Care Home: Thomas Tawell House

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What the care home does well Residents and relatives who completed the questionnaires made many very positive comments about the home including: `the staff seem to be very experienced`; `comparing Thomas Tawell House with many other like institutions I visit in my professional capacity, I do not see where any need for improvement exists at present`; `a well run home giving excellent care`. The specialist needs of visually impaired residents are well met at the home. A varied and interesting menu is provided with residents` specialist dietary requirements catered for. One relative stated `my mother belongs to a religious group with strict dietary rules. These are always observed, giving her piece of mind`. What has improved since the last inspection? A requirement that the deputy manager undertakes training appropriate to her role has been met. She has recently completed and NVQ level 3 in care that will give her the skills and knowledge to look after residents. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Thomas Tawell House Magpie Road Norwich Norfolk NR3 1JH Lead Inspector Janie Buchanan Unannounced Inspection 30th May 2007 09:30 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 Thomas Tawell House DS0000027299.V341905.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. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thomas Tawell House Address Magpie Road Norwich Norfolk NR3 1JH 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) 01603 629558 01603 766682 office@nnab.co.uk Norfolk & Norwich Association For The Blind Mrs Sharon Patricia Gaul Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Sensory impairment (37) of places Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 37 residents up to five at any one time may be between the ages of 50 and 65 4th January 2006 Date of last inspection Brief Description of the Service: Thomas Tawell House is a partially two-storey building that is run as a residential care home for thirty-seven older people who are partially sighted or blind and forms part of the facilities of the Norfolk and Norwich Association for the Blind. The Home is recognised as a specialist provider by Norfolk County Council. An extensive refurbishment programme in 2000 has provided excellent facilities for service users in thirty-two single rooms with en-suite facilities. There are four single rooms with lavatories and washbasins and one room with a washbasin. The home has a passenger lift to the first floor and contains all the equipment and adaptations to make life safe and comfortable. There is communal access to five lounges (including a quiet room), a dining room, six bathrooms, one shower room, nine toilets and a telephone kiosk. The Home is located in the well-kept grounds of the Association next to the Equipment and Information Centre and a building called The Allen Centre. The Allen Centre is a place where craft, IT, Living Paintings Trust, Braille and Moon classes are taught. There is a small amount of parking to the front of the building and the home is situated close to local health and shop facilities and is within walking distance of the city centre of Norwich. Charges vary between £379 and £435 per week. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection and was unannounced. The inspector spoke with four residents, three members of staff and the manager. A brief tour of the building was also undertaken and a range of documents were viewed. Twenty two completed comment cards from residents, their relatives and health professionals were also received. This is an excellent response and shows that the home actively seeks the views of people who use its services prior to an inspection. The vast majority of respondents showed a high degree of satisfaction with the quality of care provided at Thomas Tawell House, although two relatives reported that some carpets were worn and dirty and another reported that staff looked rushed off their feet sometimes and a resident reported that her laundry occasionally goes missing. Seven requirements and two recommendations have been made as a result of this inspection. What the service does well: What has improved since the last inspection? A requirement that the deputy manager undertakes training appropriate to her role has been met. She has recently completed and NVQ level 3 in care that will give her the skills and knowledge to look after residents. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 6 What they could do better: • Although each resident has a care plan, the practice of involving residents in its development and review is poor. The plans were not reviewed as often as recommended and this means changes in residents needs may not be picked up quickly. The information contained in some plans was very basic and did not provide enough information for staff to look after residents comprehensively and consistently. Residents should be weighed and assessed regularly so that their weight, health and nutrition can be monitored. The home’s recruitment procedures need to be more robust to ensure that only the right people look after vulnerable adults. No member of staff must be employed until two written references and a full CRB have been received. All staff must undertake training in food hygiene so that when they prepare light snacks for residents, and assist them with feeding, they do it safely and hygienically. Activities for those who spend a lot of time in their bed need to be developed so that all residents have access to stimulation and entertainment. Staff must be supervised more frequently so that their working practices can be assessed and their training needs identified. Large amounts of residents’ cash should not be kept in the home and action should be taken to pay the money into residents’ own bank accounts so that interest can be accrued. • • • • • • 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. Thomas Tawell House DS0000027299.V341905.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 Thomas Tawell House DS0000027299.V341905.