Care Home: Tenchley Manor

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What the care home does well Care needs are assessed, kept under review and met. There is an excellent activities programme in the home. There is effective communication to residents, relatives and friends. People confirmed that they have a choice of good food. There are good training opportunities in the home and the provision of National Vocational Qualification level 2 and above is excellent. The management of the home is excellent being open and supportive and mindfull of the wishes of the people who live there at all times. What has improved since the last inspection? This was the first visit to a new registration of an existing service and a large extension and a building programme has commenced. What the care home could do better: The home is functioning well in all areas. Key inspection report Care homes for older people Name: Address: Tenchley Manor Ursula Square Selsey Chichester West Sussex PO20 0HS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 23 Information about the care home Name of care home: Address: Tenchley Manor Ursula Square Selsey Chichester West Sussex PO20 0HS 01243606060 01243607816 tenchley.manor@cheerhealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cheerhealth Ltd Name of registered manager (if applicable) Miss Amanda Bessey Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 1. The registered provider may provide the following category/ies of service only: Care Home with Nursing (N) - to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category -(OP) Physical disability (PD) The maximum number of service users to be accommodated is 35 Date of last inspection Brief description of the care home Tenchley manor is a care home situated close to the sea in Selsey. It provides nursing and personal care for up to 35 older persons. The building is a large detached two-storey property, which has been converted and extended for its current use. It provides private accommodation located on the ground Care Homes for Older People Page 4 of 23 Over 65 35 0 0 35 Brief description of the care home and first floors. A passenger lift provides access upper floors with a stair lift to two rooms not accessible by the main lift. It has a large comfortable sitting/dining room and a conservatory. It is owned by Cheerhealth Ltd, the responsible individual is Mr Reginald Michael Bullock and the registered manager is Amanda Bessey. The fees charged are £650-£900 Care Homes for Older People Page 5 of 23 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 site visit as part of the inspection process took place on 17/11/09 and was undertaken by a lead inspector from the Care Quality Commission and was facilitated by the registered manager. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home and any documents required on the day were made available. We were in receipt of six surveys from people who use the service, two from staff and three from professionals. All expressed great satisfaction with all aspects of the home. Four people who use the service, one relative and five staff were involved in the Care Homes for Older People Page 6 of 23 inspection process. People who use the service spoken with stated that they are happy in the home and that they enjoy the lifestyle and the food. There is a varied activities programme in the home and all of the surveys received expressed satisfaction with the activities on offer. Staff spoken with on the day stated that they were happy working in the home that the management was very supportive, and that there were many training opportunities. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 8 of 23 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 9 of 23 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. Peoples needs are fully assessed prior to admission. Evidence: People who use the service are fully assessed prior to admission to the home. All medical, nursing and personal care need is assessed and recorded. This includes physical and mental health needs, continence, mobility and dexterity,communication and oral and foot care. Social need and carer and family involvement is recorded. Four people who use the service were case tracked and their pre admission assessment was present in the care plans. The AQAA stated that they continue to meet this standard on pre admission assessment and that there is a policy in place for emergency admissions. People and/or their representative are encouraged to visit the home prior to admission. An up to date statement of purpose and service user guide is available.The service user guide contains the complaints procedure, information on safeguarding adults and information on good nutrition. Care Homes for Older People Page 10 of 23 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. Peoples needs are assessed, recorded and met. Evidence: Four people who use the service were case tracked and their documentation was inspected, two of these people were spoken with. All had a plan of care to meet assessed needs. Assessed need covered wound care, body map and all daily personal and nursing care. There are daily records and monthly review. The manager stated that they follow a nursing model in their care planning and this was evident in the plans. There were plans for sleep, elimination, breathing and circulation, skin care, medication management, hygiene. Expressing sexuality , relationships and social needs are recorded. Risk assessment is recorded such as risk of pressure wounds and the use of slings and hoists. There is suitable pressure relieving equipment in place and it was being used correctly. Care Homes for Older People Page 11 of 23 Evidence: People who use the service have access to local health services. A company visits the home to carry out vision and hearing tests but people who prefer to go into town