Care Home: Tynedale

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What the care home does well During our inspection we were told many good things about the service offered, the staff and the food. The people staying here told us that they were Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 well cared for and that the staff are pleasant, courteous and listen to them. The service provided here helps people to remain in their own homes longer by providing a short break from home, and in offering intermediate care to help people get over hospital treatment or accidents. Mealtimes are a pleasant experience and everyone we spoke to commented positively about the food on offer. Dining tables are well presented and there is always a choice of main meal and pudding. Staff are knowledgeable about peoples dietary preferences and particular needs, for example if they need particular help, have an allergy or are diabetic. The building is a purpose built care home. It is clean and well maintained. There are regular checks by the manager to make sure the good standard is kept up. The people staying here and their relatives are asked for comments and suggestions about the service they receive. The people we spoke to all knew who to speak to if they had a concern or were unhappy with any aspect of the service. They told us that they were confident any such concerns would be properly dealt with. The home is effectively managed, and staff are well trained and qualified. What has improved since the last inspection? The manager and her team have worked to make improvements to some of the areas highlighted at the last inspection. This has included: ♦ Building stronger links with the Council`s domiciliary care service. ♦ Improved complaints recording, to ensure outcomes are documented. ♦ Ensure some staff have received training on equality and diversity (although this needs to be extended to the whole staff team). What the care home could do better: Overall the home operates at a good standard however, some areas need attention. These include: ♦ Seeking to obtain up to date assessment information from care managers. ♦ Implementing plans of care developed by other professionals, such as Physiotherapists. ♦ Developing a programme of activities aimed at supporting and promoting independence.TynedaleDS0000066634.V378744.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Tynedale Tynedale Promoting Indepedence Centre Holburn Lane Ryton Gateshead Tyne and Wear NE40 3PF Lead Inspector Lee Bennett Key Unannounced Inspection 10:00 2 , 11 & 17th November 2009 nd th DS0000066634.V378744.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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 older people 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. Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 2 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 Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tynedale Address Tynedale Promoting Indepedence Centre Holburn Lane Ryton Gateshead Tyne and Wear NE40 3PF 0191 4130210 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) Gateshead Council Beverley Ann Davison Care Home 27 Category(ies) of Dementia - over 65 years of age (6), Learning registration, with number disability (1), Learning disability over 65 years of places of age (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (2), Old age, not falling within any other category (27), Physical disability (5), Physical disability over 65 years of age (7) Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service may from time-to-time admit persons under the age of 65 within the OP category of registration 05/11/2007 Date of last inspection Brief Description of the Service: Tynedale Promoting Independence Centre is a modern, purpose-built service designed to provide short-term care and accommodation for older people, some of whom may have a physical disability. The building is on the site of the former Tynedale residential home for older people, in a village location. The new building was completed in July 2006. The service is operated and managed by Gateshead Council’s Community Based Services (formally the Social Services Department), with input from health services employees, including occupational therapists and physiotherapists. Tynedale aims to provide 4 distinct services, that is: Intermediate care for people who are receiving rehabilitative therapy, usually after a stay in hospital; Short-term ‘assessment’ care for those people being assessed for further services; Short breaks (respite care) for people who will return to their own homes. Emergency accommodation. The building provides 27 single rooms, all with en-suite shower and toilets facilities. There are also 2 communal bathrooms, which are fitted with appropriate adaptations to support people with a physical disability. There is a large communal lounge and separate smokers’ lounge on the ground floor. Two small kitchen / dining rooms are provided on the first floor, along with a larger dining room and small lounge. There is an enclosed garden at the rear of the building. Car parking at the front and side of the building includes 2 accessible parking bays, located at the entrance. There is level access into building through electronic doors into the reception area. Tynedale is a short walking distance from local shops, and a short bus or car ride from shops in both the Ryton and Blaydon areas. There is access to local transport a short walk away. The home faces onto Ryton Park, and is opposite a country club. Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 5 There is no fee for the first 6 weeks of the rehabilitative service. Information about the weekly fees for assessment and short breaks are available from the home. Additional charges apply for the use of telephone and TV facilities. Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star (Good). This means the people who use this service experience good quality outcomes. The visit; Before the visit, we looked at: ♦ Information we have received since the last visit in November 2007. ♦ How the service dealt with any complaints & concerns since the last visit. ♦ Any changes to how the home is run. ♦ The providers view of how well they care for people. ♦ The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 2nd November 2009. Further announced visits were made on 11th & 17th November 2009. During the visit we: ♦ Talked with people who use the service, their relatives, staff and the manager. ♦ Observed life in the home. ♦ Looked at information about the people who use the service & how well their needs are met. ♦ Looked at other records, which must be kept. ♦ Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. ♦ Looked around parts of the building to make sure it was clean, safe & comfortable. ♦ Checked what improvements had been made since the last visit. After the visit: We told the manager what we had found. What the service does well: During our inspection we were told many good things about the service offered, the staff and the food. The people staying here told us that they were Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 7 well cared for and that the staff are pleasant, courteous and listen to them. The service provided here helps people to remain in their own homes longer by providing a short break from home, and in offering intermediate care to help people get over hospital treatment or accidents. Mealtimes are a pleasant experience and everyone we spoke to commented positively about the food on offer. Dining tables are well presented and there is always a choice of main meal and pudding. Staff are knowledgeable about peoples dietary preferences and particular needs, for example if they need particular help, have an allergy or are diabetic. The building is a purpose built care home. It is clean and well maintained. There are regular checks by the manager to make sure the good standard is kept up. The people staying here and their relatives are asked for comments and suggestions about the service they receive. The people we spoke to all