Care Home: Tordarrach Nursing Home

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What the care home does well This home provides care for up to twenty elderly people some of whom have dementia. The atmosphere in the home is very friendly and welcoming and all of the residents spoken with were complimentary about the staff and the homes manager. On the day of the inspection most of the residents were in the lounge. All of them appeared well cared for and one resident commented that "this is the best place in the world, I`ve heard that others are not so good. " Another resident said, " this is a very happy place to live in, anything that you want you can have". Others people told us how lovely the staff were "very kind and helpful". Before moving in to the home an assessment is undertaken, to ensure that any potential residents needs can be met. These assessments then form the basis for individual care plans which detail the help and support that will be required. In some of those plans that were seen, residents and relatives had been encouraged to participate in this process. The plans are reviewed regularly so that all staff are aware of how residents prefer to be cared for and they are up to date. A key worker system is in operation in the home, which also contributes to continuity of care, helps build relationships between staff and residents and gives staff an insight into resident`s particular problems. Activities are organised for residents who wish to join in, religious services are held during the week and some residents are able to go out during the day with friends or relatives. People said that they liked the food served in the home; this includes a hot snack supper if they would like it. The chef talks with them on a regular basis to ensure that they are enjoying their meals and menus are frequently revised in accordance with their preferences. All of the people who use this service are encouraged to make choices within their daily lives as much as they are able to and their families and friends are welcome to visit them. In order to make them feel more at home, they have been encouraged to bring some of their possessions with them to personalise their bedrooms which are all very pleasantly decorated. Records kept by the home and relating to ensuring the protection and health and safety of residents and staff were generally in good order. Staff training is in place so that all staff have the skills that they need to care for the people who live in the home. What has improved since the last inspection? The majority of concerns that were raised at the last inspection have been addressed. We had asked the home to amend some of the information that was available to people considering moving into the home and this has now been done. There are copies of the homes Statement of Purpose and Service User Guide in the front entrance hall. They would tell anyone considering coming to live in the home all about it and help them decide if they would be happy living there. There is also some web-based information available on the Internet. We asked the home to look at their care plans and include some information about resident`s wishes in the event of them becoming unwell or their death. This would help to avoid unwanted hospital admissions and staff would all know how residents would prefer to be cared for at this time. This has now been done, wherever it is possible, although it is acknowledged that these issues are difficult for some people to discuss. Refurbishment and redecoration in the home is ongoing. Some areas have been redecorated since the last visit and there are plans to continue with this to ensure that the home remains a pleasant and comfortable place for residents to live in. At this inspection, staff files showed us evidence of appropriate checks being undertaken to ensure that people who have been judged as being unsuitable to work with vulnerable adults have been prevented from doing so. All care staff are now receiving regular supervision to, monitor their performance and identify any future training needs. CARE HOMES FOR OLDER PEOPLE Tordarrach Nursing Home 11 Hall Road Wallington Surrey SM6 0RT Lead Inspector Alison Ford Key Unannounced Inspection 12th August 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 Tordarrach Nursing Home DS0000019129.V369154.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. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tordarrach Nursing Home Address 11 Hall Road Wallington Surrey SM6 0RT 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) 020 8669 1494 020 8669 3533 tordarrach@yahoo.co.uk Dr R Obaro Mrs Ayodele Obaro Mrs Victoria Olufunto Akindele Care Home 20 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (0), Learning disability over 65 years of age (1), of places Old age, not falling within any other category (0) Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One (1) place for a service user under 65, in the Dementia (DE) category. One (1) place for a service user in the Learning Disability (Over 65) category (LD[E]). 22nd April 2008 Date of last inspection Brief Description of the Service: Tordarrach Nursing Home is registered with The Commission for Social Care Inspection to provide nursing care to up to 20 older people, the majority of whom have dementia. The home is a domestic style property, which has been enlarged and converted to provide comfortable accommodation over three floors. It is situated in a pleasant tree-lined road in Wallington, close to local amenities. Communal space and bedrooms are arranged over the ground, first and second floors and there is passenger lift serving all floors. There are eight single and six double bedrooms and a large dining room with an adjacent lounge. There are toilet and bathing facilities on each floor a large, accessible garden to the back and parking facilities at the front. At the time of this inspection fees ranged from £577: 50 - £650 per week with any additional charges payable being agreed prior to admission. A copy of the Homes Statement of Purpose and their latest inspection report can be obtained from the home. The inspection report can also be downloaded from