for this may do so. Surveys received from people who use the service and comments from their relatives all expressed satisfaction with the home. Some comments were They meet my needs as an individual, Look after my needs, They notify me about any problems, The home takes great care of mother. A professional from a local hospice who returned a survey commented that the staff worked collaborately with the hospice and the person using the service received excellent care The AQAA stated The Care Plans will carefully document the actions members of Staff are required to take along with the specialist equipment needed to provide the specific support and assistance each resident individually requires whilst upholding the ethos of privacy,respect, dignity and choice. We ensure staff are made aware and understand the agreed plan of care and this can be evidenced in training records. Throughout the visit staff were observed interacting with people who use the service in a respectful manner. Medicines are received, recorded and correctly stored in the home. Medicine administration charts were up to date. Controlled drugs are correctly stored and records and drugs were accurate. Fridge temperatures were recorded. There has been a recent safeguarding investigation where it was substantiated that an error had been made on a medicine administration chart but not substantiated that the medicine had been administered. All of the registered nurses are attending a medicines course accredited by Epsom University and the pharmacy has provided two training sessions in the home. Care Homes for Older People Page 12 of 23 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 lifestyle in the home suits the people who live there. Evidence: The routines in the home are flexible with people having the choice of where to eat and when to go to bed. Visitors are welcome in the home and facilities are available for relatives to stay if a person using the service is ill. There is a church visit once a month. There are varied activities in the home with three activities coordinators providing activities at various times six days a week. These include sing along with guitar, physio to music, games, quizzes, pat a dog, trips out to the town, to the shops, pubs and clubs, a mini bus is hired from time to time to go on trips to local places of interest and there are movie afternoons. People can go for walks on the beach. There are also one to one activities as well as group activities. There are photograph displays of many events on display and a folder for one person who was 100 years old was seen with photographs, cards, the Queens telegram and a newspaper cutting. People spoken with stated that they were happy with the activities in the home as did a relative spoken with who stated There is always a lot going on. Surveys received were all positive, one survey commented it is a bonus having the sea so close. Those Care Homes for Older People Page 13 of 23 Evidence: able to do so can walk to the shops. Two people use a motorised wheelchair. Peoples social activities are recorded and care plans recorded the need to encourage socialising in the home and peoples views are sought at monthly residents meetings. The chef was spoken to and there is a four week menu in place. The service user guide contains information on a healthy diet and this is also displayed on the notice board. Two hot choices are provided for lunch and people are asked daily which choice they want the next day. There is always soup and a hot choice in the evenings. The food served on the day was well presented, nutritious and people said it was very nice. One person spoken with stated The lamb was very tender. People requiring assistance were offered this discretely. The chef stated that the menu is kept under review. People are asked at residents meetings what changes they would like. Likes and dislikes are recorded and there is a folder in the kitchen with information on specialist diets. The home is meeting the requirements of the recent environmental health authority inspection. Care Homes for Older People Page 14 of 23 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. Complaints are listened to and acted on and people are safeguarded from abuse. Evidence: There is a complaints procedure in place and surveys received indicate that people know how to make a complaint. One relative spoken with on the day stated that she would know how to make a complaint and that any concerns would be addressed. There is a complaints procedure in place and the procedure was on display. There is a folder with many letters of praise and compliments. The AQAA states that 2 complaints have been received and resolved within timescales. All people who returned surveys answered yes to the question Do you know how to make a formal complaint. Safeguarding policies and procedures are in place as is safeguarding adults training for staff and training records were seen. Staff spoken to demonstrated an awareness of safeguarding adults procedures. There have been two safeguarding adults investigations, one regarding medicines was partly substantiated and the other which the home had raised when anomalies in one persons funding and finances were found, at the time of purchasing the home. We await an outcome from West Sussex Adult Services on this. Advocacy numbers were on display in the foyer. Care Homes for Older People Page 15 of 23 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. People live in a safe and well maintained environment. Evidence: The home on this occasion was neat, clean and free from offensive odours. There are comfortable and well maintained communal areas with a large sitting/ dining room and a conservatory. The furniture and fittings are homely in style and are of good quality. The home is currently undergoing a large building and refurbishment programme which although