Care Home: Tilford Park Nursing Home

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What the care home does well Personal care is delivered according to each service user`s plan of care this was evidenced by the service users signing of the care plans, by the monthly review of care plans and the signing and dating of same by care staff. The new manager has introduced the key worker /named nurse system of working and this is going satisfactorily according to carers spoken to on the day of the visit. The manager has also devised innovative ways in which she can measure how well carers are implementing new learning into their practice. Training of carers has improved, with the manager initiating and managing the learning needs of the carers to meet the assessed needs of the service users in her care. What has improved since the last inspection? Their records demonstrated that they have responded in a positive way to complaints and allegations received, and they have taken ownership of any mistakes/failures that have occurred and have taken steps to raise general awareness of the issues that can lead to complaints and allegations being made against the home. Improvements have been made to the home to include a new reception area where service users can sit and relax, Enlarged lounges, new lift and majority of the bedrooms have been refurbished. Many of the service users told us they are very pleased with the improvements to the home and that the wide screen TV is a hit with them. CARE HOMES FOR OLDER PEOPLE Tilford Park Nursing Home Grange Road Tilford Farnham Surrey GU10 2DG Lead Inspector Mavis Clahar Unannounced Inspection 11th June 2008 08:55 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 Tilford Park Nursing Home DS0000068703.V365616.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. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tilford Park Nursing Home Address Grange Road Tilford Farnham Surrey GU10 2DG 01252 792543 01252 795229 tilford@lrh-homes.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) London Residential Healthcare Ltd Care Home 40 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (40) Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home to admit persons from the age of 60 years. Date of last inspection 8th February 2008 Brief Description of the Service: Tilford Park is an established nursing and care home that provides support for people who are elderly and mentally frail. The home is situated in a quiet rural area close by to the town of Farnham and has limited access by public transport. The home has been recently purchased by a new provider London Residential Healthcare Ltd who have ten other care service establishments in the south of England region. The home can offer services to up to 40 residents in both shared and single bedroom accommodation. They are able to accept both social service and private referrals for people requiring care to be admitted to the home. The fees range from £ 650.00 to £850.00 per week. Additional charges are made for Chiropody, hairdressing and newspapers. Tilford Park Nursing Home DS0000068703.V365616.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 stars. This means the people who use this service experience good quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Mrs Mavis Clahar on the 11th June 2008 and lasted for seven hours and fifty minutes; commencing at 08:55 hours and concluding at 16:45 hours. Ms Sharon Lambourne the newly appointed manager assisted with this inspection visit. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps CSCI (us) to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by us and is referred to throughout the report. The registered manager of the home has resigned and a new manager has been appointed. CSCI will receive her application to be registered, as manager for the home as soon as she receives her CRB result. The majority of the service users spoken to were able to express their thoughts and feelings about the care they receive. The information contained in this report was gathered mainly from speaking with service users and care staff, observation by the inspector and reviewing records held by us. Further information was gathered from records kept at the home. The first part of the inspection was spent discussing and agreeing the inspection process with the manager, followed by a tour of the home, which included time spent in discussion with service users, care workers and the Chef. The manager and staff are aware of the Laws regarding equality and diversity and this was reflected in the staff mix. All service users in this home are Caucasian and reflect the population of the area in which the home is situated. All records sampled were up to date with care plans being signed by the service users or by relatives. Five requirements were issued on this visit. We received confirmation that Requirements one to three were fulfilled prior to the writing of this report. Please see Staffing and Management and Administration of the Home outcomes for full disclosure regarding the other two requirements. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 6 The final part of the inspection was spent giving feedback to the manager about the findings of this visit. The inspector would like to thank all the service users and care staff who made the visit so productive and pleasant on the day. What the service does well: What has improved since the last inspection? What they could do better: The registered person must ensure when employing new staff they follow the guidance within the care Homes Regulation 2001 Schedule 1; paragraph 1 to 9. The Responsible Individual must ensure the monthly Quality Monitoring visits are carried out and copies sent to the home for filing. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 7 The home must ensure that carers working with service users are able to speak English clearly so that service users can understand what they are saying and prevent misunderstanding which might lead to a lowering of standards in care giving. The home should risk assess the path leading up to the patio and provide safety measures to prevent an accident occurring to service users approaching and leaving the patio The home has a huge garden and this would be kept in better condition if the home employed a gardener to care for the grounds. 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. Tilford Park Nursing Home DS0000068703.V365616.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 Tilford Park Nursing Home DS0000068703.V365616.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): 3 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Prospective service users and their relatives have the information needed to choose a home, which will meet their needs and service users are being assessed to ensure the home is capable to meet the needs of the service users prior to being admitted into the home. EVIDENCE: Review of service users documents and identified policies demonstrated the home has a policy and procedure on admission and discharge of service users. Within the admission policy all service users must have an assessment prior to being admitted into the home. The manager who is trained in the principles of assessment of service users’ needs based on what the care the home says it will provide carries out all pre admission assessments of service users prior to them being admitted into the home. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 10 Review of a random sample of service user’s files including one recently admitted service user, demonstrated that pre admission assessments are being carried out and relatives were being involved in the assessment process. This was confirmed in discussion with one relative’s visitor Tilford Park Nursing Home DS0000068703.V365616.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): 7 8 9 10 People who use the service experience good quality outcomes in this area. This judgement has been using a range of evidence including a visit to this service. The home has a good and clear care plan in place for service users and this includes appropriate risks assessments. Which forms the basis for care based on the agreed care needs of the service users and demonstrated that trained staff met service users’ health and personal care needs. The home’s medication policy on receiving, storing and administering of medication was in place and being adhered to thereby ensuring the safety and protection of the service users. Care workers treated service users with respect and maintain their dignity and privacy when delivering personal care. EVIDENCE: Two allegations were received by CSCI and was directed to Surrey Adults Safeguarding Team. Records kept by the home on the day of the visit, revealed that they have been investigated and suitable actions were put into pace to prevent a repeat of the concern. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 12 The randomly selected care plans were clear and easy to read, identifying risks to service users and detailing how these risks would be managed. The daily worksheets demonstrate service users’ needs were being met according to the agreed care plans. In discussion with service users and care workers it was demonstrated that service users care needs are met. The service user or relative signed the care plans to indicate their involvement in deciding what care they received. It was evidenced that care staff undertaking the development and monthly review of the care plans also signed and dated them. In discussions with service users and two relatives on the day of the visit they confirmed they were involved in the planning of their daily care. In discussion with the manager we were told, “the service we provide enable service users to benefit from the involvement of the wider primary health care team ”. Information contained in the home’s Annual Quality Assurance Assessment (AQAA) states “we deliver high quality care including nursing assessments, personal care procedures, as detailed in the care plans”. All service users are registered with a local General Practitioner (GP) of their choice and visits are recorded, with access to specialist healthcare professionals through their GP practice as required such as sight and hearing tests which are carried out on a regular basis; and these visits are also recorded in the service user’s folder. Service users are offered access to chiropody service and weekly hairdressing facilities are available at a cost to the service users. In discussion with the registered nurse and care workers they were extremely proud of the high standard of care they provided to all service users in the home and this was supported by the records in the complimentary folder and by relatives and service users on the day of the inspection. We were told on the day of the visit that no service user at present was risked assess as capable to self medicate. However, the home had a policy on selfmedication should it becomes necessary. Records reviewed inform us qualified care staff (Registered Nurses) has all received training in the receipt, recording, storage handling and administration and disposal of medicines. All medicines are administered from lockable drugs trolleys. In discussion with the Registered Nurse we were told, “we keep a controlled drugs register and record fridge temperatures daily”. We evidenced this as correct during a tour of the home. Care staff identified as capable to administer medication are requested to leave a sample of their signature, which is dated in the medication trolley. We observed that Registered nurses were not leaving signatures but using pet names instead both in the Control drugs book and on the specimen sheet. A requirement was made on this standard to cease this practice immediately. All service users have a recent photograph included in their personal folder and medication record, to reduce the risk of mistakes happening during medication administration. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 13 We observed that care workers wore name badges to enable visitors and service users with memory impairment to be sure of whom they are speaking with; and we also observed Service users being treated in a friendly but respectful manner by care workers. In discussion with service users who were able to understand the questions, they told us they are treated with respect and dignity, and that they are able to make their own choice. One service user told us “I am very happy here. Everything is so nice. I have my own room; I can have as much privacy as I want”. Another service user said “We have good staff here; they do not ill treat me”. “I have help to choose my own clothing every day.” Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 14 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 15 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community. Service users are able to make choices in accordance with their abilities and were provided with a balanced diet in mostly pleasant surroundings and in an unhurried way EVIDENCE: The home employs a full time activity-co-ordinator who provides a range of activities based on the individual assessed and agreed needs, including their preferences, cultural beliefs and customs. We were told that wherever possible relatives are encouraged to participate in the planning and carrying out of service users’ activities. The AQAA states, “ This enables clients to have a varied activities programme that includes regular entertainers, outings to parks and shops.” We observed the activities programme displayed in the Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 15 reception area of the home, in the lounges used by the service users and in the dinning areas. We observed the home has purchased a flat screen TV for the larger lounge and in discussion with service users they told us they like the bigger screen, as the pictures are brighter. The Methodist Minister and the Roman Catholic Priest visit the home on a regular basis whilst the United Reform Church holds services weekly at the home and those service users who are able attends. We were told by service users that they are able to have their friends and relatives visit any time it is convenient for them to visit. We spoke with two visitors to the home who all expressed their satisfaction with the level of care their relatives were receiving, and they also spoke highly of the dedication and caring attitude of the staff towards their relatives. They also told us staff keeps them informed of any changes in the condition of their relatives. Five of the service users spoken to said they had choice in their clothing and sometimes they receive help from their key worker. On the day of inspection all service users were dressed appropriately for the weather. The AQAA states “service users have choice of dishes at all mealtimes”. In discussion with the resident Chef we were told “All the meals at Tilford Park are prepared fresh on site. Service users have a choice daily and can eat in either the dining room or their bedrooms”. We observed they have created a very attractive and welcoming dinning room; with tables being dressed with freshly laundered and colour coordinated table linen. We were told fresh linen is used every day and daily menus that include two alternative choices to the main courses are displayed for the use of our service users. We observed bowls of fruit were placed in the lounges whilst service users were present, and staff was seen offering drinks to service users. We observed a marked improvement in the décor of all the dining areas, and in discussion with service users they said they were very pleased with the redecorations. The inspector did not sample the lunch, but one guest and service users said the food was very good, tasty and the right amount. The inspector observed the presentation of the food was done in a way to stimulate appetite. Some service users had supplements as ordered by their GP or dietician, to maintain body weight or increase appetite. Fruit juices were served with lunch, which was served in the dinning room unless a service user requested to have their meals in their bedrooms. We observed care workers interacting in a friendly but dignified manner with service users during the lunch time, sitting down beside service users and speaking to them whilst helping them with their lunches. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 16 Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The home has a satisfactory complaints policy and procedure and training in place that evidenced that service users and relatives concerns are listened to and acted upon. Robust Safeguarding adults’ policies are in place to protect the service users from abuse. EVIDENCE: CSCI received three concerns about the home, two of which were referred to Surrey Safeguarding Adults, and one referred to the responsible individual for investigating. Both the safeguarding issue and the concern to the home have been dealt with satisfactorily as the records sent to us have demonstrated. The AQAA informs us the home received two complaints since the last inspection, both resolved in their time scale for dealing with complaints. One complaint was upheld. There was no record in the home of these complaints on the day of the visit. A requirement was made on this standard. The manager told us that she is in touch with service users on a daily basis and issues raised are dealt with immediately; this reduces the incidents of formal complaints. Service users spoken to said they know how to complain Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 18 and will do so if they are not happy. All concerns raised are always dealt with immediately and they were