www.csci.org.uk Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star, This means the people who use this service experience good quality outcomes. This report was written following an unannounced visit to the service undertaken as part of the inspection process for the year 2008/2009. When writing the report consideration has also been given to information received from other sources such as comments from people who use the service and their relatives, notifications, concerns and complaints. We assessed all of those standards thought, by The Commission for Social Care Inspection, to be key to the inspection process. We undertook a tour of the premises and spoke with many of the sixteen residents living in the home and several members of staff. We also talked to a visitor about their experiences of the home and their impressions of the care that residents receive there. Various records that the home is required to keep, as evidence of its commitment to the protection and health and safety of its residents, were seen and also a sample of care plans that show us how resident’s assessed healthcare needs are met. The home is required to make sure that people who have been judged as being unsuitable to work with vulnerable adults are prevented from doing so and we checked the personnel files of new members of staff to make sure that they contained all of the necessary documentation. Staff training schedules were also looked at to make sure that the training staff have is relevant to the needs of the people who live in the home. We also looked at menus and kitchen records. In addition, the homes manager had sent us an Annual Quality Assurance Assessment. This is a document that they have to send us every year and it tells us how well they believe that their service meets its objectives, as set out in its Statement of Purpose and about their plans for the future. The Commission has not received any complaints about the service since the last inspection. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 6 What the service does well: This home provides care for up to twenty elderly people some of whom have dementia. The atmosphere in the home is very friendly and welcoming and all of the residents spoken with were complimentary about the staff and the homes manager. On the day of the inspection most of the residents were in the lounge. All of them appeared well cared for and one resident commented that “this is the best place in the world, I’ve heard that others are not so good. “ Another resident said, “ this is a very happy place to live in, anything that you want you can have”. Others people told us how lovely the staff were “very kind and helpful”. Before moving in to the home an assessment is undertaken, to ensure that any potential residents needs can be met. These assessments then form the basis for individual care plans which detail the help and support that will be required. In some of those plans that were seen, residents and relatives had been encouraged to participate in this process. The plans are reviewed regularly so that all staff are aware of how residents prefer to be cared for and they are up to date. A key worker system is in operation in the home, which also contributes to continuity of care, helps build relationships between staff and residents and gives staff an insight into resident’s particular problems. Activities are organised for residents who wish to join in, religious services are held during the week and some residents are able to go out during the day with friends or relatives. People said that they liked the food served in the home; this includes a hot snack supper if they would like it. The chef talks with them on a regular basis to ensure that they are enjoying their meals and menus are frequently revised in accordance with their preferences. All of the people who use this service are encouraged to make choices within their daily lives as much as they are able to and their families and friends are welcome to visit them. In order to make them feel more at home, they have been encouraged to bring some of their possessions with them to personalise their bedrooms which are all very pleasantly decorated. Records kept by the home and relating to ensuring the protection and health and safety of residents and staff were generally in good order. Staff training is in place so that all staff have the skills that they need to care for the people who live in the home. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: At this inspection we have made some recommendations, which would improve care practices in the home. Medication procedures were in order and it would seem that people receive their medication as it has been prescribed. We have asked the home to look at dating the packets of medication in use when they are opened. This will make it easier for us to check that the right amount is in the packet. We have also asked them to devise a training matrix so that we are able to check the training that staff have attended. We have recommended that the quality assurance tool that they use to measure the satisfaction of residents in the home could be developed so that views of other people who visit the home can be gained. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 8 We have also recommended that the homes manager should be given more time to undertake managerial functions within the home such assessment of staff competencies and monitoring and audit of care practices in the home. One concern has been raised regarding the monitoring of hot water temperatures in the home. We previously asked for this to be done every week so that the risk of a resident entering a bathroom unaccompanied and inadvertently scalding them selves was minimised. This is still not being done and advice is being taken as to the next steps to be taken to ensure compliance. 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. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 9 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 Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 10 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): Standards 1,3,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anyone who is considering moving into the home would be able to get all of the information that they might need to help them to make their choice. There is an assessment available from either a Care Manager or a senior nurse at the home, which shows that they are able to meet the needs of that person. This home does not offer intermediate care therefore Standard 6 does not apply. EVIDENCE: After the last inspection we asked the home to make some amendments to the information that was available to any one considering moving in. These have been done. At this visit we looked at the revised Statement of Purpose and Service User Guide that have been produced. Copies of these have been given to all the Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 11 residents and are kept in their rooms. There is also a copy in the front entrance hall. They would tell anyone considering coming to live in the home all about the home and help them decide if they would be happy living there. There is also some web-based information available on the Internet. In some of the care plans that we looked at, we saw assessments that had been obtained from residents Care Managers before they came in to the home. These outlined the care and support that they would need. In addition a senior staff member would go out and undertake an assessment of their own if they could. This would ensure that the facilities in the home would be suitable for them. We spoke with the relative of one of the residents and they told us that the home had been very helpful during the admission process and were able to answer all of their questions. The Annual Quality Assurance Assessment tells us that, if it were possible, people thinking about moving in to the home would be able to come and spend some time there first to see if they liked it. Also, the needs of the potential resident are discussed with the staff before they arrive so that they will know how to support them when they move in. All placements would be reviewed after three months to make sure that the resident and their resident was happy with everything. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have an individual care plan, which is reviewed regularly, to make sure that their healthcare needs are always met and any changes are identified. There are medication policies and procedures in place to protect them. They are always treated in a way, which respects their dignity, and privacy. EVIDENCE: All of the people in the home on the day of the inspection looked clean and well cared for. People who were being nursed in bed looked comfortable and free from pain. The Annual Quality Assurance Assessment says that, where possible, people would be supported to manage their own healthcare and during the inspection one resident attended an outpatient appointment in hospital. Transport was ordered for him however, he was able to go to the appointment on his own as he had done in the past. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 13 Each resident has an individual care plan, which sets out the action that staff need to take in order to ensure that all of their healthcare needs are being met. During the course of the inspection visit we looked at four of them. We particularly liked the fact that residents had been able to contribute to their care plans. They had signed them to acknowledge their involvement and in one case we saw that they had put comments in them about how good the staff were. All the plans had assessments of physical and mental health, risk assessments, continence and tissue viability assessments. We saw that there was lots of information about residents personal lives and achievements and the problems that had lead up to them needing to come into the home. This helps staff to understand more about the people that they are caring for. Factors, which might predispose to the risk of developing pressure sores, are monitored carefully and appropriate interventions are in place. Throughout the home we saw pressure relieving mattresses and cushions being used and there are not currently any residents who have pressure sores. There were also entries showing that other healthcare professionals are consulted as required if their particular expertise is needed. Formal decisions regarding residents care at the end of their lives and advanced directives are recorded where possible although it is acknowledged that some residents and their families find this issue difficult to discuss. Personal care is carried out in resident’s own rooms to ensure their dignity and privacy. Visitors could be received there if they wanted to be although, those spoken with at the time of the inspection were happy to sit in the lounge. There is a public telephone in the hallway that residents could use if they wished. At this visit there were staff on duty who had been employed since the last inspection. Three of them had been healthcare professionals overseas and had come to the home to participate in a programme of further education. They were observed to be very kind and gentle with the residents and seemed to have a good relationship with them. They told us about the induction programme that they had had and said that when it was finished they had felt quite confident about working in the home. Both residents and relatives commented on how good staff were and one said how “ happy and cheerful they always seemed to be”. Medication records and storage were seen. Trained nurses administer all of the medication; no resident currently in the home is able to manage this for themselves. Records showed that residents receive their medication as the doctor has prescribed it and no errors were noted. It was recommended that Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 14 packs of tablets that are not in blister packs should be labelled with the date when they are opened to make it easier to check that the right amount is still in the box. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home tries to make the routines of daily living flexible, to meet the needs of residents. They are offered activities, which suit their preferences, and their relatives and friends are encouraged to visit whenever they wish. People enjoy the food served in the home and they are given the opportunity to comment on and influence the menus. EVIDENCE: The Annual Quality Assurance Assessment tells us that home practices person centred care, treating service users as unique individuals. Therefore they try to make the routines of daily living as adaptable as possible. The people that we spoke with agreed that they could choose how they spend their days, they decide what they want to wear, what they would like to eat and times for getting up in the morning and going to bed at night are flexible. There is an activities programme arranged for them and they are encouraged to participate although some chose not too. Some people are able to go out of the home and enjoy a stroll down the road or go to church. Apparently there is company transport, which can be used for personal or group outings and the home also liaises with outside transport agencies, such as dial a ride. There is Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 16 an activities organiser in the home on a regular basis and carers also spend time interacting with residents. On the morning of the inspection one of the staff was leading a chair based exercise session and the amount of laughter from residents suggested that they were all enjoying themselves. The home recognises the importance of the personal and social relationships and visitors tell us that they are always made welcome. Residents say that the meals that are served in the home are very good. The lunchtime meal was served during the inspection and it looked appetising and well presented. There is a menu available and it includes pictures of various dishes as well. Lunchtime seemed to be pleasurable experience for everyone and most people sat up to the tables in the dining area. Staff were available to help those who needed it. A new chef has recently been employed and he came out to talk with residents to make sure that they had enjoyed their meal. He always tells them what he will be cooking so that they can have something else if they wish. Special diets can be catered for and there is currently one person in the home who is a vegetarian. On the day of the visit they were having fish for lunch. Tordarrach Nursing Home DS0000019129.V369154.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): Standards 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents say that they are confident that any complaints would be taken seriously and dealt with. There are procedures in place within the home to ensure that they are protected from harm and from those who have been judged as being unsuitable to work with vulnerable adults. EVIDENCE: There is a copy of the complaints procedure on the wall in the entrance hall and also in the Service User Guide. There is also a book in the hall for them to use if they wished to record any complaints. Residents and their relatives all agreed that they could raise any issues with Matron and she would deal with them. The Commission has not received any complaints about the home since the last inspection. The home has a policy regarding the protection of vulnerable adults and any concerns would be referred to the appropriate agency. All staff have received training and those spoken with knew about the procedures that they should follow to report any concerns. Staff have all had appropriate clearance from The Criminal Records Bureau, obtained before they started work in the home. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 18 The Annual Quality Assurance Assessment says that the home has recognised the need to consider Independent Mental Capacity Advocates for some residents with dementia and are going to look at ways to implement this. Tordarrach Nursing Home DS0000019129.V369154.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): Standards 19,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People tell us that they live in a comfortable, clean home, which suits them. They have been encouraged to bring in their own possessions to enable them to personalise their rooms. EVIDENCE: Tordarrach, a converted private house, is situated in a pleasant tree-lined road and is clean, homely and generally well maintained. The Registered Provider is currently applying for planning permission to extend and improve the premises. Ramps at the doors mean that the home is accessible to people who need wheelchairs and there is an attractive large garden to the rear of the property with garden furniture on the patio area. It has a passenger lift to all of the upstairs floors and bathrooms and toilets have adaptations to help people with limited mobility. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 20 There is a large communal lounge, which overlooks the garden with two televisions, one at either end. There are call bells throughout the home and it complies with the requirements of the fire service and environmental health department. People that we spoke with said, “it is a nice home to live in, and it is always clean and tidy” On the day of the visit it was warm and free from odour. We walked around the home and saw that resident’s bedrooms are pleasant, and they are well furnished. Many of them have been personalised by their occupants with pictures, ornaments and small pieces of furniture from home. Everyone is offered a lockable cupboard and, if they wish to leave their doors open, these have been fitted with a mechanism, which means that they close automatically in the event of a fire. Some areas have been redecorated since the last inspection and the Annual Quality Assurance Assessment tells us that there is an ongoing refurbishment programme in place and this will be continuing. As noted before, laundry facilities are far from ideal, situated in the basement, and it is hoped that this will be addressed if the intended improvements go ahead. Tordarrach Nursing Home DS0000019129.V369154.