Several have special dietary needs such as diabetic, gluten free, and soft or pureed - which are all catered for. Menus seen were very varied, and balanced; the day’s menu was displayed at the entrance to the dining room. The lunchtime observed was a calm occasion, with tables set with cloths, etc. and wine served. Staff sat with people needing help, assisting them in an unhurried way. Tyspane Nursing Home DS0000026726.V345090.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. 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 peoples’ concerns or complaints used to improve the service. There are good safeguarding policies and practices in use, to try to protect residents from abuse. EVIDENCE: Surveys from people at the home (or their representative) said they knew who to speak to if they weren’t happy. One said they might speak to the manager if really needed, but the staff usually dealt with the matter before that became necessary. A copy of the home’s complaints procedure was prominently displayed in the home’s entrance, and is included in information seen in bedrooms. People confirmed that they would feel comfortable making a complaint, and were sure that it would be taken seriously and action would be taken. This was reflected in care notes seen which included concerns a person had raised and what action staff had taken about them. A complaints log was Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 19 also kept by the manager, with evidence that action was taken to find underlying causes of complaints and address them. One concern was raised with us, relating to timely attention by staff when alone or waiting in the dining room after meals, which the person said they had also spoken to the manager about. The manager confirmed awareness of the problem, saying staff tried to assist anyone who was anxious at being kept waiting but they also varied the order in which people were helped to leave the area, so the same person would not always be the last to leave. People asked said they felt safe with staff, both in terms of care skills and trustworthiness of staff. Staff gave appropriate examples of what the home considered to be poor practice or abuse. They said they would not hesitate to report these to a senior member of staff; two were not aware of organisations outside the home to which concerns could be reported if necessary. The manager said all staff had received relevant written information since the last inspection, which included such agencies, and that she would remind staff of this. Tyspane Nursing Home DS0000026726.V345090.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. 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. People benefit from a well maintained, clean and accessible home. EVIDENCE: All people spoken with were happy with the general environment and their personal accommodation, feeling it was free from hazards, with minor repairs attended to quickly. People said how much enjoyment they get from the Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 21 home’s well-kept gardens (- although we saw that armchairs in the main lounge were not positioned so that people could enjoy the lovely garden views). Bedrooms we visited were personalised with furniture, pictures and other sentimental, personal items. People said how much more at home this made them feel. Aids and adaptations included external ramps (giving level access at the entrance and from the dining area), a large passenger lift that accommodates wheelchairs easily, and grab rails. Several people using wheelchairs were seen moving independently around the home. One staff survey suggested more hoists of a particular type would be useful; people we spoke with felt there was sufficient equipment to meet the current needs of people living at the home. Communal areas were well decorated and well furnished. The home was clean and fresh during this visit. People spoken with and surveys confirmed that it was “always” like this. Domestic staff spoken with had received the appropriate training and said that they had the equipment and materials to do their job properly. Care staff described appropriate systems in place for reducing cross-infection (use of readily available disposable gloves and aprons combined with handwashing, separate laundry staff, etc.). The laundry is well equipped and organised. The member of staff working in this area had received the appropriate training and was aware of the system to use to maintain infection control. One person felt the laundry service was particularly good, they said, “Everything comes back fresh and nicely ironed.” Tyspane Nursing Home DS0000026726.V345090.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good staffing arrangements within the home promote the care and safety of people living at the home. The staff as a team have good knowledge and skills to guide practice and ensure peoples’ safety. However, development of their knowledge and skills regarding equal opportunities and diversity would help ensure people living at the home are properly supported and enabled. People living at the home are protected by the home’s good recruitment policies and practices. EVIDENCE: Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 23 All people spoke highly of the staff. Comments included, “They work so hard”, and “Staff are very kind and thoughtful”. Those asked said staff responded quickly to call bells. Surveys from people at the home said staff were available when needed. One said staff came to them even when they hadn’t rung for attention. Another reflected this, saying staff ‘popped in’ to check on them, especially later in the evening to see if they were ‘okay for the night’. Staff felt staffing levels were appropriate to meet the needs of current residents, some saying there were fewer people with complex needs (who would need a lot of help) at present. They said no agency staff were used at present but that the manager always acted if more staff were requested redeploying staff from less busy areas of the home, which they felt worked well at present. During the inspection, staff were occupied but not appearing in a rush. Three personnel files were checked. They had timely police checks and other information required, apart from interview notes about a gap in one person’s employment history, which had not been put into the personnel file. The manager agreed to ensure such information was properly kept and readily available, to fully show applicants are suitable to work in a care home. People asked said staff knew what care they needed. Someone with poor sight said staff were mindful of this – telling the person where they had left drinks, meals, etc. Nearly half of the care assistants have a recognised care qualification with more undertaking it currently. Two said they had undergone relevant training (including use of specific equipment) before someone returned to the home from a hospital stay, so staff could safely meet their new mobility needs. Staff confirmed they had supervision sessions with the manager, which were sometimes used for training or which gave opportunity to discuss training needs and requests. Some also said they could ask for help or advice at anytime. The manager confirmed she observes staff on medication rounds, for example, to ensure they follow know correct and safe procedures. Two staff surveys said they were asked to look after people outside of their area of expertise, but people we spoke with did not feel this way. We spoke with a member of the care staff who, along with a colleague, also work as trainers. They have received some external training to inform them for this role. Since they work both night and day duties, they are able to give training to care staff in their actual work situation, thus ensuring the training is very relevant to that work. Staff spoken with had referred to these colleagues as people with whom they had supervision. A recommendation was made at the last inspection that staff receive equal opportunities training, including disability equality training. The pre-inspection information provided by the home did not reflect that this had been provided, Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 24 in the record of staff training; staff with the care qualification will have gained some knowledge through that course, but other staff will not have benefited in the same way. Tyspane Nursing Home DS0000026726.V345090.