satisfied with the outcomes. It was noted that the home received a number of compliments from relatives of service users commending the staff on their kindness and understanding and for the high quality of work they perform. A copy of the most recent CSCI report was made available for visitors to the home on top of the receptionist desk and a recommendation was made to find a more suitable place to display the report where it is easily seen. In discussion with care workers, it was apparent they are aware of the homes’ policy and procedure on Safeguarding Adults and felt secure in the knowledge that if they had to use the whistle blowing procedure the manager and the owners of the home would support them. During discussion with care workers it became apparent they had a full knowledge on Equality and Diversity issues relating to the service users they were responsible for. They informed us they have had training in Equality and Diversity with the new manager and this was confirmed in discussion with the manager. A random sample of care workers training record demonstrated that care workers are being trained to undertake the duties of meeting the service users assessed needs, thereby protecting them from abuse. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 19 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 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables service users to live in a safe, well-maintained and comfortable home, which encourages independence, and protect their privacy and dignity. The home does not have an on-going maintenance programme, so that essential maintenance is not carried out as a preventative method, thereby resulting in the environment could be unsafe for service users. EVIDENCE: The manager told us that the management and staff encourage service users to see the home as their own home. It presents as a comfortable, attractive home, which has specialist adaptations needed to meet the service users needs and were serviced and records kept verifying this. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 20 The home has huge gardens, which are not well maintained. A requirement was made on this standard for the home to employ a gardener to keep the huge gardens in a state suitable for the use of the service users. There is good access from various parts of the house to the gardens. However, there is a slight incline to get to the back garden where summer seating is arranged on the patio. It is Recommended that railings be erected along the paved path leading up to the patio area for the use of service users. Two spans of fencing one to the rear and one to the side of the garden needs replacing to ensure the safety of service users. An immediate requirement was issued for this to be done within 48 hours of the inspection. It was noted that service users were able to personalise their bedrooms with small items of furniture, paintings on the wall and many family photographs. Generally, the home presents as clean, safe, pleasant, hygienic and tidy and free from offensive odours. Random review of care workers training record demonstrated they have had training in infection control and this was evident in the storage of waste. The home has not received a regulation 26 visit since January 2008 and a requirement was made on this standard to commence monitoring visits this month and these must be sent to us for the next six months. Laundry facilities are situated away from where food is stored, and in discussion with the laundress on duty she explained that health and safety precautions are taken when attending the laundry. All soiled laundry is washed at the end of the day, as there is only one washing machine with sluicing facilities. We noted hand-washing facilities suitable placed in the laundry. The laundry floor finishes appear to be impermeable and we were told these and the walls are washed daily at the end of the day. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 21 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The service has a recruitment procedure that does not meet statutory requirements and the national Minimum Standards. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of the service users. However, due to poor use of the English language service users’ care might be compromised. EVIDENCE: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twenty-four period was sufficient to meet the assessed care needs of the service users. The home has a programme of planned training in place and we were told all members of staff have an individual training record this was verified by the randomly reviewed staff folder audited. The Manager told us 47 of care workers have obtained the National Vocation Qualification at Level 2 (NVQ L2) or above”, and in discussion with care workers on the day of the visit they all said they had NVQ L2 and L3 qualification or were in the process of doing the course and this was evidenced in the random sample of files reviewed. 100 of catering staff and 60 of care staff have received training in safe food handling. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 22 Care workers are encouraged and enabled to undertake developmental training as well as the mandatory training according to the AQAA and this was verified during review of the home’s training records and care workers files reviewed. All newly appointed staff undertakes an induction programme as recorded and documented in their personal files. The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the manager and care workers and from review of care workers training records. Random sampling of care workers file demonstrated the homes recruitment processes are not in line with the Care Homes Regulations 2001 Schedule 2 whereby all care workers are Criminal Records Bureau, (CRB) and Protection of Vulnerable Adults (POVA) checked prior to commencing employment, and two written satisfactory references are obtained. Staff files sampled contained did not contain the required work history. A requirement was made on this standard. Care workers are in receipt of terms and conditions of employment as evidenced in their randomly selected files. A review of randomly selected Registered Nurses Personal Identification Numbers verified current registration with the Nursing and Midwifery council. We were told that supervision records were up to date and this was verified during random sampling of care workers files. In discussion with care workers some were able to give examples of how the home applied equality and diversity to the different needs and wishes of the service users in their care, and also within the diverse staff group. Staff files contained their up to date training records and it was noted that Equality and Diversity training was done. In discussion with the manager she provided evidence that this aspect of training was carried out. We observed on the day of the visit that the majority of Staff on duty were from overseas and their spoken English was not easy to understand. A recommendation of good practice was made on this standard for staff whose first language is not English to have English lessons to enable them to communicate effectively with the people they are employed to care for. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 23 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 38 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. The newly appointed manager supported by the Responsible Individual manages the home and works to continuously improve services and provide an increased quality of life for the service users. There is a strong ethos of being transparent and open in all areas of running the home. The views of service users and their relatives are actively sought in the running of the home and The service provides training on health and safety issues and equality and diversity for all staff.. Service users financial interests are safeguarded. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 24 EVIDENCE: The newly employed manager is a registered nurse with a diploma in management. She has had long nursing and managerial experience both in the private sector and NHS and has been a manager for another home in another area. The manager has demonstrated that she has kept herself updated on issues relating to care of the service users and staff in her charge. In discussion, it was evident she was knowledgeable about the training needs of the care workers to meet identified needs of the service users. She has discussed initiative ways in which the learning of carers can be measured to ensure service users are getting the best and up to date care. There are clear lines of accountability within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities. We were told that regular residents meetings are arranged and minutes of the meetings are passed to the owners who will action requests as soon as possible. The home does not become involved in service users finance. Receipts are kept and logged for all transaction carried out on behalf of service users and are sent to Head Office where all financial transaction are dealt with. Review of documented records demonstrated that health and safety checks are routinely carried out in the home, but not necessarily in the grounds of the home. See environment for more details. All equipment examined on the day was properly maintained. Records indicated that fire drills, fire alarm, water temperature fridge and freezer recordings were regularly checked. On the day of the visit one Hot water boiler was being replaced. Random sample of care workers’ training files demonstrated that up to date and relevant training were carried out by care workers to protect service users’ health, welfare and safety. In discussion with care workers they discussed their understanding and implementation of appropriate procedures to safeguard service users. Further more they spoke about their understanding of promoting safe working practices based on their health and safety training. The AQAA stated that equipment necessary for the care of service users are serviced and records kept. In discussion with the acting managers she was able to evidence this. Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP9 Regulation 13 (2) Requirement The registered person must ensure medications are recorded correctly. Registered Nurses must sign the Control drug record with their legal names. The registered person must ensure that complaints records are available at all times at the home. The registered person must ensure the two broken fences are replaced, thus ensuring service users safety The registered person must ensure persons are employed by the home are subjected to paragraphs 1 to 9 of the care Homes Regulation 2001 Schedule 2. The registered person must ensure that monthly monitoring visits to the home are carried out. Monthly monitoring visit reports are to be forwarded to CSCI for the next six months, starting with June 08 visit. Timescale for action 11/06/08 2. OP16 17 (3) 9b) 13/06/08 3 OP19 13 (4) (a) 13/06/08 3 OP29 19 (1) (b) 25/07/08 4 OP33 26 30/06/08 Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 27 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 Refer to Standard OP19 Good Practice Recommendations The huge garden would benefit from the services of a full time gardener and rails should be fitted along the path up to the patio to ensure service users safety whilst going to and leaving the patio. It is recommended that English language be taught to the carers whose first language is not English. 2 OP30 Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 28 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 Tilford Park Nursing Home DS0000068703.V365616.R01.S.doc Version 5.2 Page 29 - 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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