Care Home: Tegfield House

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What the care home does well There are good systems to assess people`s needs before they move into the home. This helps to assure people that the home will be able to meet their needs. People`s needs are set out in clear care plans, which they have been involved in writing. This gives staff the information they need to provide the right care. People are able to attend the health services they need and there are good systems to safely manage people`s medication. The home provides a good range of activities to meet people`s different needs and there is a good choice of food that people generally like. People are supported to keep in touch with their family and friends and visitors are made to feel welcome. There are good systems to deal with complaints and respond to allegations of abuse. This gives people confidence that any complaints they make will be taken seriously and investigated. The home is well maintained and provides a homely, comfortable and safe environment for people. Staff are thoroughly checked, well trained and there are enough of them to meet people`s needs. There are good systems to assess the quality of the service provided and plan improvements. What has improved since the last inspection? The home has now produced a statement of purpose and service users` guide. These give people clear information about home the home operates and the services that are provided. Staff meet with the manager regularly and are supported to do their jobs effectively. Equipment in the home is regularly checked and serviced to ensure it is safe to use. What the care home could do better: There are no areas identified in this report that the home must take action to improve. There are good systems to identify shortfalls and plan improvements. These plans should be implemented. CARE HOMES FOR OLDER PEOPLE Tegfield House 24 Chilbolton Avenue Winchester Hampshire SO22 5HD Lead Inspector Craig Willis Key Unannounced Inspection 28th March 2008 09:15 X10015.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 Tegfield House DS0000060876.V359477.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. 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. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tegfield House Address 24 Chilbolton Avenue Winchester Hampshire SO22 5HD 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) 01962 854600 tegfield@hartfordcare.co.uk Hartford Care Ltd Mrs Shirley Ann Bartlett Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 24. Date of last inspection Brief Description of the Service: Tegfield House is a care home registered to provide accommodation and support for up to twenty-four older people. Hartford Care Limited owns the home. Tegfield house is situated in a quiet residential area of Winchester, within easy reach of local amenities. The home comprises of twenty-four single bedrooms, most of which are en-suite, a large lounge, dining room and a room that is used for the hairdresser when she visits. The accommodation is located over two floors and there is a passenger lift. The home has a large, secluded wellmaintained garden. The range of fees range from £461 to £620 per week. Additional charges are made for items such as newspapers, hairdressing and chiropody. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The evidence used to write this report was gained from a review of the information the provider sent to us since the last visit and the previous inspection report. This information included incident reports and an annual quality assurance assessment. A site visit to the home was made on 28 March 2008. During the visit we spoke with people who live in the home individually and in a group. We also spoke with the manager and staff on duty. The communal areas of the building were viewed and documents relating to the running of the home were inspected during the visit. What the service does well: There are good systems to assess people’s needs before they move into the home. This helps to assure people that the home will be able to meet their needs. People’s needs are set out in clear care plans, which they have been involved in writing. This gives staff the information they need to provide the right care. People are able to attend the health services they need and there are good systems to safely manage people’s medication. The home provides a good range of activities to meet people’s different needs and there is a good choice of food that people generally like. People are supported to keep in touch with their family and friends and visitors are made to feel welcome. There are good systems to deal with complaints and respond to allegations of abuse. This gives people confidence that any complaints they make will be taken seriously and investigated. The home is well maintained and provides a homely, comfortable and safe environment for people. Staff are thoroughly checked, well trained and there are enough of them to meet people’s needs. There are good systems to assess the quality of the service provided and plan improvements. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems to assess people’s needs before they move into the home and give them information about how the home operates. This helps to assure people that the home will be able to meet their needs. EVIDENCE: The manager reported in the annual quality assurance assessment for us that people are not admitted to the home before they have had a full needs assessment. We looked at the files of five people who live in the home during the visit. Each person had an assessment of their needs that was completed before they moved into the home. This assessment included people’s mobility, personal care, social, spiritual and cultural needs. People spoken with who live in the home said they were able to visit before they decided whether to move in and were reassured that the home would be able to meet their needs. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 9 A requirement was made following the last inspection that the home must provide a statement of purpose and service users’ guide. These documents have now been written and are given to people in a welcome pack when they move into the home. Copies of the documents are available in the entrance area of the home and provide clear information about the way the home is run and the services that are provided. The home also produces a newsletter, which gives details of events that have happened in the home. Fourteen people who live in the home completed a survey for us; thirteen said they received enough information about the home before they moved in so they could decide whether it was the right place for them. One person said they did not receive enough information but did not give any details of what else they would have liked. The home does not provide intermediate care, therefore standard six is not applicable. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are set out in good care plans, which give staff the information they need to provide the right care. Health care needs are well met and there are good systems to manage people’s medication, which helps keep them safe. EVIDENCE: The files of five people who live in the home were inspected during the visit and all contained a care plan. The care plans had been developed from the initial needs assessments and set out how these needs should be met. The plans include an assessment of any risks identified, for example concerning people’s mobility or how they take their medication. The risk assessments contain action that should be taken to minimise the risks identified. All of the care plans seen had been reviewed each month, with amendments made where people’s needs had changed. A requirement was made following the last inspection that people must be involved in the development and review of their care plans. People spoken with confirmed that they had been involved in Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 11 developing the care plans and said the information in them was accurate. People had signed the plans where possible. The manager reported that she is working to make the care plans more person centred and less ‘clinical’. Additional information about people’s history and lifestyle is currently being collected so that plans can give a fuller picture of people’s needs. Staff spoken with said they found the information in the assessments and care plans to be accurate. Records inspected demonstrated that people have access to a range of health services, including GP, district nurse, dentist, chiropodist and optician. Records of visits were kept in people’s file and included any advice from the practitioner. Most people spoken with said they were able to see their doctor when they need to, although two people were concerned that their doctor did not always visit when they wanted them to. These people did say that the home staff would always help them to phone the doctor when they need to. People who live in the home are able to control their own medication, following an assessment that this is safe. Where people are not able to, or don’t want to control their own medication, it is administered by staff who have completed training. Medication held by the home is stored in a locked trolley and cabinets and most tablets are provided in blister packs. A specific fridge is used for medication that must be refrigerated. The fridge is checked twice a day to ensure it is operating at the correct temperature. The medication administration record for the current month was inspected and had been fully completed. This gives a record of medication that has been received into the home and when staff have supported people to take their medication. At the time of the visit some people were prescribed controlled drugs. These were separately recorded in a controlled drug register and stored in a controlled drugs cabinet. The records for one person were checked and the balance recorded matched the tablets held. People spoken with said staff treat them well. All fourteen people who live in the home that completed a survey for us said staff listen to them and act on what they say. During the visit staff were observed responding to people in a manner that maintained their privacy and dignity, for example waiting for a reply before entering a bedroom and taking prompt action to arrange pain relief for a person who requested it. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good range of activities to meet people’s different needs and provides a choice of good food that people generally like. People are supported to keep in contact with their family and friends and visitors are made to feel welcome. EVIDENCE: The home has a staff member responsible for co-ordinating the activities provided. People are asked what activities they would like and a monthly programme is produced, so people can plan what they would like to take part in. As well as group activities, time is set aside for one-to-one activities, for example staff are supporting one person to complete crosswords. Most people spoken with said they liked the activities that are organised, although one person said they felt there should be more one-to-one activities. The manager reported that following feedback about the activities programme, additional outings and one-to-one contact was being planned. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 13 The home has an open visiting policy, with visitors able to come to the home at any time. Details of the visiting arrangements are set out in the statement of purpose. Thirteen relatives completed a survey for us. Ten said they were kept informed about important issues affecting their relative and three did not answer the question. People spoken with during the visit said their relatives were always made to feel welcome. People spoken with said they were able to decide how they spent their time and what activities they took part in. People are able to practise their religion, with spiritual leaders made welcome in the home, for example so that people can receive communion. Support is also provided for people to travel to places of worship if they wish. The home has a menu that is planned each week and provides a choice of two meals. People spoken with said the lunch options were very good and confirmed that alternatives were available if they wanted. People were less positive about the supper choices. The manager reported that she has asked people for alternatives to the current supper options, but there has been little feedback. Details of people’s specific dietary needs were included in the care plans. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems to deal with complaints and respond to allegations of abuse. This gives people confidence that any complaints they make will be taken seriously and investigated. EVIDENCE: The home has a complaints procedure, which is included in the service users’ guide and displayed in the home. Since the last inspection the procedure has been given to all people who live in the home to ensure they are aware of what to do if they wish to make a complaint. The home has received four complaints in the last year. These concerned the way a staff member was working, access to health services and fees. The complaints were investigated and records were available of the findings. The people who made the complaints were written to with the findings of the investigations and the action that the home was going to take. People spoken with during the visit said they were confident any complaints they made would be taken seriously and investigated. Fourteen people who live in the home completed a survey for us. Thirteen said they are aware of the home’s complaints procedures. The home has procedures in place to respond to allegations of abuse and staff have received training in the safeguarding adults procedures. Staff spoken with demonstrated a good understanding of different types of abuse, signs that Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 15 someone may be being abused and what to do if abuse is witnessed, reported or suspected. One incident has been referred to adult services under the safeguarding procedures since the last inspection. This was fully investigated and action taken against the member of staff concerned. Records of the allegation, investigation and response were available for inspection. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a homely, comfortable and safe environment that meets people’s different needs. EVIDENCE: All of the home’s communal areas were inspected during the visit. All areas were clean and well maintained. There is a large lounge, which can be divided to create smaller spaces for activities. People said the home is kept clean all of the time and their bedrooms were very comfortable and had all that they needed in them. All fourteen people who live in the home that completed a survey for us said the home was always or usually fresh and clean. The home has a maintenance person and staff reported that maintenance is completed quickly when required. There is a large, well-maintained garden, with areas that are accessible to people with greater mobility needs. Following Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 17 consultation with people who live in the home a woodland walk has been built in the garden, with level paths suitable for people who use walking aids and seating areas. An aviary has also been built in the garden and people said they enjoy going out to see the birds. People who live in the home were also consulted over re-decorations to the lounge and about the choice of soft furnishings. The home has a separate laundry room, with machines capable of washing soiled clothes if necessary. There are infection control procedures in place and hand washing facilities in the laundry room, kitchen, toilets and bathrooms. Staff are provided with protective clothing, for example gloves and aprons, and were seen using them during the visit. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are thoroughly checked, well trained and employed in sufficient numbers to meet people’s needs. EVIDENCE: The home has four care staff including a senior between 8am and 2pm, three care staff including a senior between 2pm and 8pm and two care staff between 8pm and 8am. There are two housekeepers and one laundry staff between 8am and 2pm. In addition, there is a deputy and the manager who will cover care duties if necessary. Most people spoken with said they thought there were enough staff to meet their needs, although some thought staff did not have enough time to stop and talk to them as they were too busy. Of the fourteen people who live in the home that completed a survey for us, five said staff were always available when they need them, eight said staff were usually available when they need them and one said staff were sometimes available when they need them. Staff spoken with said they thought there were sufficient staff on all shifts. The manager reported that the home has recently been a little short staffed, particularly housekeeping staff. Recent recruitment has resulted in all the staff vacancies being filled. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 19 The manager reported that all staff working in the home have had suitable preemployment checks. The records of two staff employed in the last year were inspected and contained confirmation that a Criminal Records Bureau disclosure had been obtained, confirmation that the person was not on the protection of vulnerable adults list as unsuitable to work in a care home and two written references. Staff complete a twelve-week induction when they start work, which must be completed for them to pass their probationary period. Eleven of the twentyfour care staff have completed the National Vocational Qualification in care at level 2 or above and four are currently completing the award. The home has a training programme in place, with courses including first aid, food hygiene, fire safety, infection control, moving and handling, risk assessment, safeguarding adults, medicine management, dementia, bereavement and challenging behaviour. Staff spoken with said they thought the training was relevant to their role and gave them skills and knowledge to meet people’s needs. Most people spoken with said staff had the right skills to meet their needs. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified person, who supports staff to do their job effectively. There are good systems to assess the quality of the service provided and plan improvements. EVIDENCE: The manager has completed the National Vocational Qualification in care at level 4 and the registered manager’s award. During the visit the manager demonstrated her knowledge of the service and a commitment to ensure that the service continues to improve. Staff spoken with said they receive good support from the manager. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 21 A requirement was made following the last inspection that staff should have at least six supervision sessions a year. Formal one-to-one supervision sessions are scheduled for each month. Nine staff completed a survey for us, all saying they meet with the manager for support and to discuss how they are working. A senior manager from the company visits the home each month to assess the quality of the service provided. Reports are made of these visits and sent to the manager. The reports contain details of any actions that are required and these are followed up at the next visit. People who live in the home and their relatives are regularly consulted about the quality of the service provided, through both meetings and surveys. The results of these consultations and regular audits are used to create a development plan to improve the service. The manager reported that they do not hold money or act as an appointee for anyone who lives in the home. A requirement was made following the last inspection that documents confirming the safety of the building and equipment must be kept. The manager reported in the annual quality assurance assessment that all equipment in the home is regularly serviced and checked to ensure it is safe. During the visit we sampled servicing records for the fire alarm and extinguishers, gas system and the lifts, which confirmed the manager’s report. Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 22 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tegfield House DS0000060876.V359477.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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