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): 1,2,3,4 Quality in this outcome area is good. There is good information about the home to help residents decide if it is where they want to live. Residents’ needs are assessed before they move in so they can be assured that the home can meet them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose and Service User Guide that give good information about the home, although references to the National Care Standards Commission must be updated to read the Commission for Social Care Inspection so that residents are aware of the right organisation to contact. This information is available in Braille and on audiotape and there is also a website about the home. Residents and their relatives are encouraged to visit prior to their admission to assess the home’s facilities. One relative commented about his mother’s admission to the home: ‘The team at Thomas Tawell met us, gave us the assurance of being heard (and thoroughly checked out) and offered a place-making all clear throughout as to what was involved’ Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 9 Each resident is issued with a contract that gives details of the fees to be paid, the services on offer at the home and how to terminate the contract. Thomas Tawell House DS0000027299.V341905.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): 7,8,9,10,11 Quality in this outcome area is adequate. Care plans do not give enough information about residents’ individual social, personal and health care needs. Residents receive help from staff in a respectful and appropriate way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents were not actively involved in drawing up and reviewing their plans of care and staff reported that residents’ ‘rarely’ or ‘never’ get to see their plans. The inspector showed two residents their care plans: both stated that they had never seen them before, despite both being very able to read and understand their plans. None of the plans had been signed by residents and none had been reviewed monthly. Detail in the plans was poor. For example in one plan it stated that a resident needed assistance to transfer from a chair. No other information was given as to what assistance was required, whether it was from one or two staff, whether equipment was needed or actually how to move the resident. In another plan it stated that staff had to monitor urine output for the resident. However, no monitoring chart had been implemented and no record of the output was actually kept. In two plans residents’ social histories and cultural needs had not been recorded. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 11 A GP visits the home every Tuesday, (and also when required), to attend to residents, a chiropodist every 6 weeks and an optical health care company visits yearly to conduct eye tests. Staff can accompany residents to hospital appointments for a charge. One of the home’s GPs completed a questionnaire and stated ‘they care for the individuals very well and use health care services appropriately’. One relative commented: ‘my father is very well looked after and is in a much better condition than he was last year when still at his home’. Some staff have received training in Parkinson’s Disease and Multiple Sclerosis so that they better understand the needs of those residents with these conditions. However it was of concern that residents are not weighed regularly and no nutritional screening is completed, despite some frail residents being clearly at nutritional risk. A requirement that residents be weighed is outstanding from the last inspection. Information regarding training on this topic has been provided to the home. Residents reported that staff treat them well and the inspector witnessed a member of staff knock loudly on a bedroom door, and waiting for the resident’s response before entering it. Interactions between staff and residents were observed to be respectful and appropriate. The medication round, observed during lunch, was carried out with due regard to the wishes and dignity of residents. A sample of medication administration records were checked and, on the whole, were found to be satisfactory although in one instance a tablet had been signed as having been given to a resident, but was in fact still in the blister pack. No explanation for this could be found. Although the home’s policies and procedures in relation to death and dying were not assessed on this occasion, one relative was very appreciative that two members of the home’s staff attended his uncle’s funeral recently. Thomas Tawell House DS0000027299.V341905.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): 12,13,15 Quality in this outcome area is adequate. Residents’ family and friends are made welcome at the home. However recreational and social activates for frail residents who spend their time in bed could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are activities for those who are more able. Shove Halfpenny is played on a Thursday night; exercise classes are held and a men’s discussion group has recently been established. There is craft group on a Tuesday and once a fortnight three residents attend the Rainbow Club (a specialist deaf/blind club in Norwich). Many residents receive Braille literature, RNIB Talking cassettes and books from the home’s own specialist library. However, there was little evidence that appropriate activities are provided for those residents who are frailer. One resident told the inspector ‘I just stay in my bed all day and watch TV, nothing else’. Another; ‘I would like more stimulation for people like my mother who are unable to reach from their bed to choose talking books and music CDs’. Residents told the inspector they regularly receive visitors and have the opportunity to entertain them privately if they want. One relative wrote: ‘I cannot speak highly enough of all the staff who not only care for my mum, but also the welcome and hospitality I receive on my visit’. Another reported that, Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 13 ‘visitors are welcome at all times, and care regimes are applied to fit around regular visiting schedules wherever possible’ Residents confirmed that they are always given a choice of what to eat and lunch on the day of inspection consisted of chicken curry or savoury mince or mushroom soup. The food looked plentiful and nutritious and the cook showed a good awareness of residents’ differing dietary requirements. Resident’s individual requirements are met at the home. One relative commented ‘my mother is a member of The Church of Jesus Christ of Latter Day Saints’ (Mormon’s) and once explained, Thomas Tawell House was able to allow for her dietary requirements’. Thomas Tawell House DS0000027299.V341905.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): 16, 18 Quality in this outcome area is good. Residents’ concerns and complaints are taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure was on display in the home but references to the National Care Standards Commission must be update to the Commission for Social Care Inspection so that residents are aware of the right organisation to contact should. Concerns are addressed and one relative commented:’ any requests we have made have been actioned fairly quickly’ Residents spoken to felt able and confident about raising concerns. A copy of the ‘Vulnerable Adults At Risk of Abuse’ policy was on display on the home’s notice board and staff stated they had received training in protecting vulnerable adults. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 15 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): 19,20,22,26 Quality in this outcome area is good. Residents live in a safe, comfortable and well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been specially designed to meet the needs of people with visual impairments. It was clean, well maintained and free from strong smells on the day of inspection. All bedrooms are single with ensuite facilities and each room has a telephone and television point. There is a dedicated games/crafts room and a reading room that is equipped with specialist equipment to help those with visual impairments, as well as numerous aids and adaptations to help residents remain independent. There is a large courtyard area furnished with wooden tables and chairs where residents can enjoy fresh air and sun. One resident told the inspector she particularly enjoys a morning walk outside in the home’s grounds. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 16 Infection control is good and one member of staff spoke knowledgeably about the extra infection control practices implemented at the home for residents with MRSA. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome area is good. Staff in the home are trained and in sufficient numbers to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a minimum of four staff on each day between 7am and 9pm and two ‘waking’ staff on at night to meet the needs of 37 residents. Scrutiny of the duty rota showed these levels to be maintained. Although this resident to staff ratio is high, residents reported that staff were available when needed and that they rarely waited long for help. The home does rely on agency staff to cover vacant shifts and it was of concern to note that one agency member of staff had worked a 14-hour shift on a Saturday and followed by another 14-hour shift the next day. Staff training is good and 70 of staff hold an NVQ level 2 in care: this exceeds the national minimum standard. In addition to mandatory training staff also receive training in deaf/blind awareness. Staff reported that the training they receive equips them to do their job well. The personnel files of two recent employees were checked. One member of staff had started working at the home with only one reference having been received and whilst still awaiting a CRB disclosure. Although a POVA first check had been completed the member of staff was working unsupervised. This puts residents at unnecessary risk. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 18 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): 31,33,35,36,38 Quality in this outcome area is good. Residents live in a well run home where their health and safety is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager holds appropriate qualifications for her role including an NVQ level 4 in management, BTEC Higher Diploma in Management of Care Services and is an NVQ assessor. Staff described her as experienced and empathetic. The deputy manager holds an NVQ level 3 in care. A sample of residents’ monies was checked and the amount and purpose of all financial transactions undertaken on behalf of them was recorded appropriately. However, it was of concern to note that large amounts of cash were held on behalf residents. Although this money is kept securely in a safe, the amount should be significantly reduced or transferred into residents’ own bank accounts so their money can accrue interest. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 19 Supervision records checked showed that staff were not receiving supervision as frequently as recommended, and the deputy manager had never received formal recorded supervision from her manager. Despite this, however, staff reported that they felt supported by the management team and that regular staff meetings were held. Regular residents’ meetings are held and the home seeks feedback about the quality of its service by sending out detailed questionnaires to relatives and visitors to the home. Records in relation to a number of health and safety issues (fire, electrical wiring, hoist servicing and portable appliance testing) were checked and found to be of a good standard and routinely completed. Training records checked showed that staff had received up to date training in moving and handling, infection control, and health and safety. However, some staff had not received any training in food hygiene despite preparing light snacks for residents and also helping them eat. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 20 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 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 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 3 x 2 2 x 3 Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13. (4)(ac) Requirement Assessments for risk activities that residents undertake must be completed so that residents are protected. Timescale of 31/03/06 not met Care plans must be written in consultation with the residents and/or their representative and must be signed wherever possible by the residents, or a reason recorded as why this has not been possible. The plans must be reviewed monthly so that changes in residents’ needs can be picked up quickly. Information in residents care plans must be much more detailed so that their needs can be met. Residents must be weighed regularly so that their health and nutrition can be monitored. Timescale of 30/04/06 not met Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 22 Timescale for action 01/09/07 2 OP7 15 01/08/07 3 OP7 15 01/08/07 4 OP8 12(1) 01/07/07 5 OP29 7,9,19 Sch. 2 Two references must be obtained 01/07/07 for all prospective employees before they start working at the home so that residents are protected. All staff must receive regular supervision so that their working practices can be monitored and their training needs identified. Timescale of 31/03/06 not met 01/07/07 6. OP36 18.2 7. OP38 13(4)(c) All staff who prepare snacks, handle food or help feed residents must receive training in food hygiene 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP12 OP35 Good Practice Recommendations Suitable activities for very frail residents should be provided so that they are stimulated and entertained. Large amount of residents’ monies should not be kept at the home but paid into residents’ own bank accounts where it can accrue interest. Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Thomas Tawell House DS0000027299.V341905.R01.S.doc Version 5.2 Page 24 - 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. 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