Care Home: Tudor Grange Care Centre

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What the care home does well A warm and welcoming atmosphere was evident on entering the building. Staff were observed to maintained good relationships with service users and relatives and talked freely. Staff were knowledgeable and able to discuss service users needs fully. Service users spoken with said, "I am very happy here, staff are always available when you need them," "I enjoy the activities on offer and trips out," "food is very good and there are always choices available" and "staff are very kind and they always listen to what you have to say." Plans of care are in depth and cover service users identified needs, there was evidence to show that service users and relevant others are fully involved in the development of the plans of care. An activities coordinator has been employed offering a full range of activities for service users. The environment is well maintained and offers a comfortable and homely atmosphere. Staff are well trained and competent to do their jobs. What has improved since the last inspection? Plans of care have continued to develop to ensure that service users complex needs are fully addressed thus ensuring these are met. There was evidence available to show that service users are fully consulted about their plans of care ensuring that their personal needs are fully addressed. Additional measures have been implemented to ensure the safe administration; recording and storage of medication ensuring service users are protected. Staff have received further training in first aid, equality and diversity and dementia awareness ensuring service users needs are fully met. What the care home could do better: Continue to work with the Commission for Social Care Inspection methodology - Key Lines of Regulatory Activity to further develop the service. CARE HOMES FOR OLDER PEOPLE Tudor Grange Care Centre 54 Main Street Radcliffe On Trent Nottingham NG12 2BP Lead Inspector Karmon Hawley Key Unannounced Inspection 6th September 2007 10:00 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 Tudor Grange Care Centre DS0000008782.V342031.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. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor Grange Care Centre Address 54 Main Street Radcliffe On Trent Nottingham NG12 2BP 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) 0115 9334404 0115 9332966 tudorgrange@ashbourne-homes.co.uk the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Andrew Stewart Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: Tudor Grange is an adapted and extended period house situated within the village of Radcliffe-On-Trent, Nottinghamshire. The village provides access to shops, the library, banks, a post office, restaurants, public houses and local bus, rail and road networks. The home is registered to accept up to 33 residents within the category of old age only. The accommodation is provided mainly in single rooms, all of the rooms have ensuite facilities. There are sufficient bathing facilities, two of which have recently been refurbished. There is one main lounge and a dining room for service users plus a small seating area in the main entrance. There is limited outdoor space, confined to a small patio area as the car park takes up most of the available space. However by verbal agreement residents may use the gardens of the flats adjacent. The deputy care manager stated that the current fees are £380 - £415 cost is dependant upon the level of care required. Additional costs include hairdressing and chiropody. The previous inspection reports are on display in the main entrance for prospective service users to view. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager about Tudor Grange and by undertaking a visit to the service with the inspector using a method called “case tracking.” “Case tracking” involves identifying individual service users who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspector also checked that information provided by the manager matched individual experiences of the service user living at the home by talking with them and observing the care received. General records maintained by the home were looked at to ensure these were maintained and provided positive outcomes for service users. What the service does well: What has improved since the last inspection? Plans of care have continued to develop to ensure that service users complex needs are fully addressed thus ensuring these are met. There was evidence available to show that service users are fully consulted about their plans of care ensuring that their personal needs are fully addressed. Additional measures have been implemented to ensure the safe administration; recording and storage of medication ensuring service users are protected. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 6 Staff have received further training in first aid, equality and diversity and dementia awareness ensuring service users needs are fully met. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are confident that the service will assess their needs and they are assured these will be met prior to admission. EVIDENCE: A trained member of staff visits prospective service users in the community and carries out a preadmission assessment to ensure the service can meet their needs. There was evidence of this assessment taking place on service users files. One service user spoken with explained that their relatives had been to look at the home before they moved in, they said, “it was the best choice they made, I am very happy here.” Service users may also visit the home and spend time there before they make a decision to move in if they wish. