Care Home: Tunnicliffe House

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What the care home does well Staff provide support for people who live in the home to enable them to keep in touch with their families and friends. We saw that people living in the home were comfortable with staff who work with them. Over half the staff have achieved a national vocational qualification (NVQ) in care at level 2 or above. This is a nationally recognised qualification for people involved in providing care and shows they have the skills to make sure that the needs of the people they work with are met. What has improved since the last inspection? The manager and other joint proprietors have, with the support of Cheshire East social services and staff from the local PCT, put procedures in place to address issues identified at our last inspection so ensuring quality of service has improved for the people who live at the home. The care files (which includes the plans of care) for people who live at the home have been improved and reflect their changing needs. They include up to date information and guidance for staff so they know what they must do to meet the needs of each person. Information about people`s health care has been updated and shows how these are being met. The information about how the home works and who it is for, known as the statement of purpose and service users guide to the home, has been updated to include information about the proprietors, manager and staff. This is to make sure that people who live at the home, those who might be interested in living at the home, their families and representatives have up to date information about the home. Changes have been made to the way complaints are recorded to show how they are investigated and what action was taken as a result. This shows that people`s complaints and concerns are taken seriously and acted upon. Staff have received training on safeguarding adults, moving and handling, fire safety and food hygiene. This will make sure staff know how to provide safe care, in line with up to date best practice, for the people who live in the home. Improvements to the overall management of the home will make sure that the care needs of the people living there are met in the way they prefer. What the care home could do better: The management for the home must ensure the improvements put in place since our last inspection, which include regular staff training, supervision and support, are maintained so that staff continue to develop their skills and have up to date guidance to provide appropriate and safe care for the people who live at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Tunnicliffe House 16 Tunnicliffe Street Macclesfield Cheshire SK10 1DE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Flannery     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Tunnicliffe House 16 Tunnicliffe Street Macclesfield Cheshire SK10 1DE 01625617129 F/P01625617129 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sydney Neville Warrington,Mrs June Mary Warrington,Mrs Giles care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD - maximum number of service users - 16, Learning disability - Code LD - maximum number of service users - 4. The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home Tunnicliffe House is a large detached property in a quiet cul-de-sac close to Macclesfield town centre. Although it is a three storey building, the people who live there are accommodated on the ground and first floors as the second floor is not registered to accommodate residents. The home is registered to provide care for adults with mental health problems and up to four adults with a learning disability. The home does not have a passenger lift or adaptations, as the people who live in the home are Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 0 4 16 1 1 0 6 2 0 0 9 Brief description of the care home able to use stairs and move around the home without help. Please contact the manager for information on accommodation fees and other charges, Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for Tunnicliffe House is two stars. This means that the people who use the service experience good quality outcomes. This visit took place on the 25 November 2009. It was carried out by one inspector and took a total of four hours. The report will say we when referring to what we did and what we found because it is written on behalf of the Care Quality Commission. During our visit we spoke with the people who live in the home, the manager, joint proprietor and staff. We looked around the premises and looked at various records held by the home. The visit was just one part of the inspection. The home manager had completed a questionnaire to provide up to date information about the home; this had been done for our previous inspections in April and June 2009 and we were able to use this information again to help us plan this visit. CQC questionnaires were made available to the people who live in the home so they could tell us what they think about Care Homes for Adults (18-65 years) Page 6 of 26 it. The last inspection of this home was completed on the 11 June 2009. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 26 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 information about Tunnicliffe House in its statement of purpose and service user guide is accurate and up to date so that people have correct information about the home, how it runs and who it is for. Evidence: During our visit to the home, we saw copies of the information about how the home works and who it is for (the statement of purpose and service user guide to the home). The copies we saw had been updated to show the details and qualifications of the providers and manager, the numbers and experience of the staff and the correct details on how to contact the Care Quality Commission. This means that people would have up to date, thorough information about the home. At our last inspection we had looked at the processes used for when people move into the home and found these were satisfactory, although the assessments done before people moved into the home needed to show that they had been consulted and involved in their own assessment. At this inspection, no new people had moved into the home. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 plans of care we saw were up to date and showed how the persons needs were to be met so staff have the information they need to ensure their safety and well being. Evidence: During our visit to the home, we looked at the care files of two of the people who live in the home. The files included plans of care with important information about the person such as their likes and dislikes, the important people in their lives, their wishes and their daily routines. The plans we saw showed that they are being reviewed and that the person and their family/other important people in their lives were involved in this process so they could have a say in how care was being provided. There was records available to show that the people who live in the home and their representative (where appropriate) are being consulted about how they live their lives and the support they need to stay safe and well. We saw that risk assessments have being updated to show what staff should do to keep people safe when they were out in the local community and when they were in the home. We saw that changes have been made so that the daily routines for the people living Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: in the home are more flexible. For example, it is now clear that people can have their meals and drinks when they wish. Drink making facilities are now available in the communal areas so that people can make drinks as they wish. During our visit we saw people who live in the home using the drink making facilities provided. Staff we spoke with during the visit told us that since our last visit to the home, they have received training on moving and handling. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this 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 daily routines within the home have become more flexible, so encouraging and supporting the people who live at Tunnicliffe House with their personal development. Evidence: On the day of our visit, we saw one of the people who lives in the home going out to visit local shops with a friend. We saw staff support one person to make a drink, we also saw others who live in home make drinks for themselves. We saw the people moving freely between their bedrooms and the communal areas. The care plans of the people who live in the home showed how they were supported by staff to keep in contact with their families and other people who were important in their lives. Families and friends are able to visit at any time and are kept informed of events that may effect the lives of their relatives living in the home. Since our last visit the routines of the home have been changed so it is clear that Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: people can have their meals when they wish. We also saw that drink making facilities have been provided in two areas of the home so that the people living there can make drinks when they want. On the day of our visit the member of staff preparing lunch said they had asked people what they wanted for lunch and, as a result, had prepared three different meals to meet peoples preferences. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 care plans had up to date information about the personal and health care needs of the people living in the home and how these should be met so staff are able to ensure safe and appropriate care is provided to keep the person well and healthy. Evidence: The care files we saw of two people who live at Tunnicliffe House showed clearly how they wished to be supported with personal care by staff. The level of support they needed with personal care tasks had been recorded. The people who live in the home are able to move about the home by themselves, eat their meals unaided and require minimal help from staff with personal care. The plans of care showed how the health care needs of the people were being monitored and the action taken by staff to address any concerns. The plans of care we saw during the visit were dated and, where possible, signed or initialed by the person whose plans they were to show they had been involved in drawing them up. Since our last visit the procedure for staff giving out medication to the people who live in the home has changed. We were told by staff that individual people are asked to come to the room where the medication is stored so that staff can give them their medication. We were also told that a number of people are managing their own medication with support and guidance from staff. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: We could see the arrangements for this had been made properly so that people could manage their own medicines safely. We saw from the staff training records that six staff, including the manager, had received training on moving and handling in 2009. This helps to make sure that they can carry out their work safely, without injury to themselves or the people they are providing support for. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 is a procedure for making complaints or raising concerns about the home so people living there can be confident their complaints will be listened to and acted upon. The staff have received training on safeguarding adults so they know what to do to make sure that the people living in Tunnicliffe House are protected from harm and abuse. Evidence: We saw that record of complaints received at the home had been updated since our last inspection. There were two complaints recorded, although neither was about the care the people living in the home were receiving. The record showed that one of the joint providers had spoken with the people who had made the complaint and had taken action to address the issues raised. The complaints procedure included the updated contact details for the Care Quality Commission. These improvements showed us that complaints and concerns about the home are taken seriously and acted upon. We were told that the home have not made any referrals under the local safeguarding adults procedure. We saw a copy of No Secrets, the guidance on making sure that adults are protected from abuse, in the managers office. This means that guidance is available in the home for staff to refer to. We spoke with the staff who told us that they have received training on safeguarding. The training records we saw showed that six of the seven staff (including the manager) had received adult protection training during November 2009. This means that they have up to date knowledge on how to protect the people who live at Tunnicliffe House from abuse and harm. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and tidy so the people at Tunnicliffe House are living in a safe and comfortable environment. Evidence: During our visit, we walked around the home and saw that it was clean, tidy and free from bad odours. We were told by one of the joint providers that since the last visit they have made improvements to the utility room by replacing the work top, sink and medication cupboard. Also that they have fitted a small breakfast bar and and tiled the floor in the utility room. We were also told that they have replaced the extractor fan in the smoking room and re-decorated one of the bedrooms. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 people who live in the home are supported by staff who have received up to date training on health and safety matters so ensuring they are safe from possible harm and abuse. Evidence: On the day of the visit there was one senior care assistant on duty; the registered manager/joint proprietor and another of the the joint providers were also in the home. There are normally two staff on duty during the day and one staff member on waking night duty. The staff are responsible for carrying out domestic tasks and preparing meals for the people who live in the home. We saw the staff training records which showed that, since our last visit, staff have received training on moving and handling, safeguarding vulnerable adults, fire safety and food hygiene. We also saw records which showed that four of the six care staff have achieved an national vocational qualification (NVQ) level 2 or above in Health and Social Care. These are nationally recognised qualifications for staff working in social care and show that they are competent to provide support and care. The staff we spoke with during our visit said they have received lots of training since the last inspection. During our visit we saw staff talking with and supporting the people who live in the home. The people living in the home were comfortable and relaxed in the company of Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: the staff. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 overall management of the home has improved with staff receiving training and guidance so ensuring the health, safety and well being of the people living in the home is maintained. Evidence: We spoke with the manager, who is also a joint proprietor, and another of the joint proprietors during our visit. We were told that, since the last visit, the home has had a link installed to an internet provider so that they access the Care Quality Commission web site and other sources of information about current good practices. We also saw minutes of meetings that have been held with the local authoritys social services department which showed that the home is being supported with staff training and developing care plans. We saw a copy of a monitoring report which had been carried out by Cheshire East social services which showed that the home will continue to receive support with staff training and improving care plans. We saw a record to show that, since the last visit, the manager has received training on safeguarding vulnerable adults, food safety and moving and handling. The home has also consulted with an advisory company for advice and guidance on completing risk assessments. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: We saw copies of completed service user questionnaires where the home had asked people who live there to comment on the quality of service provided. One of the people who lives in the home had raised an issue in one of the questionnaires which, according to manager, will be addressed by sitting down with the person and come to an agreement with the person about the best way to deal with the issue. Ten completed CQC questionnaires had been returned where the people who live in the home had given us their views about the home. These showed that the people living there are satisfied with the care offered. They told us that the home helps to maintain a good quality of life, I like living here, its nice and clean, I like the home because it gives me company, Keep a happy ship, Looks after us, good home, organization and meals, and Girls do well and treat me with respect. meals very nice and my washing is done very clean. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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