Care Home: Tudor House

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What the care home does well Tudor House provides a homely, safe environment for residents. It has a safe accessible garden that is enjoyed by the residents. Staff receive a good level of training, which includes Health and Safety, and service user specific training. Residents enjoy the food provided by the home and a good activity programme is in place. What has improved since the last inspection? Tudor House continues to update furniture and fittings within the home. The training programme for staff has been expanded. What the care home could do better: Some of the floor coverings need to be replaced in the near future as they are looking worn. CARE HOMES FOR OLDER PEOPLE Tudor House 79 Victoria Drive Bognor Regis West Sussex PO21 2TB Lead Inspector Jo Hartley Unannounced Inspection 30th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000014807.V367780.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. DS0000014807.V367780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor House Address 79 Victoria Drive Bognor Regis West Sussex PO21 2TB 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) 01243 823406 Mr Marimuthu Subramaniam Mrs Brenda Swee Chin Subramaniam Mrs Brenda Swee Chin Subramaniam Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24) DS0000014807.V367780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2006 Brief Description of the Service: Tudor House is a care home providing personal care and accommodation for twenty-four older people over the age of sixty-five who have dementia. It is privately owned by Mr & Mrs Subramaniam. Mrs Brenda Subramaniam is the registered manager. The home is situated in a residential area of Bognor Regis, West Sussex and is a short distance from the town. The property is an extended detached house with accommodation arranged on two floors both of which are served by a passenger lift. The home has a combination of single and double rooms with seven of the single bedrooms having en-suite facilities. There is an enclosed rear garden and large front garden both of which are accessible to service users and very well kept. The current fees range from £410 to £420. DS0000014807.V367780.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 site visit formed part of the key inspection process and was carried out over three and a half hours by Ms J Hartley, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, where possible speaking with the residents and staff, and observing care and support practices. Previous inspection reports and information held by the Commission regarding Tudor House were examined prior to the site visit. Surveys were sent to residents, staff and health professionals. Information received from these is also contained in this report. A tour of the home took place and documents relating to health and safety were viewed. What the service does well: What has improved since the last inspection? Tudor House continues to update furniture and fittings within the home. The training programme for staff has been expanded. DS0000014807.V367780.R01.S.doc Version 5.2 Page 6 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. DS0000014807.V367780.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 DS0000014807.V367780.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 residents have their needs assessed prior to moving into the home to ensure that the home is able to meet their needs. Tudor House does not provide intermediate care therefore Standard Six does not apply to this service. EVIDENCE: Residents’ files seen on the day of the inspection included full assessments provided by the placing authority or undertaken by the registered manager. Information is gathered from the referrer and relatives prior to the resident moving into the home to ensure that the home is able to meet the needs of prospective residents. This information is used to draw up a plan for daily living that sets out individual needs and long-term goals. DS0000014807.V367780.R01.S.doc Version 5.2 Page 9 Tudor House does not provide intermediate care. DS0000014807.V367780.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are in place and reviewed monthly. Residents have their health care needs met and are treated with dignity and respect. EVIDENCE: During the visit we examined the records of six residents. Each contained a detailed care plan generated from the initial assessment, and reviewed on a monthly basis. Residents are encouraged to be involved in the drawing up of care plans and in reviews if they are able to. Care plans include details of residents’ personal history that have been gathered from relatives and, where possible, residents as well. Care plans are person centred and include individuals’ likes and dislikes, preferred routines, hobbies, and health and social needs. Various risk assessments are in place that are tailored to individual residents. For example, one resident has a nutritional risk assessment as they sometimes refuse to eat; another resident DS0000014807.V367780.R01.S.doc Version 5.2 Page 11 has a risk assessment for sleep patterns as they have difficulty sleeping and can wander around the home when they are awake. Evidence was seen that residents have access to GP’s, opticians, dentists, chiropodist, district nurses and other healthcare professionals as required to meet their health needs. The district nurse visits the home every two weeks and at additional times, when required. The home also receives advice and input from Occupational Therapists, a dementia specialist and the wheelchair service. Records seen showed that the home gained advice from a dietician for a resident who is vegan, to ensure that the resident receives enough protein. Medication records seen were up-to-date and correctly recorded. The home has a procedure for the receipt, recording, storage, handling, administration and disposal of medicines. There are no controlled drugs being administered at the home at present. The medication cabinet was seen to be in good order with no over-stocking of medication. The home’s medication procedures are inspected by Boots pharmacy on a regular basis. Due to the needs of the service users at Tudor House, no one is currently self-medicating. However a risk management framework is in place so any future residents who wish to self-medicate would be able to following an assessment. Staff are only allowed to administer medication after training and an assessment by the registered manager. During the inspection staff were witnessed treating residents with respect, dignity and kindness. Screening is provided in shared rooms to protect privacy and maintain dignity. DS0000014807.V367780.