Care Home: The Tower House

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well There are good-sized communal areas for residents to use and the manager and staff promote a family atmosphere for them to enjoy. Staff are focussed on improving what they provide to the people they support. What has improved since the last inspection? The practices for medication administration have improved and now protect the people who live in the home and in receipt of medications. Staff have been trained and provided with the necessary knowledge to identify and protect the people they support from possible abuse or harm. The staff are more aware and have been supported to carry out good control of infection practices that ensure that the possibility of the spread of infection around the home is minimised. The management of the home have started to assess and develop the quality of the record keeping for the care planning to ensure that there is continuity of care that meets the needs of individuals and their choices and wishes. What the care home could do better: They should continue to develop the care planning records to show that they identify the changing needs of the people they support and how they are going to meet them. The management should continue to develop the practices for record keeping and information for the management and administration of the service. This would support them to ensure that they are meeting their responsibilities of providing a safe and comfortable environment for people to live in. It would also ensure that they meet their responsibilities as an employer. CARE HOMES FOR OLDER PEOPLE The Tower House Reading Road Shiplake Henley on Thames Oxon RG9 3JN Lead Inspector Ruth Lough Unannounced Inspection 7th January 2009 10:35 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 DS0000040609.V373652.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. DS0000040609.V373652.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Tower House Address Reading Road Shiplake Henley on Thames Oxon RG9 3JN 01189 401197 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) kiddsinead@yahoo.co.uk Bridget Kidd Bridget Kidd Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places DS0000040609.V373652.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2008 Brief Description of the Service: Tower House is a privately owned care home with large attractive gardens, situated approximately two miles from the town of Henley on Thames. It is on the main road from the town to Reading and on a regular bus route. Mrs Bridget Kidd is the proprietor and registered manager and provides care for up to nine people aged 65 and over who, for one reason or another, are no longer able to live in their own homes. She employs a small team of carers all of whom are responsible for providing care, domestic and catering duties in the home. Agency staff are employed regularly to provide assistance when the need arises and are familiar with the home and the service users. There are a good variety of communal areas including a conservatory and a separate dining room, all situated on the ground floor. The bedrooms are situated on two floors all with en - suite facilities and one on the first floor a double bedroom with an en-suite bathroom. There are two communal bathrooms with walk in shower and assisted bath. Access to the first floor is via staircase and stair lift. Fees from £2700.00 per month. DS0000040609.V373652.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 that people who use the service experience good quality outcomes. This was an unannounced key inspection process that was generated from the poor findings at the last inspection in July 2008 and two subsequent visits to the service. This visit was to review the quality of what is provided, that there are positive outcomes for those living there, and to assess if the legal requirements made to improve the service, have been met. The inspection process included information provided previously prior to the last key inspection in the Annual Quality Assurance Assessment, the findings from the close monitoring carried out by the commission, and a day visit to the service. Records for the care provision to people living in the home, staff employment, and the management of the service were also reviewed. From this key inspection process it was found that the outstanding requirements made previously have been met. A small number of good practice recommendations were made and passed to the manager and deputy manager during the visit and can be found in the body of the report. What the service does well: What has improved since the last inspection? The practices for medication administration have improved and now protect the people who live in the home and in receipt of medications. Staff have been trained and provided with the necessary knowledge to identify and protect the people they support from possible abuse or harm. The staff are more aware and have been supported to carry out good control of infection practices that ensure that the possibility of the spread of infection around the home is minimised. DS0000040609.V373652.R01.S.doc Version 5.2 Page 6 The management of the home have started to assess and develop the quality of the record keeping for the care planning to ensure that there is continuity of care that meets the needs of individuals and their choices and wishes. 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. DS0000040609.V373652.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 DS0000040609.V373652.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): 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users needs are assessed before they are offered a place in the home. EVIDENCE: The care records for two new residents were reviewed to see what the service carries out to identify individuals needs before a decision is made that they will be able to meet them and a place is offered to them to live in the home. For one individual the home who was transferring them to The Tower House, supplied the assessment information they carried out. Additionally, the manager visited the proposed new resident at the home and sought supporting information from the family. The other individual had been, again been visited in hospital, by the manager who undertook an assessment of their needs. DS0000040609.V373652.R01.S.doc Version 5.2 Page 9 From the records we reviewed the homes own assessment document does ask the majority of the necessary information, but could be improved to give greater detail in some areas as to assist with the initial care planning as they move into the home. This was in particular to giving an explanation to yes/no answers for some of the practical activities of daily living, personal choices, and communication. This observation was passed back to the manager during the day of the inspection. From previous information, prospective residents are offered the opportunity to visit the home before making a decision to move there. For these two most recently admitted individuals, this was not possible, although their families were involved with the process of identifying and the choice to use the home. Whilst assessing the care planning records the prepared contract of agreement for one new resident was reviewed. The document content is brief but holds all the required information with the exception of the agreed bedroom location (private space) and the excepted communal areas to be accessible to the resident. The manager was advised to review the contractual document and seek professional advice to assure that both the resident and the service are protected. DS0000040609.V373652.