Care Home: Tweed

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What the care home does well The comfortable, relaxed and homely environment, which is a feature of Tweed, has evolved over many years and reflects the general stability within the dedicated staff team, the approachable and inclusive management style and the ongoing involvement and support of the Trustees. People are encouraged to be as independent as possible and to maintain as many independent skills as they can. This enables people to have control over their lives. The food is of a very good standard. Fresh produce is served on a daily basis by two chefs. Several residents commented about the high quality of the food. The dining room has been recently decorated and lunchtime was observed as a relaxed and pleasant experience. The staff team is long standing and experienced. A high level of staff have a National Vocational Qualification in care so residents are in safe hands. What has improved since the last inspection? The contract, service user guide and statement of purpose have been reviewed and updated. This ensures that people have the information they need about the home and the services provided. Staff have attended training specifically related to residents` needs to ensure that they have the skills to support people. A bathroom has been converted to a walk in shower room which is easier for some residents to access. A WC has been adapted so it is more accessible for people. Access to the garden has been improved and new garden furniture purchased. This means that everyone can enjoy the garden. CARE HOMES FOR OLDER PEOPLE Tweed 8-10 Silverdale Road Eastbourne East Sussex BN20 7AL Lead Inspector Kim Rogers Key Unannounced Inspection 09:40 18th March 2008 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 Tweed DS0000021276.V359621.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. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tweed Address 8-10 Silverdale Road Eastbourne East Sussex BN20 7AL 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) 01323 733223 01323 649741 info@tweedcarehome.co.uk Emilie Galloway Trust Mrs Jacqueline Heywood Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2007 Brief Description of the Service: Tweed is a large detached house on three floors, with a basement area, situated in the Meads area of Eastbourne, and five minutes walk from the seafront. There are local shops, and other social and leisure facilities in close proximity. Public transport routes run near to the home and there is a main line railway station in the town. Décor and furnishings are maintained to a good standard. Service user accommodation comprises of ten single rooms and ten double bedrooms, of which only two should be used for double occupancy at any one time. The home is registered to accommodate up to a maximum of twenty one service users. The communal areas comprise of a separate dining room and a large lounge and snug area on the ground floor. Information about the service, including the Statement of Purpose, Service User’s Guide and CSCI reports is made available to prospective service users or their relatives, on request, as part of the admission process. The range of weekly fees is £360 to £415 a week with a rise due in April 2008. Additional charges, not included in the fees, include hairdressing, chiropody, reflexology and newspapers. For more information about the fees and services please contact the Provider. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key inspection. The site visit took about five and a half hours. The key National Minimum Standards were assessed. The inspector spoke with service users (residents), staff and the manager. Records were sampled including care plans, medication records, staff training and recruitment records. The inspector also had a look around the home and made observations. An ‘expert by experience’ accompanied the inspector. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Some work was done before the site visit. We looked at all the information that we have received, or asked for, since the last key inspection. This included: · The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service.The AQAA was detailed and full of information about how the home has improved and how it intends to improve in the future. · What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. · The previous key inspection. · Relevant information from other organisations. · What other people have told us about the service Residents said ‘I love it here’ ‘I don’t want to be anywhere else’ ‘I’ll never find another place like this’ Residents experience some good and excellent outcomes. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: The comfortable, relaxed and homely environment, which is a feature of Tweed, has evolved over many years and reflects the general stability within Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 6 the dedicated staff team, the approachable and inclusive management style and the ongoing involvement and support of the Trustees. People are encouraged to be as independent as possible and to maintain as many independent skills as they can. This enables people to have control over their lives. The food is of a very good standard. Fresh produce is served on a daily basis by two chefs. Several residents commented about the high quality of the food. The dining room has been recently decorated and lunchtime was observed as a relaxed and pleasant experience. The staff team is long standing and experienced. A high level of staff have a National Vocational Qualification in care so residents are in safe hands. What has improved since the last inspection? What they could do better: We found that to enable staff to support people consistently and safety some care plans need more detail. For example better directions about how to safely move and handle people. We found that some risk assessments need to be reviewed and updated. This is because some peoples’ needs have changed creating potentially bigger risks. Assessments will enable staff to think about how to reduce these new potential risks. We found that at times more appropriate referrals for support should be made. For example when people need specialist support for personal, health or emotional reasons. This is because there are times when staff or families do not have the skills or training to help. Residents should always be fully informed and be at the centre of this consultation. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 7 We found that the adult protection policy needs to be reviewed. This is because staff need to be clear about what action to take if they think a person is at risk of harm or abuse. We found that records need to be kept of what medicines and the amounts of medicines/tablets are in the home and in people’s rooms. This is to ensure that the home knows about quantities of medicines on site and to protect residents. 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. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 is not applicable. People who use the service experience good outcomes. Documentation, including a concise and informative brochure, statement of purpose and service users’ guide ensures that prospective service users and their relatives have sufficient information about the home and the services provided. The admission procedures ensure that service users are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As well as the detailed statement of purpose and service user guide that are in place, an informative brochure has also been developed for the benefit of prospective service users and their relatives. Details include the history and location of the home, aims and objectives and information regarding staffing, activities, accommodation and facilities provided. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 10 People are able to stay for trial visits to find out what life is like at Tweed before they decide to move in. A person has recently had a month trial stay and now plans to move in. The person has chosen a colour for their bedroom, which is now being decorated and is planning to bring in some personal furniture and items. This means their room will feel more like home. We sampled two care plans and found that assessments of peoples’ needs are carried out, usually by the manager. This ensures that the home can meet the persons’ needs. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8 9 and 10 People who use the service experience good outcomes. Each person has a care plan. Some plans need more detail to ensure staff support people safely and consistently. Risk assessments need updating when a person’s need changes to ensure that potential new risks are minimised. Residents take control of their medication if they can but the home still has a duty of care to take stocks of all medication on site. People know that their health care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an individual care plan. Residents are involved in developing their care plans to ensure they are person centred. There is an emphasis on maintaining and maximising independent skills so people are encouraged to do as much for themselves as possible. Staff are at hand to give support where necessary. We sampled two care plans. We found that care plans have detail about people’s past and significant events in their lives. This gives staff a good Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 12 picture of the person, their life, family etc. Personal and health care needs are recorded although some lacked detail. This means that staff may not have the information they need to support people safely and in the way they prefer. For example a person needs support with moving and handling but there was no detail about how staff should do this. Risk assessments are included in care plans although we found that one had not been updated even though the risk to the person had increased. A simple colour coded review system is used and changes are made to care plans when a need changes but this did not follow through to risk assessments. This means that strategies may not have been considered or be in place to reduce risks. Through direct observation and discussions during the inspection, it is clear that staff at Tweed are aware of and respect service users’ privacy and dignity. Members of staff were seen knocking on doors before entering private rooms and were observed to be professional in their manner and sensitive and respectful when interacting with residents. Each bedroom is fitted with a lock and residents have keys to their rooms and to the front door. Staff support residents to manage their medication and some residents manage their own. This enables people to maintain their independence and keep control of their medication. Aspects of the homes’ medication practice were assessed including checking storage, stocks, records and observing administration. We found that storage was safe and records in order. Medication was administered to residents at lunchtime and this was observed. This interrupted some people as they were eating. It was discussed with the senior staff and manager that it may suit people to wait until a gap between courses or after the meal to administer medication. Staff did not check the medication administration record before administering medication. This should be done to make sure the person has not already had their medication. We found that some practice does not relate to the homes’ medication policy so this needs reviewing. Some residents keep their medication in their rooms. One person keeps controlled drugs. The manager said that a record is not kept of the amounts of these drugs on site. A requirement was made that the manager must ensure that records are kept of all medicines on site. Stocks of medicines should be checked regularly to protect residents. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 13 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 and 15 People who use the service experience excellent outcomes. Social activities and meals are both well managed, creative and provide daily variety and interest for people living in the home. People are supported to have control over their lives and to maintain contact with family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Within a risk management framework, independence continues to be promoted in the home and, wherever possible, service users are enabled and supported to pursue their own lifestyles and individual routines. For example residents go and collect their own newspapers and have the facilities to do their own washing and ironing if they wish. A structured programme of activities, events and entertainment has been developed and is on display in the entrance foyer. As well as the many organised group activities, time is also given to individuals, who prefer to spend time alone or remain in their room. A couple of people suggested an organised outing was a good idea. The manager said she would look into organising this. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 14 Service user’s individual social and recreational interests, likes and dislikes are recorded in their care plan. There is also a record maintained of an individual’s participation in organised activities. The four-week rolling menus were examined and found to be balanced, wholesome and nutritious. An alternative to the main meal is always available as well as a second alternative if necessary. A choice of desserts is also offered. Fresh vegetables are served daily and fresh fruit is always available. All residents spoken to said the food is of a very good standard, with plenty of variety. Residents said that they are involved in panning the menu with the chef regularly asking them for input and ideas. The dining room has been recently decorated and lunchtime was observed as pleasant and relaxed. There are fridges on each floor for residents to keep their own food items if they wish. Visitors are welcome at reasonable times and can stay for lunch if they wish for a small charge. People who do not have their own phones in their rooms can use the home’s portable phone to make private calls. One resident keeps in contact with their family who live abroad by e mail. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 15 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 and 18 People who use the service experience good outcomes. Residents know who to complain to and that complaints will be listened to and acted on. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure. This is given to people when they move in with other information so they know how to make a complaint. The procedure is written and not currently produced in any other format. For example large print for people who are visually impaired although the manager said this could be done if requested. There is a complaints book in the hallway for people to use. There have been two complaints since the last inspection, which the manager and trustees investigated. The manager said that there is an open door policy and residents are encouraged to raise issues and concerns. Regular residents meetings are held to facilitate this. The home has a policy for safeguarding vulnerable adults. This is for staff to refer to should they suspect that someone is at risk of harm. The policy needs reviewing as it currently emphasises the home’s role in investigating an incident when it should be adult protection at social services or the police. The Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 16 policy also needs reviewing in light of the Mental Capacity Act 2005 to ensure that residents’ rights are protected. Staff attend training in safeguarding adults so they know about signs of abuse and how to report it. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 17 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 and 26 People who use the service experience excellent outcomes. The service is accessible, safe and clean and remains clearly suitable for it’s stated purpose. Service users benefit from pleasant accommodation that is comfortable, generally well maintained and decorated to a satisfactory standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tweed is an established service and both its location in a residential area of the town and its layout remain appropriate and suitable for its stated purpose. The well maintained décor and good quality furniture and furnishings provide a comfortable, pleasant and homely environment for service users. The character of the building is reflected in the spacious lounge and dining room and in the varied shapes and sizes of peoples’ rooms. It is evident and good to see that so many have been personalised, with pictures, family Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 18 photographs and other items of furniture and personal belongings, reflecting individual taste, choice and preference. Everyone spoken to said that they are happy with their rooms and that the home is always clean. Infection control procedures are in place and clearly adhered to and levels of cleanliness remain high throughout. Improvements have been made since the last inspection including some redecorating and improvements to the front garden. A bathroom and WC have been made more accessible to residents. There are plans for further redecoration and some new carpets. We found that residents can access both the front and back garden. However the wrought iron gate leading to the back communal garden is rusted and difficult to open. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 and 30 People who use the service experience good outcomes. There are enough trained and competent staff to meet residents’ needs. Recruitment checks are robust which protects residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs care staff, chefs, domestic, administration and maintenance staff. Residents said that staff are on hand when they need them. Staff were observed talking respectfully to residents. Residents confirmed that they are treated with respect and dignity. The staff team is long standing giving residents consistency. A high percentage of staff have a National Vocational Qualification in care so have knowledge about residents’ needs. An ongoing programme of training ensures that staff keep up to date with mandatory training and other courses. We found that induction procedures for new staff are in line with the Minimum Standard. A staff file was sampled and we found that recruitment checks are carried out before a person starts work at Tweed. This protects residents. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 20 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 and 38 People who use the service experience good outcomes Residents and staff benefit from the manager’s open and approachable style of leadership. The home is run in the best interests of residents. Staff are aware of and adhere to policies and procedures relating to health and safety, ensuring the health, safety and welfare of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A deputy manager and an assistant manager support the manager. The manager has been in post for over 25 years and is qualified for her role. Staff and residents made positive comments about the management of the home. The Annual Quality Assurance Assessment was completed fully and in detail and returned to the Commission when we asked for it. It showed that the Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 21 management of the home have a good understanding of issues relating to equality and diversity and gave evidence that the home is good value for money. Systems are in place to safeguard residents including financial systems. We found that there are good quality assurance systems in place. Trustees carry out monitoring visits to ensure good practice continues. Residents, their relatives and other stakeholders are given questionnaires to complete on a yearly basis. This checks out satisfaction with the service provided. Results are collated and shared with residents. Improvements have been made following suggestions from residents including improvements to bathrooms and toilets so residents’ views underpin development in the home. Health and safety is protected by clear polices and procedures and regular checks of equipment and the premises. We found that staff have training in health and safety including infection control and fire awareness. We found that the Commission had not been notified of one incident affecting residents. All other incidents and accidents had been recorded and reported appropriately. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 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 Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The manager must ensure that care plans, including risk assessments have the information staff need to support people safely and consistently. This especially relates to moving and handling people. The manager must ensure that records are kept of all medicines on site. Stocks of medicines should be checked regularly to protect residents. To ensure residents get the support they need referrals should be made, when necessary, to health and other professionals after consultation with residents. Timescale for action 30/06/08 2 OP9 13 30/04/08 3 OP8 12 30/06/08 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 Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 24 1 2 OP18 OP9 The safeguarding adults policy should be reviewed and updated to protect residents’ rights. The medication policy should be reviewed to reflect actual practice in the home so staff have clear guidance. Tweed DS0000021276.V359621.R01.S.doc Version 5.2 Page 25 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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