Care Home: Tile House

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

What the care home does well The environment at Tile House, over the years, has been extensively upgraded and refurbished and this trend continues with a disused swimming pool having been filled in and grassed over, a new ramp built at the front of the property improving access for people with disabilities, the creation of a management office on the ground floor and good decorative standards throughout the home maintained. Training and development opportunities for staff appear to be another area were the company and the service are excelling, with a training matrix in place, which maps people`s completion of mandatory courses and aids the management when monitoring when people require updates. Over 50% of the staff posses a National Vocational Qualification (NVQ) at level 2 or 3, with additional staff enrolled on level 2 and 3 courses that are due to finish later this year. Advertisements and booking sheets for forthcoming training events, like awareness of the `Mental Capacity Act` and palliative care were observed on display on a staff notice board.The home`s recruitment and selection process is also well structured and managed, with all staff completing a full and comprehensive recruitment programme, which includes, employment enquires checklists, all preemployment checks, interview records, induction outcomes, photographic identification and medical health questionnaires. The company`s use of quality assurance methods to monitor and appraise the service being delivered at the home was also good, with a senior manager appointed to visit all services operated by the company and to produce detailed reports on how the home is performing and where improvements in the services can be made. The manager is also required to complete a monthly self-assessments, which measure the services performance against a set criteria, determined by the company`s directors, which consider quality outcomes for service users. This occurs on top of residents and staff meetings and supervision sessions, used to support staff maintain good standards of performance within the home. What has improved since the last inspection? At the last inspection no requirements or recommendations were made and the service considered to be providing good outcomes for service users. At this visit the service was again considered to be providing good outcomes for people and to have made improvements to the environment, as mentioned above. They have created a `Group Liaison Manager` role, this person taking on the quality assurance role discussed above and acting as support to the Registered Manager. CARE HOMES FOR OLDER PEOPLE Tile House Tile House 34 Victoria Avenue Shanklin Isle of Wight PO37 6LS Lead Inspector Mark Sims Key Unannounced Inspection 20th February 2008 10:30 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 Tile House DS0000055596.V356722.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. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tile House Address Tile House 34 Victoria Avenue Shanklin Isle of Wight PO37 6LS 01983 862762 01983 866161 ihl.mail@btconnect.com 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) Island Healthcare Ltd Vacant Care Home 21 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (15) of places Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2006 Brief Description of the Service: Tile House is a residential home providing care and accommodation for up to 21 older people, with capacity for six people in the dementia care category. The single room accommodation is arranged over three floors, with access to both the lower ground floor and the first floor via a series of stair-lifts. Currently 13 of the 17 rooms have en-suite facilities. The home is located in Victoria Avenue, Shanklin and is only a short distance from the amenities and facilities of the main town. A regular bus service operates along Victoria Road with the nearest stop a few metres from the premises. The building itself is a period town house, with off-road parking to the front, and level access into the home. The fees for accommodation at Tile House rang from £369.25 to £452.41 per week. Tile House DS0000055596.V356722.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 3 stars. This means the people who use this service experience excellent quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over six hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met staff and management. The inspection process also involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. Seven relative and five staff surveys were returned to the Commission, prior to the fieldwork visit-taking place, no service user or professional surveys were received, however, service users were spoken with during the fieldwork visit. What the service does well: The environment at Tile House, over the years, has been extensively upgraded and refurbished and this trend continues with a disused swimming pool having been filled in and grassed over, a new ramp built at the front of the property improving access for people with disabilities, the creation of a management office on the ground floor and good decorative standards throughout the home maintained. Training and development opportunities for staff appear to be another area were the company and the service are excelling, with a training matrix in place, which maps people’s completion of mandatory courses and aids the management when monitoring when people require updates. Over 50 of the staff posses a National Vocational Qualification (NVQ) at level 2 or 3, with additional staff enrolled on level 2 and 3 courses that are due to finish later this year. Advertisements and booking sheets for forthcoming training events, like awareness of the ‘Mental Capacity Act’ and palliative care were observed on display on a staff notice board. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 6 The home’s recruitment and selection process is also well structured and managed, with all staff completing a full and comprehensive recruitment programme, which includes, employment enquires checklists, all preemployment checks, interview records, induction outcomes, photographic identification and medical health questionnaires. The company’s use of quality assurance methods to monitor and appraise the service being delivered at the home was also good, with a senior manager appointed to visit all services operated by the company and to produce detailed reports on how the home is performing and where improvements in the services can be made. The manager is also required to complete a monthly self-assessments, which measure the services performance against a set criteria, determined by the company’s directors, which consider quality outcomes for service users. This occurs on top of residents and staff meetings and supervision sessions, used to support staff maintain good standards of performance within the home. What has improved since the last inspection? What they could do better: The Annual Quality Assurance Assessment (AQAA) discusses on several occasions the use of person centred care or support plans. However, the plans seen during the fieldwork visit contain very little evidence of person centred planning having been implemented within the home. In order to achieve their goal of delivering person centred plans the manager will need to review each client’s current needs and wishes in association with the service user and to reflect these appropriately through the home’s service users plans, which should be written in the first party. The manager should also consider involving people close to or familiar with the clients present needs and past wishes, as their input can be useful when generating plans for people with expressive or cognitive problems. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 7 Elements from a recent complaint, which has been addressed by the manager but was copied to the Commission for Social Care Inspection for information, were considered during the fieldwork visit. One issue identified by the complainant was the lack of access to cold drinks by the service users. On entering the home we (the Commission for Social Care Inspection) noticed that jugs of squash had been provided in each lounge along with glasses. Later, during the tour of the premise and when generally around the home speaking to people or reviewing process like the management of people’s medications, we took the opportunity to monitor the use of the squash jugs, which had not been touched or used all day. This is not implying that service users are not accessing sufficient fluids, as teas and coffees, etc were observed being provided to people on numerous occasions. However, service users, due to physical and or cognitive limitations/restrictions are unable to access the cold drinks left out, unless supported or assisted by the staff. It also appears that staff are failing to identify this as a need and are failing to offer or provide people with drinks other than at set times, as mentioned above when teas and coffees are provided. 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. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 8 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 Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are having their needs appropriately assessed prior to moving into the home. The service does not provide an intermediate care service. EVIDENCE: Three service users plans containing pre-admission assessments were reviewed during the fieldwork visit, including the person most recently admitted to the home. Each plan evidences that the assessments were undertaken prior to the person being admitted to or offer accommodation at Tile House. A different member of the home’s management team, the manager, her deputy and the group liaison manager had completed the assessments. The assessments are needs based documents and consider both physical and emotional health care problems. Each assessment should link or feed into the Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 10 care planning process, however, it was felt at times that some assessed needs where not appropriately reflected within the care plans. Examples being one client whose assessment information and initial list of medications would suggest the person has a history of cardiac/vascular problems, this however, has not been followed up through the care planning or service user plan process, which could have implications for their future care within the home, fluid intake considerations, exercise considerations, wound care management, pressure area monitoring, etc. Another client has a stoma, which is identified within the assessment and the care plan; however, the latter document contains very limited information about the citing of the stoma, the flanges and bags to be used and the levels of support required by the client. In discussion with a person recently admitted to the home it was apparent that they had been supported by their family in choosing an appropriate care service and that they had visited the home and felt it to be the service that best meet their next-of-kins needs. When asked the service users stated that they felt their relatives had made a wise choice and that home and staff were lovely and that they were settling in well. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s care planning process would be improved, if as stated within the AQAA the person centred plans were introduced. The home provides good levels of support to clients’ when accessing health and social care services and manages people’s medications appropriate. The service users feel as though they are treated with respect and dignity. EVIDENCE: The AQAA indicates that the service has: ‘Developed Person Centred Care plans that endeavour to enable clients to let us know the things about their life that are important to them and to set goals that are individualised and appropriate for them personally’. However, on reviewing the ‘service user plans’ for five people it became evident that the person centred plans referred to within the AQAA documentation has yet to be fully implemented, although the files contained Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 12 several forms that will eventually form part of the person centred planning process. Each file did however, contain generic care plans, which are pre-populated documents that the staff can tick to implement and amended to personalise, i.e. strike through his or hers to indicate the sex of the person and add information like the agreed bathing day, etc. The remainder of the information is, as indicated, generic and considers that each client will require their care provided in a uniformed or ridged way, although two care plans did included additional handwritten plans, which provided greater information on how the person wished to be supported with their personal care. Risk assessments are undertaken and all client’s had falls assessments, which rate the potential for harm based on the persons ability to mobilise safely and plans to support their differing mobility needs are available. Nutritional screening assessments are also undertaken and the generic plans do take into account the need to provide specialised diets. One persons’ professional assessment / discharge documentation, recorded