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): 7,8,9,10, and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that the care planning to meet their needs has improved and that the medication practices now do not put them at risk. EVIDENCE: The records for three residents were reviewed as to see what improvements had been implemented with the care planning to support staff deliver the assistance individuals may need. During the previous inspection in August 2008 it was identified that the care records showed good detail about the daily routines of the person concerned but held minimal instruction of how to carry out the support. From two of the records reviewed the deputy manager has improved the current documentation, which has become more personal to the individual and provides instructions for the actions of how staff are to meet their needs. There were a few areas that could be enhanced throughout both documents, DS0000040609.V373652.R01.S.doc Version 5.2 Page 11 with giving more thought to some of the persons health care needs and the monitoring of their wellbeing. The other person who had been resident in the home for two days did not have a formally recorded plan of care in place, although the manager had noted a daily routine for staff to follow. They were reminded that it was in the best interests of the people they support that a basic care plan, however minimal in content it may be, should be put in place as soon as possible to the person coming into the home. It must be noted that through discussion with the manager and staff it was apparent they had already identified key areas of need for the individual concerned and were putting actions to support them. However, they should ensure that what knowledge and understanding of individuals needs is not only handed over verbally to staff it is recorded in detail in the care planning records. Records are kept to support consultations and appointments with health practitioners such as opticians, district nurses, and community psychiatric nurses are obtained. Additional information in the care records includes a fall prevention checklist, pressure sore risk assessment, and the current and changes to the medications an individual is prescribed. For one person there is a Blood Glucose monitoring record. The systems for safe storage, management and administration of medicines in the home were reviewed as they were identified during the previous inspection visit in August 2008 as to be putting the people living in the home at significant risk. The home was subject to two focussed visits, during September and November by the commission as to establish that the manager had put improvements in place and the homes practices were compliant to the regulations. From the records reviewed and an assessment of the practices going on in the home it was evident that the management have implemented the changes required and now have safer process to manage the medication held. An example of the improvements in place is better recording practices for the movement of medications through the home, ensuring safe storage for all medications in suitable facilities and training provided to staff. The deputy manager did state that they had started looking at the most recent guidance and recognised good practices to support them improve how they seek personal choices and wishes about individuals care at the end of their lives. They have yet to incorporate this within the initial care planning fully, DS0000040609.V373652.R01.S.doc Version 5.2 Page 12 although some residents have already provided information about the care they want after their death. The opportunity to speak with residents about their opinion of the service during the day of the inspection was limited as at least half were unwell with a cold/flu virus and others were in the process of recovering. The manager did consult with all of the residents if they would like to speak to the inspector. However, they declined on this occasion. DS0000040609.V373652.R01.S.doc Version 5.2 Page 13 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): 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 people who use the service are given the opportunity to exercise choice over their lives and be able to maintain their interests. The meals and menu planning is based on individuals health needs and personal choices. EVIDENCE: As previously identified the personal choices for individuals daily routines is noted well and gives staff a good picture of how they wish to conduct their lives. The assessment and care planning records reviewed showed that interests, hobbies, and pastimes are identified for the person concerned. How staff support them to achieve them is not noted in detail. This is an area they could develop in the care planning as to assure that staff provide a consistent approach to supporting individuals. There are a small number of communal activities provided that has included during the warmer months a Garden Party, where family and friends can join in. DS0000040609.V373652.R01.S.doc Version 5.2 Page 14 Personal choices for food and any dietary needs are noted briefly in the initial assessment process, this could be seen in the two care records sampled. The meal and menu planning is undertaken by the manager and is based on the choices people express and usually they are offered a selection of two hot meals at midday or alternatives if they so wish. Previously in the survey carried out by the commission in August 2008, residents expressed that the variety and quality of the meals usually suited their needs and that they were able to obtain snacks and drinks between the planned mealtimes if they were hungry. Residents are encouraged by staff to meet for their midday meal for company and conversation in the main dining room. The staff take time to make the presentation of the table and meal pleasant as to ensure that the experience is enjoyable for them. The manager did state that due to the varying health of individuals in the home over the Christmas and New Year period that some of the residents had been to unwell to eat their meals in the main dining room and had remained in their rooms. DS0000040609.V373652.R01.S.doc Version 5.2 Page 15 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): 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 staff working in the home, now have sufficient knowledge and support available to be able to protect the people living in the home from possible harm or abuse. EVIDENCE: The residents and their families are given a copy of the complaints procedure in the Statement of Purpose and Service User Guide in the initial enquiry and when they are admitted to the home. As previously identified during the last inspection by residents, the home continues to have a very positive and open process for individuals to express concerns or worries that appear to be dealt with swiftly by staff. From information provided by the manager and deputy manager they have not received any complaints since the last inspection visit in August 2008. The commission has not been in receipt of any concerns, complaints, or information about the service, either. They have not yet implemented a tool to monitor comments or concerns made to