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): Standards27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are always enough staff on duty in the home to meet the needs of the people who live there. Recruitment policies and procedures are in place to protect people from those who have been judged as being as unsuitable to work with vulnerable adults. EVIDENCE: On the day of the inspection a trained nurse was on duty in the home with four care staff. Administrative and ancillary staff supported them. We looked at the rotas and they showed that there were always enough staff on duty. It would seem that the homes manager has very little supernumery time in order to carry out the managerial functions of her role and we would recommend that this should be addressed. Over 50 of care staff have attained an NVQ level 2 qualification and the home also employs trained nurses from overseas who are working as carers while they undertake further education. The staff that we spoke with said that they had attended training sessions relevant to the work that they do, such as infection control, dementia awareness, moving and handling, and health and safety. However, it was difficult to evidence this when looking at the training plan and it was recommended that a training matrix should be designed to make it easier. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 22 The personnel files of newly appointed staff were seen and these showed that the necessary checks had been undertaken before staff started work to ensure the safety of the people living in the home. New staff were able to tell us about the induction programme that they had undertaken when they first started work and they said that they had felt confident that it had addressed their needs. All staff receive regular supervision and records of the sessions are kept. Tordarrach Nursing Home DS0000019129.V369154.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): Standards 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed and run in the best interests of the people who live there. Records that are required to be kept as evidence of a commitment to health and safety are generally in order. EVIDENCE: The home is managed by Mrs Victoria Akindele, a trained nurse, who has been in post for some time. As at previous visits several residents particularly remarked on her kindness. As noted in standard 27, she still has a limited amount of time to discharge her managerial role; when she is on duty she is generally the trained nurse on the shift. It is recommended that this issue should be addressed to allow her more time to undertake managerial functions such as staff supervision, audit of care practices in the home and the assessment of potential residents. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 24 There is an expectation from The Commission that- Registered Managers will achieve a relevant management qualification. Mrs Akindele has enrolled at college to undertake an NVQ assessor’s course. There will need to be evidence supplied to The Commission as to how the completion of this course will provide her with the skills that she needs to manage the home. The Annual Quality Assurance Assessment tells us that the home listens to the views of the people who live in the home and that their views influence the provision of services. Resident’s are invited to complete satisfaction surveys every year to help the home monitor its progress. It is recommended that this could be expanded upon by asking for the opinions of other people who visit the home frequently such as Care Managers and healthcare professionals. Visits are made by an independent consultant in line with regulation 26, to monitor the home, and the reports of these were seen. Evidence that equipment is well maintained and serviced was generally in order. Any accidents to residents are recorded and the forms are put into their case files. It is recommended that details of these be also kept centrally so that they can be easily audited. The temperature of hot water is always recorded prior to residents being bathed however; it must still be monitored on a weekly basis to ensure that it is not too hot and would not pose any risk to residents who may wander into a bathroom on their own. This requirement is repeated from the last inspection. The last Environmental Health Officers visit found no particular problems in the kitchen and awarded 4 stars however, currently there seemed to be some confusion about temperature recording for the fridges and freezer. This was discussed with the chef and with the Registered Manager. Fridges and freezers must be checked twice a day to ensure that the temperature is correct and a new form has been introduced to make this easier. Tordarrach Nursing Home DS0000019129.V369154.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 3 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 3 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 3 X 3 X X 3 Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 9(2)(b)(i) Requirement There must be evidence available to show how the Registered Managers qualifications will provide evidence of their competence to manage the home. There must be evidence to show that the temperature of hot water is checked on a weekly basis, as well as prior to bathing residents, to minimise the risk of accidental scalding. This requirement is repeated from the last inspection. Timescale for action 30/11/08 2. OP38 13 (4)(c) 30/11/08 Tordarrach Nursing Home DS0000019129.V369154.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. 2 3 4 Refer to Standard OP9 OP27 OP30 OP30 Good Practice Recommendations It is recommended that medication not in a blister pack should be dated on opening to make it easier to check that the right amount is still in the packet. It is recommended that the manager of the home should be given more supernumery time in order to discharge her managerial responsibilities. It is recommended that the quality assurance tool should be developed to include the views of people who visit the service frequently. It is recommended that a training matrix should be devised to make it easier to see which staff members have attended training sessions. Tordarrach Nursing Home DS0000019129.V369154.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Tordarrach Nursing Home DS0000019129.V369154.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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