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. 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.V345090.R01.S.doc Version 5.2 Page 26 There are good quality assurance arrangements in place, ensuring that people living at the home, and staff, can influence the service’s development. Good systems and practices used by the home protect peoples’ financial affairs. Health and safety matters are generally well attended to, although use of certain equipment should be reviewed to fully protect the welfare of everyone at the home. EVIDENCE: All residents and staff spoken with praised the manager, describing her as approachable, supportive, “very nice, helpful and chatty”. A survey from a relative said she was “always eager to attend to any matter.” The manager has the Registered Managers Award, is a Registered General Nurse, and has managed the home for four years approximately. She has had recent training on fire safety, infection control and dementia care, amongst other topics, as well as having regular formal supervision with her manager. Staff felt valued by her, and as she operates an ‘open door’ policy (as seen during the visit) residents and staff can speak with her whenever they wish. Some people choose that the home take care of their money needed for everyday outgoings such as shopping and hairdressing. Clear records of incoming and outgoing funds were seen for each individual, where requested. These are computerised, individualised and easily accessible. Regular residents’ meetings are held, with recent minutes seen in the home’s entrance lobby. These were in normal print but the manager said alternative formats could be produced if requested. Staff meetings are also held. Barchester Healthcare satisfaction questionnaires, recently sent to people who live at the home, were designed so they could be returned direct to the company’s head office if people wished. The manager said once they informed her of the findings, she would produce a report - including an action plan to address any issues identified – and share it with residents and other interested parties. We looked at several completed ones handed to the manager; topics included food, activities and staff. Responses were generally positive. Various satisfactory servicing and maintenance records were seen, including gas and electrical safety certificates. The maintenance person is well organised and has had training necessary to undertake his responsibilities. He confirmed that window restrictors were fitted to all first floor windows to prevent falls and that these are checked regularly. Hot water temperatures are controlled to prevent scalding. Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 27 Fire safety was good; all equipment is serviced and checked on a regular basis, some people confirming fire bells were tested. The manager described measures introduced since the last inspection in view of new fire safety legislation, with related equipment seen around the home to promote people’s welfare in the event of a fire. A new kitchen has been fitted since the last inspection, with changing rooms provided for staff. Fridges and freezers were clean and tidy, with regular temperatures recorded to show safe food storage conditions. Staff said more beds are being bought that have integral bedrails, which reduces risks from ill-fitting rails. Although there was information displayed for staff on safety checks for bedrails, two care staff spoken with did not seem fully aware of their responsibilities regarding these. No risk assessment was found for use of bedrails seen on one person’s bed, although assessments were seen for other people. Tyspane Nursing Home DS0000026726.V345090.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 3 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 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 3 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 2 Tyspane Nursing Home DS0000026726.V345090.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 OP3 Regulation 14(1)(d) Requirement You must confirm in writing that the home can meet individuals’ needs, before their admission, thus promoting their rights. You must confirm in writing that the home can meet individuals’ needs, before their admission, thus promoting their rights. Unless it is not practical to consult people, you must consult individuals or their representative, and prepare a care plan as to how staff are to meet their health and welfare needs. They must also be involved in reviews of their care plan, unless impracticable, and be notified of any changes to the care plan. This should include evaluations of care plans that are sufficiently detailed as to identify when the care plan needs changing. Previous timescale of 15/08/06 partly met. Timescale for action 15/08/07 2. YA2 14(1)(d) 15/08/07 3. OP7 15(1) & (2) 15/08/07 Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 30 4. YA6 15(1) & (2) Unless it is not practical to consult people, you must consult individuals or their representative, and prepare a care plan as to how staff are to meet their health and welfare needs. They must also be involved in reviews of their care plan, unless impracticable, and be notified of any changes to the care plan. This should include evaluations of care plans that are sufficiently detailed as to identify when the care plan needs changing. 15/08/07 5. OP38 13(4)(c) You must ensure all staff are aware of safety issues when bedrails are used, with risk assessments in place for each person for whom they are used, to ensure their safe and appropriate use. You must ensure all staff are aware of safety issues when bedrails are used, with risk assessments in place for each person for whom they are used, to ensure their safe and appropriate use. 31/08/07 6. YA42 13(4)(c) 31/08/07 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. Refer to Standard OP9 Good Practice Recommendations You should ensure all medication is stored at correct temperatures and for the time period advised by manufacturers, to ensure that when used, they remain effective and safe to use. DS0000026726.V345090.R01.S.doc Version 5.2 Page 31 Tyspane Nursing Home 2. YA20 You should ensure all medication is stored at correct temperatures and for the time period advised by manufacturers, to ensure that when used, they remain effective and safe to use. All staff should receive equal opportunities training, including disability equality training, so that peoples’ diverse needs are met by appropriately trained staff, staff fulfil the aims of the home, and meet peoples’ changing needs. 3. YA35 Tyspane Nursing Home DS0000026726.V345090.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Tyspane Nursing Home DS0000026726.V345090.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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