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle of the home meets the needs and preferences of the service users. Residents enjoy the food provided by the home. EVIDENCE: Tudor House provides a varied activity programme that includes karaoke, ball games, quizzes and singing. On the day of the visit the residents were engaged in a sing-song that they were clearly enjoying. The home organises mini bus outings every week. Relatives and friends are able to visit at any reasonable time. A relative told us that she is always made welcome when she visits and is always offered tea and biscuits by the staff. It was seen from residents’ care plans and daily notes that they are encouraged and supported to make choices in their lives and to remain independent as long as possible. They are encouraged to get involved with DS0000014807.V367780.R01.S.doc Version 5.2 Page 13 daily chores in the house such as laying tables, folding their laundry and tidying. A member of staff said that residents are able to make choices such as what time they go to bed and what they want to wear. For those who are unable to communicate verbally staff give them visual choices, such as holding up two jumpers and encouraging the resident to point or look at which one they want to wear. The home has good links with local churches and is able to provide for the diversity of religious beliefs of the residents. Holy Communion is held once every three weeks at the home. Residents told us that they enjoy the food provided by the home. One resident said that the food is, “absolutely lovely, they know what each of us like”. Special diets such as diabetic and vegan are catered for by the home. A speech therapist has been consulted for a resident that has swallowing problems. Staff were seen assisting residents to eat when needed. DS0000014807.V367780.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from harm or abuse. Complaints are dealt with promptly and appropriately. EVIDENCE: The home has received one complaint since last inspection; this was investigated by social services and not substantiated. The home co-operated throughout the investigation. The complaints book and procedures were inspected. The procedures were clear and included recommended timescales. The home’s procedures on abuse, Adult Protection and whistle blowing were seen and found to be clear and comprehensive. Staff records show that staff have received training in Adult Protection. The manager attended the roadshow set up by social services to launch their new Safeguarding Adults guidance. DS0000014807.V367780.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at Tudor House is safe, comfortable and adequately maintained. Some of the floor coverings need to be replaced. The home is clean, pleasant and hygienic. EVIDENCE: Tudor House is a detached house in its own grounds situated close to the town centre of Bognor Regis and to the sea. The location and layout of the home is suitable for its stated purpose and is adequately maintained. A visitor said, “It is always very clean in the home. Some floor coverings are getting tatty and could do with replacing, but they are always clean.” The manager told us that they are in the process of finding suitable, practical and long lasting floor coverings to replace those that are worn. Some bedrooms have had new floor coverings fitted since the last inspection. DS0000014807.V367780.R01.S.doc Version 5.2 Page 16 A tour of the premises found Tudor House to be clean and free from offensive odours on the day of the inspection. The home has central heating. All radiators and pipe work are covered. Windows have restrictors fitted for safety. Emergency lighting is provided throughout the home. Up to date maintenance certificates were seen during the visit. The home has policies and procedures in place regarding the control of infection. The laundry is sited away from food storage and preparation areas, has impermeable floor finishes and is easy to clean. DS0000014807.V367780.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient numbers of experienced and qualified staff. EVIDENCE: The number of staff on duty on the day of the inspection was appropriate for the size of the home and the needs of the residents. The rota for the home showed that four staff are on duty in the mornings, three in the afternoon and two waking night staff. The home also employs a gardener and a cleaner. Mr Subramaniam does the cooking and the maintenance. A relative said Tudor House is an “absolutely brilliant home and staff. Staff are always willing and cheerful.” The home’s recruitment policies and procedures were found to be thorough. Criminal Records Bureau and Protection of Vulnerable Adults checks are carried out prior to employment. Staff records show that all new staff undertake induction training within six weeks of starting work. The induction programme meets the current guidelines. The home has a training programme in place for staff. The home has a training programme in place for staff. Mandatory training includes Health and Safety, Manual Handling, First Aid And Protection of Vulnerable DS0000014807.V367780.R01.S.doc Version 5.2 Page 18 Adults. Staff also attend training relevant to the specific needs of the service users including Skin Care, Fluid Intake, Pressure Area Management and Dementia Care. Six staff have a level three National Vocational Qualification an Care and the rest have a level two. DS0000014807.V367780.R01.S.doc Version 5.2 Page 19 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. The registered manager is competent and qualified to manage the home. The home is run in the best interest of residents. EVIDENCE: Mrs. Subramaniam’s qualifications and experience show her to be competent to run the home. She is a registered nurse and has completed the Level Four NVQ Registered Manager Award. In discussions during the site visit Mrs. Subramaniam came across as very knowledgeable about dementia and about the needs of the individual residents in the home. A visitor said that the manager is very approachable. DS0000014807.V367780.R01.S.doc Version 5.2 Page 20 Tudor House has a quality monitoring system in place. Once a year they send out questionnaires regarding the quality of care and the running of the home. The replies are then audited to enable the home to monitor its performance and identify areas for improvement. The home does not handle the finances of any of the residents. The home has detailed policies and procedures in place regarding Health and Safety, manual Handling and Infection Control. The records for maintenance checks and services of equipment were seen during the visit and found to be up to date. DS0000014807.V367780.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 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 DS0000014807.V367780.R01.S.doc Version 5.2 Page 22 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 DS0000014807.V367780.R01.S.doc Version 5.2 Page 23 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. 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