the service overall, they do record any made in the individuals daily records. The quality of the information, training, and information in regard to safeguarding the residents from possible harm and abuse was subject to concern during the last inspection visit. This area along with the weak medication practices generated the two compliance visits in the Autumn of 2008, to check that improvements had been made. From information and DS0000040609.V373652.R01.S.doc Version 5.2 Page 16 evidence obtained during these visits and this inspection it was clear that steps had been taken to improve and ensure that residents are protected. Copies of the local interagency procedure for safeguarding adults from possible harm or abuse have now been made available to staff and training has been provided to them. This was also evident in discussions with staff during the visits to the home and confirmed by training certificates made available. The staff we spoke to now appear to have confidence that they could deal with any concerns raised and able to seek assistance should they need to. Both the manager and deputy manager had had confirmation that they had passed a training course for safeguarding adults in the last few days prior to this inspection. DS0000040609.V373652.R01.S.doc Version 5.2 Page 17 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): 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 kept clean, pleasant, and homely for the people who live there. EVIDENCE: The home is not purpose built but has been adapted to provide a homely, comfortable environment for the nine residents it supports. There is goodsized private accommodation and plenty of communal spaces for people to use. All of which is kept to a pleasant and well maintained standard. The deficits in the some of the practices for the control of infection that were found during the last key inspection process have now been eliminated. With staff undertaking training in infection control and strategies put in place to remove the areas of risk that were identified. Clean linen and disposable sundries, such as paper towels are now stored away from possible areas of contamination such as bathrooms and the laundry DS0000040609.V373652.R01.S.doc Version 5.2 Page 18 room and are kept separate. The home have invested in providing a Red bag system for possible contaminated linen to be handled in the home, therefore reducing the possibility of the spread of infection. Staff have also looked at improving their practices and have included daily checks for the bedrooms, bathrooms, and toilets to ensure that the facilities are kept to a high standard. DS0000040609.V373652.R01.S.doc Version 5.2 Page 19 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): 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. The people who use the service can be confident that they will be supported by, a consistent and trained team of staff. EVIDENCE: From the information provided by the manager and deputy manager there has been no changes in the staff employed in the home since the last key inspection. The deficits identified previously about the records for recruitment and employment have been partially addressed by a review of the current employment records held and the development of a new application form in preparation should they need to recruit new staff. The records for two staff were revisited during this inspection, one had been employed early in 2008, and one has been supplied on a long-term contract from a local employment agency. From these records it was evident that the management of the home have started to review how the obtain and keep information to support the employment of staff in the home. The files are now more organised and efforts have been made to ensure that some of the gaps in information found previously, closed. The home now has now sought confirmation from the supplying agency about the recruitment and checks they have carried out on the member of staff they provide and the training the individual has obtained. DS0000040609.V373652.R01.S.doc Version 5.2 Page 20 The manager confirmed that she has completed her RMA(Registered Managers Award). The deputy manager also stated that she was about to commence on a new training course, Leadership and Management for Care Services Award which replaces the RMA(Registered Managers Award). The most recently employed member of staff has now commence on NVQ 2. The employment records reviewed showed that all of the care staff, including the individual supplied by the agency, do have regular formal supervision by the senior staff and that key information about training and development are beginning to be obtained. DS0000040609.V373652.R01.S.doc Version 5.2 Page 21 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): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home has improved and has ensured that the safety and well being of the people living there, is better protected. EVIDENCE: The management of the home has not changed since its first registration, nine years ago. The Registered Manager continues to take the lead in the day-today delivery of the service to the residents, ensuring that the practical provision of care meets their needs. The deputy manager over the last six months has been improving her skills in developing some of the administration and record keeping for the service. The manager remains living in the homes premises and reconfirmed that residents and relatives found this reassuring that she was contactable easily. DS0000040609.V373652.R01.S.doc Version 5.2 Page 22 The staff are gradually building on the processes for assessing and monitoring the quality of the support they provide. The deputy manager stated that they were in the process of a formal consultation with the people living and visiting the home to seek their opinion of what is provided. This is in preparation for the end of the financial year and planning for the development of the service. The advice given at the last key inspection about developing audit processes for the management and administration of the service have been listened to. This could be seen by the checks made on the environment of the home, medication administration, and the regular supervision of staff. The deputy manager has started looking at improving some of the key policies and procedures that were previously weak in places. They were advised again to look at developing their policy and procedure for risk assessments as to ensure that they can improve the quality of the processes carried out. The manager has made sure that all the relevant safety checks have been implemented, including those for the gas, water, and electrical equipment used in the home. However, the documented information about the chemicals used in the home that should be stored under Control of Substances Hazardous to Health Regulations (COSHH) are scanty and the manager needs to keep the required safety information accessible to staff and that which is relevant to the products they use. All items used are stored securely and are not accessible to the people who live in the home. DS0000040609.V373652.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000040609.V373652.R01.S.doc Version 5.2 Page 24 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 DS0000040609.V373652.R01.S.doc Version 5.2 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000040609.V373652.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!