that the person was at risk of pressure sore damage, with their waterlow scored at 17 and a history of grade two pressure area damage documented. However, the care plan and risk assessment / screening documentation had failed to identify or consider this concern, with no repeated or continuing waterlow score undertaken, despite this being part of the generic care planning record, no base weight had been documented and no plan to monitor and review the person’s pressure areas implemented. It was also noted that some care plans, specifically those associated with dementia or cognitive impairment, state that representatives of the person are to be involved in the planning of their care / identifying and agreeing risk assessments. However, on reading through the documentation, we (the Commission) found only one record that supported; that relatives / representatives were being involved in the review process of their next-of-kin. The importance, where people lack capacity, of involving family members or their representatives in reviewing their ongoing care needs and ensuring that the persons wishes are respected, were discussed, as were the need to ensure that were people request to be part of the review process, that this wish documented and where appropriate accommodated. The need to implement and/or introduce assessments, which consider people’s abilities to make decisions for themselves, in accordance with ‘Mental Capacity Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 13 Act’, were also discussed, as the home should review when people have or lack capacity to make informed decisions and when it is appropriate for another party to make decisions on their behalf. The AQAA indicates that staff are receiving training on the ‘Mental Capacity Act’, which should promote understanding of this process within the staff and management team. Four of the seven relatives to complete surveys on behalf of their next-of-kin said that they felt the home ‘always’ provided the care they or their next-of-kin had agreed upon, whilst the other three respondents indicated that this was ‘usually’ the case. Records within the service user plans, also provide evidence of the clients’ involvement with various health care services, records of general practitioner and community nursing visits seen on all five plans, whilst optician reports and appointments with acute or hospital based services, etc, were seen on three people’s files. As mentioned earlier, the plans contained discharge summaries, which are provided by St Marys Hospital, the local National Health Service (NHS) facility and social services assessments or review records provided by the person’s care manager. Each service user plan contained a hospital admission sheet, which is a fact sheet completed by the home should the client require hospitalisation, whilst generally these documents are left blank, one client had recently returned to the home, following a spell in hospital and their completed hospital admission form was returned to the home, which demonstrated its use. During the fieldwork visit one client was observed having returned from attending a clinic at the local health centre. During a brief conversation it was established that the person attended the clinic regularly and that they managed this independently. A comment made by one of the survey respondents, stated, ‘my mother has had a recent hospital and optician visit. I was called and asked about a dentist – also kept informed of doctors appointments or psychiatric visits and have attended a recent care review. One issue, which was discussed with the manager, was access to fluids, as during the tour of the home, it was noted that jugs of water or squash were left in locations (tops of cupboards), which made them difficult for people with mobility and / or cognitive impairments to access. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 14 During the fieldwork visit a jug in one of the lounges was monitored and noticed not to have been touched, which supported the view that service users were not inclined to access fluids without staff support. The manager accepted this observation and acknowledged that staff would need to routinely ensure that people were both supplied with cold drinks and that these should replenished throughout the day. Resident’s were however, noted to have access to regular hot drinks, which reassured us (the Commission), that adequate fluid intake was being maintained for people generally, although with the summer approaching this may need monitoring. Professional visit, according to the manager, are undertaken either within the clients own room, or people make use of the quiet room, which has been created by the provider. All accommodation is provided on a individual basis, which means people who prefer to conduct meetings in their bedrooms are assured of privacy, which can be enhanced by the person locking their bedroom door, as all doors are fitted with locks. During the tour of the premise however, the suitability of some locks, given the complexity of some people’s needs, were discussed with the manager who stated that the provider is in the process of reviewing and upgrading some locks and that they are aware of the problem/issue. The quiet lounge is situated adjacent to the sunroom and just off the main lounge and therefore provides less privacy than the persons’ own bedroom, however, its provision does allow people choice of location to meet and offers far more privacy than either the lounges or dining room. During the fieldwork visit no one was observed using the quiet lounge to conduct a meeting, however, one client was observed making use of the lounge to relax and rest. The AQAA makes clear reference to staff being provided with access to policies and procedures around the promotion of dignity for clients and at not time during the visit did any person spoken with raise a concern about their treatment at the home. The tour of the premise did highlight isolated incidents, which the manager undertook to address immediately, which could compromise people’s dignity and/or privacy, these including a missing or broken lock on a toilet door, which was entered into the maintenance log; and catheterisation equipment left on display in one persons room, which the manager arranged to be stored more privately without prompting by us. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 15 It is important to reflect however, that these were isolated occurrences and neither issue was repeated anywhere else around the home. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users social and recreational interests are being suitably addressed within the home and people are maintaining appropriate contact with family, friends and representatives Where appropriate people who have capacity are being supported to make independent decisions, however, were or when people are unable to make independent determinations, this is not being adequately considered or demonstrate via the home’s records and has implications under the Mental Capacity Act. People’s nutritional requirements and their personal preferences are being identified and documented. The meals provided were well presented and appreciated by the clients. EVIDENCE: The AQAA indicates that the home provides a dedicated activities co-ordinator, who was seen during the visit overseeing an art class, which was well attended by residents and considered to be an enjoyable event, given people’s participation and engagement. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 17 The co-ordinator maintains’ her own, independent activities record, which document people’s individual involvement with the activities arranged and provided. The manager stated during conversation that the activities co-ordinator also arranges and/or organises for people to go out on trips, the home having access to its own transportation. In conversation with relatives it was confirmed that their relatives have been taken out by the home to local attractions or venues. Such outings are also documented within people’s running records with one such entry recording how a couple had been supported to go to the beach for a walk. During the fieldwork visit visitors were noticed arriving at the home and involved in conversations with resident. Details of the home’s visiting arrangements are made available to people via the ‘statement of purpose’ and ‘service users guide’, which are documents made available to people within the entrance hall. Responses to the surveys, were a little confusing, in relation to social contacts, as only two people provided a response to the question raised regarding contact, one ticking always and the other usually when asked ‘ does the care home help your friend or relative keep in touch with you?’ However, two other respondents provided additional comments in relation to visits/contacts, ‘I always contact the home to speak with (the service user), she is unable to use a phone confidentially on an outwards call’ and ‘ I live a short distance from Tile House and visit my mother on most days’, both of which suggest the person is satisfied with the arrangements in place. Peoples running records, the daily record of events that affect them, contained evidence of relatives/representatives visits to the home, the earlier reference to a couple being supported to go out for a walk, involving a husband who visits his wife daily. The ability of residents to make independent decisions is something the service will need to consider, given the introduction of the ‘Mental Capacity Act’ in October 2007. The AQAA, manager and training records, indicate that staff are receiving training around the introduction and implementation of this ‘Act’, which will require services to consider people’s capacity to make decisions and when this may vary. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 18 As highlighted above the service is quiet responsive and supportive of people’s rights to make independent decisions, one client observed returning from a clinic appointment, which they had opted to attend independently and people’s involvement in activities. The home’s risk assessment documentation is used to consider potential risks to people and their abilities to respond appropriately to those risks however, this does not necessarily reflect capacity, which is now a vital aspect of the process. The introduction of the person centred plans will increase people’s involvement in making decisions about varying aspects of their care, although the case reviews do provide some evidence of people’s or their relatives inclusion in the process already. Survey respondents also indicated that the people feel or believe residents are provided with sufficient information about the service to make decisions, five people ticking ‘always’ and two ‘usually’, in response to the question. The manager was also able to produce records of meetings, which are used to establish people’s satisfaction with the service provided and encourage people to raise and discuss any changes they would like to see made within the home. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to voice their concerns and have access to an effective complaints procedure and are protected from abuse. EVIDENCE: The dataset, which forms part of the AQAA documentation, establishes the existence of the home’s complaints and concerns procedure but does not indicate when this was implemented or last reviewed. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: 4. No of complaints upheld 0. Percentage of complaints responded to within 28 days: 3 (75 ). No of complaints pending an outcome: 1. The evidence indicates that people’s complaints are generally being appropriately handled, although the need to respond in writing to a complainant was discussed, especially when the original complaint was received in writing, as this is both polite and professional. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 20 Details of the home’s complaints process has been included within the ‘statement of purpose’ and ‘service users guide’ documentation, which is made available to people within the entrance hallway. The indication, from the survey respondent is that people are aware of the home’s complaints process and will/have implemented it where necessary. During the visit the manager produced copies of the homes training matrix, which indicates that all staff have completed ‘safeguarding adults’ training and this corroborated the information contained within the AQAA, which states that staff have undertaken ‘adult protection training’. The AQAA also indicates that one of the company directors sits on the Isle of Wight Safeguarding Board, which looks to review and streamline peoples’ management and response to safeguarding alerts. The AQAA and dataset establish that policies for the protection for the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, however, as with the complaints procedure the implementation and review dates are not included. A review of the Commission’s database, established that within the last six months three ‘safeguarding’ alerts had been brought to the Commission’s and Local Authorities attention. Correspondence from the home however, evidences that these issues have been appropriately addressed, managed and concluded. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained throughout and systems are in place to report and manage breakages or damage to the fabric of the home. The home is clean, pleasant and hygienically maintained throughout. EVIDENCE: The AQAA states that over the last twelve months the following improvements have been seen: ‘Completion of refurbishment to whole house including kitchen and office area. Car park has been completely resurfaced and an approprioate access ramp incorporated which has made the area safer and the building more accessible for clients with mobility problems’. The AQAA also indicated that whilst these improvements have been made, the company still feel further enhancements to the premise are possible, identifying locks on clients doors, as mentioned earlier, as an area for Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 22 improvement: ‘A gradual programme to provide locks and master key system on all client doors,. The tour of the premise and property confirmed that a new ramp and car parking surface were in place and that the interior of the home is decorated and finished to a good standard. A recent visit to the service by ‘Environmental Health Officers’ has resulted in a five star rating for the kitchen, which would have considered the upgrading and physical improvements made to the environment. A new office has also been created on the ground-floor, which provides the management team with a separate facility from which to manage the service and to conduct meetings or take calls in private. Whilst touring the premises it was noted that a lock on a downstairs toilet was broken, this provided the manager with an opportunity to demonstrate the home’s maintenance reporting process, which involves logging the issue, which the maintenance person then must sign off when addressed. A quick review of this process indicated that all items identified and entered into the log, are addressed and signed off by a member of the estates team within 48 hours, unless an outside contractor is requested, which can delay the process. In discussion with residents it was clear that they felt the home was well maintained and provided a good environment to live within. One newly admitted client stated when asked that their relative had chosen the home for them and had said it was the best service they had visits. When asked the client confirmed that their family had been right and that the home and staff were lovely. The home employs a dedicated domestic staff team, who were observed during the fieldwork visit cleaning the home. All chemicals or cleaning agents used by the domestic staff were noted to be safely and appropriately stored, when not in use and environmental risk assessments and Control Of Substances Hazardous to Health (COSHH) information was available. The tour of the premise established that the home was both clean and tidy throughout and despite people suffering from incontinence related problems, no odours were evident, a comment / observation which was also made by a relative. The home’s internal quality auditing system, both regulation 26 visits and questionnaires consider issues of cleanliness and upkeep of the premise, the Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 23 ‘Group Liaison Manager’, who undertakes the regulation 26 visits recording her finding in reports, whilst the questionnaires ask people to comment on both cleanliness and décor. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 27: The home employs sufficient numbers of staff is providing access to skills development training. Standard 28 & 30: staff training and development opportunities are good and well managed. Standard 29: The home’s recruitment and selection process is robust, thorough and well managed. EVIDENCE: The AQAA makes clear that a dedicated training and development manager is employed by the company and that her role is to: ‘organise and promote training - both internally and externally. The Training Manager timetables relevant training for all staff and advises managers monthly about the staff who have training needs outstanding and progress of qualifications’. During the fieldwork visit the manager provided us with sight of the training matrix produced by and maintained by the training manager, a copy was also noticed on display on a notice board outside the staff office. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 25 It was also noticed that this board is used to advertise forthcoming training events, which at the time of the fieldwork visit included ‘dementia awareness and Mental Capacity Act’ training. Each staff member is also provided with their own training and development portfolio, these folders were seen during the fieldwork visit and provide further evidence of the training completed by staff, include e-learning training programmes. Five surveys returned by the staff indicate that they feel generally well supported when completing or accessing training, four people ticking ‘always’ and one ‘usually’, in response to the question: ‘do you feel you have the right support, experience and knowledge to meet the different needs of people who use the service’. Information taken from the dataset and confirmed with the manager, indicates` that currently the home employs twelve care staff. Seven of the twelve care staff has completed a National Vocational Qualification (NVQ) at level 2 or above and this gives the home a percentage of 58 of its care staff possessing an NVQ at level 2 or above. The dataset also indicates that one person is completing their NVQ, which would increase the percentage of staff holding an NVQ level 2 or equivalent to 67 . Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the management staff when employing new staff. It also indicates that all of the people who worked in the home over the last twelve months had undergone satisfactory pre-employment checks. On reviewing the files of three newly recruited staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references. The files also contained completed application forms, health declarations, photographs of the employee, interview summaries, personal information and information used to support the CRB application process. Feedback, taken from staffing surveys, establish that people were happy with the recruitment and selection process and that they had undergone the required checks prior to commencing employment and completed a period of induction. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 26 Comments taken from the surveys of relatives indicate that people are satisfied that the staff possess both the skills and knowledge to meet their next-of-kins needs: ‘the staff I have meet are always kind and obviously care for mum I have noted they are trained to NVQ 3 – mum is happy’ and ‘we have found all members of Tile House staff to be most caring and attentive, we often visit without prior notice and the atmosphere is always good’. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has applied for registration with the Commission and is being provided with support by the company as she settles into her new position/role. The home’s quality assurance systems are well structured and managed and ensure service users and their representatives are involved in developing the service. Residents’ are appropriately supported to manage their own financial interests and their health, safety and welfare is appropriately considered and promoted by the policies, procedures and practices within the home. EVIDENCE: Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 28 The company tell us via the AQAA that: ‘ the manager, holds an NVQ Level 4 in Care and is working towards an RMA qualification. The Manager works closely with the Corporate Management team in developing the ethos and general business plan for the home. She has overall, day to day, operational responsibility for the running of the home and management of all staff and ancilliary services. QA procedures require the Manager to review significant performance indicators monthly that identify areas of good practice and also areas where performance could be improved. Action plans are developed as and when necessary to assist in efforts to constantly improve practice. Administration is provided by full time support and the back up from the Head Office Team in terms of finance and strategic planning. The Manager is supported by the organisations Training Manager in developing comprehensive training support for all staff’. A review of our (the Commission’s) database, established that the manager has submitted an application to become the Registered Manager for Tile House and during the fieldwork visit the manager confirmed a date has been set for her ‘fit person interview’, which is the interview prospective Registered Managers must complete, as part of the process. Information taken from the staff surveys indicate that the manager is a supportive person, who provides / arranges for staff to be supported via the supervision process and team meetings, minutes and records for both processes were seen during the fieldwork visit. Throughout the fieldwork visit the manager demonstrated a professional attitude and was courteous and co-operative. She has overseen or introduced a number of new systems into the home, aimed at improving the management of the service, as evidenced by the structured way she maintains records, many of which were reviewed during the fieldwork visit and which the manager easily and promptly accessed. The service’s approach to quality audit or assessment was found to be good, with a number of surveys or questionnaires available to the manager and the ‘Group Liaison Manager’, who coordinate’s all evaluation of the service’s performance. Three questionnaire proforma’s were produced during the fieldwork visit for consideration and review, as were details of the results of the home’s last two surveys. Whilst the responses were disappointing the feedback provided had been collated and used to monitor and improve the service delivered. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 29 Details of the monthly performance indicators, as mentioned within the AQAA and referred to above, are made available in a graphic depiction and displayed on the notice board outside of the carers’ office. The performance indicators are designed to measure the services performanace againts key National Minimum Standards (NMS) and events such as accidents, incidents, deaths or complaints activity. The ‘Group Liaison Manager’ also undertakes visits to the home in accordance with Regulation 26 of the Care Homes Regulations. The reports produced as a result of these visits are robust and thorough and idenfity areas of good practice and areas where improvements in the service could be made. Residents meetings or client forum meetings are also regular occurences with records indicating that these are monthly events, the minutes of the last meeting documenting that people discussed: food, social activities and care practices. The record did not however, record who attended the meeting. Previous inspectors have recorded that the home does not become involved in the management of people’s monies or finances. Offering instead the opportunity for the person to join an invoicing scheme, whereby the service pays for any item required by the resident and then itemises this on a monthly invoice, which is provided for payment, receipts for items purchased are made available. At this visit the manager was asked if any changes or alterations had taken place to this process and she confirmed they had not. The AQAA and Dataset information establishes that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. The AQAA also indicates that: ‘ A Director is an IOSH qualified Health and (H&S) Safety Technician and keeps up to date with current practice by attending regular external training’, and that in addition to his ‘responsibility for H&S he holds a Portable Appliance Testing qualification and is reviewing the Fire Safety Risk Assessment Policy’. Health and safety training is being made available to staff, with the training matrix and plan providing evidence of the courses attended and to be attended by staff, including: health and safety, infection control and moving and handling, etc. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments do consider both potential areas of harm and how these can be managed, as highlighted by the service’s decision to improve the ramped access at the front of the home. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 30 Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety issues. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 31 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 32 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. 1. 2. Refer to Standard OP8 OP7 OP14 Good Practice Recommendations The manager should ensure that care staff assist residents to access drinks that are left out within the lounges. The manager should ensure that people’s capacity to make judgements is assessed and recorded and where appropriate families or representatives are invited to attended case reviews. Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent 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 Tile House DS0000055596.V356722.R01.S.doc Version 5.2 Page 34 - 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. 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