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 9 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social cares needs are met. Service users are treated with respect at all times and their right to privacy is maintained. EVIDENCE: Service users undergo several assessments such as manual handling and the activities of daily living to highlight their needs. All highlighted needs and support required was covered in the plan of care. Relevant risk assessments for identified risks were in place. There was evidence of reviews taking place to ensure that continuity of care is maintained. Staff spoken with were able to discuss service users individual needs and the support required. All service users spoken with said that staff were very kind and caring and their needs were met. There was evidence within service users plans of care to show that services such as the doctor and district nurse and other specialist services such as the optician and dentist are accessed as required. During the brief tour of the home relevant equipment such as specialist beds, cushions and hoists were in Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 10 place. Two members of staff were seen using the hoist, they gave clear explanations at all times and the service user was moved safely. One service user spoken with said that they can always see the doctor when they need to and another said that they see the optician when they need new glasses. To ensure that service users are protected by the homes medication policies and procedures all staff who administer medication has undergone training in this area. Medication checked on the day of the visit corresponded with the prescription chart, if medication had been omitted this was clearly recorded. Records such as drugs returned to pharmacy were kept. Due to the warm temperatures in the home thermometers have now been place in the drug trolleys, these are recorded daily. The temperature had been recorded on the day of the visit and was satisfactory for the safe storage of medication, however on checking this at lunch time it had risen to above the recommended temperature for the storage of medication. This was discussed with the manager who stated that they would look at alternative places for the medication trolley to be stored. One service user spoken with said, “staff look after my tablets, they give me them when I need them, I am pleased about this as I know I get them when I should.” To ensure service users privacy and dignity are maintained staff receive training in customer care. Staff spoken with were able to discuss how they ensure that this is maintained by knocking on doors, talking with service users respectfully and telling them what they are doing. All service users spoken with said that staff were very kind and caring and were always respectful. Staff were seen to interact with service users in a respectful manner. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to live a fulfilling life and make their own choices about how they spend their time. Service users receive a wholesome and appealing diet in pleasing surroundings. EVIDENCE: An activities coordinator has now been employed by the service to enhance activities that are on offer. Activities such as shopping, trips out, videos, one to one time, crosswords, cake decorating and singers are offered. The activities coordinator was spoken with who discussed many ideas that they are looking at implementing to continue to improve activities that are on offer. Service users spoken with expressed that activities had improved and there was enough for them to do. One service user said, “I enjoy it when I go shopping and visit the café,” and another said “I enjoyed the summer fete.” Staff stated that the routine of the home was flexible and service users may spend their time as they wished, this was observed throughout the visit and all service users spoken with confirmed this. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 12 There are no restrictions on visiting and visitors may be received in private should they wish. One visitor was spoken with during the visit, they stated that they visit regularly and are made welcome. Service users spoken with said, “I have my family visit, it is very nice that they can come at any time,” and “I often have visitors, they are made welcome when they come.” To maintain contacts with the local community several service users visit the local Salvation Army and the activities coordinator takes service users on trips out. Staff are trained in the issues of equality and diversity to ensure that service users are treated as individuals and their rights and choices are respected. Staff spoken with discussed how they ensure they get to know each resident and their personal likes and dislikes ensuring that care is delivered appropriately. All service users spoken with said that staff were respectful and listened to what they had to say. They also stated that they can make their own choices with regard to their daily lives. A wholesome and appealing diet is on offer and there are choices available at each mealtime. A recent questionnaire has taken place to ensure that service users views are taken into consideration when planning the menu. Service users spoken with said, “there is plenty to eat and there are always choices,” “the food is lovely,” and “I enjoy my meals and there is usually something I like on the menu.” Staff were observed to assist service users appropriately during the lunch time meal. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and relevant others are confident that they can express any concerns and these will be acted upon. A well trained staff team and policies and procedures in place ensure that service users are protected from abuse. EVIDENCE: To ensure that complaints and concerns are dealt with appropriately in depth policies and procedures are in place. These are made available for service users and are on display in the main entrance. Staff spoken with were able to discuss how they would deal with a complaint should it be received. Service users spoken with said, “the staff are very good, they listen to what you have to say, I do not have any problems,” “I have a good relationship with staff, they care about you and help if you are worried about anything” and “I know how to complain if I need to, but I am happy here.” To ensure service users are protected from abuse staff receive training in this area. Staff spoken with discussed how they ensure that service users rights are maintained and how they aim to offer quality care. Service users spoken with spoke highly of the staff and the care received. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and homely environment, which is well maintained. EVIDENCE: On going redecoration and refurbishment takes place to ensure service users live in a well-maintained environment. The dining room has recently been refurbished and redecorated; the manager said that service users were involved in the choosing of materials used. Two service users spoken with said that they enjoyed eating in the dining room and it was much nicer now it had been redecorated. A maintenance person is employed by the service who carries out routine maintaince as needed. The service employs sufficient domestic staff to ensure that the home remains clean and tidy. All areas seen on the day of the visit were, clean and fresh. One service user spoken with said that they had brought in their own Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 15 belongings to make it feel like home and the staff make sure that this is looked after and cleaned when needed. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel that staff are always available when needed to meet their needs. Staff are well trained and competent to do their jobs. EVIDENCE: The duty rotas seen showed that sufficient staff are employed to meet service users needs. Staff spoken with said, “there are always enough staff available to look after residents and to spend time talking with them throughout the day,” “staffing levels are good, some staff also help to take residents out on outings so that they have one to one support.” Service users spoken with said,” staff are always there when I need them,” I am lucky I do not need much help but if I did I know that staff will be there.” The relative spoken with also confirmed that staff were available when needed. The information provided by the manger before the visit showed that 57 staff have achieved the National Vocational Qualification in care (a nationally recognised work and theory based qualification). One staff member spoken with confirmed this. To ensure that new staff are aware of their responsibilities and the running of the home they undergo an induction. One member of staff spoken with said they were on their induction at the moment and were always supported by a senior member of staff, they said they had done a lot of training during this time and it was very helpful. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 17 To ensure service users are protected by the homes recruitment policies and procedures all required documentation such as an application, references and a Criminal Record Bureau check (a police check to see if an individual has a police caution or conviction) were in place. Staff spoken with confirmed that they had undergone these processes. To ensure that the staff team are well-trained and competent to carry out their job and in depth training plan is maintained. This covered both compulsory training such as manual handling and health and safety and specialist training such as nutrition, challenging behaviour and dementia awareness. Staff spoken with said that training was at a high standard and there was always some sort of training on offer. Two service users spoken with said staff are very good at their jobs and they feel they are well trained. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is well run and where their best interests are fully considered. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. He has previous experience in managing a care home and has completed the Registered Managers Award. He stated that he felt supported by the company and staff. Staff spoken with said that the manager had made many changes since his arrival and these had been good changes which have improved standards of care. All service users and the relative spoken with spoke highly of the manager and said that he was always approachable when needed. Service users’ and relatives’ meetings take place giving the opportunity to express their views and opinions. In addition to these regular questionnaires Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 19 are sent out. A recent audit of the food delivery had taken place; the manager had implemented changes in the menu in account of results received. The manager also carries out monthly audits on all areas of the service such as care planning, the environment and accidents to ensure that a quality service is maintained. One service user spoken with recalled completing the questionnaire about the food, and said that they did not feel any changes were necessary as they were happy with what they already had. Service users are enabled to keep money in safe keeping should this service be required. One service user spoken with said that staff look after their money but they can get some whenever they need it. Plans of care demonstrated if there were any special arrangements in place regarding service users finances and the support they required. The information provided by the manager prior to the visit demonstrated that the maintenance and servicing of the building and equipment such as the gas, electrics and hoists had taken place. To ensure service users remain safe in the day-to-day activities relevant risk assessments are in place. Staff have received training in health and safety issues and first aid, on discussing falls and accidents with staff they were able to discuss how these incidents would be dealt with. Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X 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 Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Tudor Grange Care Centre DS0000008782.V342031.R01.S.doc Version 5.2 Page 23 - 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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