will increase numbers by only two, it will create seven new en suite rooms of generous dimensions. It will increase the communal space and will present staff with a working environment that enables better access to provide nursing care to people who use the service. People who use the service have been kept fully informed of this building work. People can personalise their rooms as they wish and there is storage space throughout the home. There is a permanent maintenance man who is responsible for carpet cleaning as well as maintenance work. He also maintains water temperatures and these were up to date. There are suitable toilet and bathing facilities throughout and the laundry has machines with the necessary programmes to prevent the spread of infection. Care Homes for Older People Page 16 of 23 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. The needs of people who use the service are met by a suitably qualifies and motivated staff. Evidence: There were suitable numbers of staff on duty to meet the needs of people who use the service. There is always a registered nurse on duty. There is kitchen, housekeeping and maintenance support. There is a keyworker system in place. Staff files inspected had evidence of identity, Criminal Records Bureau clearance and POVA first. Nursing and Midwifery Council (NMC) Personal Identification Number was on file for registered nurses and current. Surveys received and people who use the service spoken with all stated that the staff are kind and caring.One commented They take great care of residents another commented I am impressed by the way they answer bells. A professional survey received commented The home ensures staff are up to date. There is a training programme in place and evidence of staff training was seen. Induction is in place. As well as mandatory training there is additional training on dementia, pressure care, palliative care, challenging behaviour, mental capacity act and medication. Some registered nurses take a lead in areas such as diabetes, palliative care or learning disabilities and these staff have had training in these areas. Registered nurses update their clinical skill by attending training in catheterisation. wound care and phlebotomy. Care Homes for Older People Page 17 of 23 Evidence: 98 of care staff have attained the National Vocational Qualification level 2 or above in care. Staff spoken with on the day expressed satisfaction with the support, training and management in the home. A survey received from a staff member commented They give the staff adequate training to meet clients individual needs. Care Homes for Older People Page 18 of 23 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. The management of the home is open and the home is run in the best interests of the people who live there. Evidence: The registered manager is a registered nurse with many years experience and holds the registered manager award. She has been in post for three years and transferred to the new provider when Cheerhealth Ltd took over in May of this year. She stated that there have been many improvements in the home since the new provider took over. The AQAA states that there are clear lines of accountability and responsibility in place to ensure decisions are made swiftly and efficiently for the benefit of people who use the service and staff. A professional survey received stated that The home is well organised, the manager is excellent and communication is excellent. There is an awareness of diversity in the home and disability in staff is not a bar to employment. Staff spoken with on the day all expressed satisfaction with the management of the Care Homes for Older People Page 19 of 23 Evidence: home, they stated that they were well supported and that there were good training opportunities. Two surveys received from staff were both positive. One commented I think the home meets all the high standards that are required and the other commented It is a good working environment, understanding and helpful management. Staff are generally quite happy There are monthly meetings for people who use the service to elicit their opinions on matters in the home and people spoken with confirmed this and stated that they feel involved in decisions in the home. The home also sends out surveys to people who use the service and relatives. People spoken with stated that they have been kept informed on the building programme in the home. The registered manager stated that she is introducing a resident representative group. The AQAA was returned to us when we asked for it and it contained comprehensive information on the service. Staff supervision is in place and is up to date. Staff spoken with confirmed supervision. The AQAA states that staff handbooks are available to staff at all times. The ethos of the home is open and the home has cooperated fully with West Sussex Adult Services in recent safeguarding investigations. A medication recording error has resulted in increased training for registered nurses and the pharmacy has provided two training sessions in the home for all staff. The home does not manage or hold any monies for people who use the service and people able to do so hold and manage their own accounts. The health and safety of people who use the service is promoted and protected by the provision of policies, procedures, induction and training. The responsible individual regularly visits the home to monitor the environment and practises in the home. Water temperatures are monitored in the home and the home is meeting the requirements of the local fire and environmental health authorities. Care Homes for Older People Page 20 of 23 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 21 of 23 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 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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