knew who to speak to if they had a concern or were unhappy with any aspect of the service. They told us that they were confident any such concerns would be properly dealt with. The home is effectively managed, and staff are well trained and qualified. What has improved since the last inspection? What they could do better: Overall the home operates at a good standard however, some areas need attention. These include: ♦ Seeking to obtain up to date assessment information from care managers. ♦ Implementing plans of care developed by other professionals, such as Physiotherapists. ♦ Developing a programme of activities aimed at supporting and promoting independence. Tynedale DS0000066634.V378744.R01.S.doc Version 5.2 Page 8 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are occasionally assessed before moving here. The lack of information is usually addressed after admission. Obtaining information about a person’s needs is important in ensuring that everyone concerned is confident that this is a suitable place to live, and that everything is in place to make people safe and comfortable. EVIDENCE: Before a person moves to a care home they are entitled to have an assessment of their needs carried out, either by social services or a health care worker, such as a nurse assessor. Even when a person pays for their own care, they are still entitled to such an assessment. All of the people staying Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 11 here have their care arranged by Social Services or the NHS. None have come here by private arrangement. The manager of a care home must make reasonable efforts to obtain up to date information about those people who would like to come here. This will usually include a copy of the social workers or health care workers (care managers) assessment, and a summary care plan, written by them. The home manager may also undertake their own assessment, which explains how each persons needs are to be addressed. This is to make sure that each persons needs are looked at and then can be properly met, for example by ensuring appropriate equipment such as pressure relieving aids are in place. The stated purpose of Tynedale House is to offer short breaks, intermediate care and to carry out assessments for people, some of whom may not have previously used care services. Therefore for these people there may not be an up to date care managers assessment available. In these circumstances an assessment must be carried out within five days of admission. For those people whose reason for coming here was for a short break or for intermediate care we found that assessment information from a health or social worker had been obtained in one out of the two cases we looked at. For the person who had an assessment, this was not up to date or accurate. For example we found that the assessment was over three years out of date and did not reflect the persons current needs. More up to date care plans had been developed to offer better guidance, but some in-house assessments carried out used a standarised, or core assessment approach. This is understandable given the numbers of people who stay here, but as these are not always person centred they do not reflect current best practice. Some key areas of risk, such as choking, were not covered in assessments but other aspects assessed and care planned were more person specific. One purpose of Tynedale is to offer intermediate care. This is where a person receives temporary support to help them return home after a stay in hospital or other care service. Accommodation and facilities are integrated into the home as a whole, and a team of healthcare workers retain a supply of equipment here to support people to regain or maximise their independence. For a person admitted here for this type of support we found that specific plans of care had been developed by a Physiotherapist, to be implemented by the staff here. However, there was no documented evidence that this had been consistently followed through. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here receive generally well planned care that meets their needs, but which could be further strengthened by effective assessment, clear implementation and regular monitoring. This can help ensure that the goals set for each persons stay are achieved. Medicines are safely handled safely. EVIDENCE: The health and personal care that people receive has to be based on their individual needs. These are identified and documented through assessments carried out by a persons care manager. It is from these assessments that clear plans of care can be developed. Where people are able to express their wishes they can help develop and be involved in care planning arrangements. Care plans are useful as they can help guide the care practice of staff. We found that in every case we looked at, that after a person has been admitted Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 13 here a plan of care is written up. This is so that important areas of need, such as those around health and personal care, diet and social interests, can be clearly identified, and the support that staff are to provide is clearly explained. For the people whose files we looked at, the care plans themselves are clear and generally relevant to the needs observed and that have been assessed by the manager and social workers (that is where such information has been obtained). There were however some key omissions. For example we found insufficient detail in manual handling assessments to detail how people are to be supported and what equipment is used. Core care plans / risk assessments are also used, which lack information specific to the individuals concerned. There was a lack of baseline assessment, goal setting and monitoring for a person who needed intervention and support to assess and develop their kitchen skills. As detailed above, we also found that where a physiotherapist had specified a detailed programme of exercise for staff to support a person with, there was little evidence that these had been followed through. Staff do nevertheless keep regular notes about each persons welfare and a summary of the care that they have provided. These records are clear, factual and relate to each persons health and personal care needs. Where people have medical needs, evidence is kept of appointments attended, district nursing care that has been provided, and other visits by healthcare professionals. This can help ensure peoples health needs are regularly monitored and met, and proper advice and intervention sought. Importantly, a care plan is only one aspect of how care is delivered, and acts to inform how staff support each person. Of more direct relevance to people is the quality of the care actually delivered, and an important element of this is maintaining each person’s dignity and privacy. During our inspection, there were no instances where personal care was carried out in the public areas of the home (other than support with eating), which shows that staff are conscious of peoples privacy and dignity. The support offered by staff was carried out in a friendly, and pleasant manner. Everyone was well dressed, and provided with clean, well laundered clothes. Each persons personal tastes and dress appeared to be promoted and the people we spoke to told us that they are cared for in a good manner. The comments we heard from service users and relatives included: - The care is excellent. - Theyre good at keeping in touch. - Theyve got mum settled, her sleeping is sorted out and shes eating now. - Very good reports ... Im very much pleasantly surprised. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 14 - Everything’s good, the food, the attention to people. I cannot fault it in any way. - Its nice to have peace of mind. A common area where staff help people with their health care is in the way medicines are administered. Some people deal with their own medicines, whilst others have some or all of their medicines looked after for them. This is based on a risk assessment, carried out on a persons arrival here. To keep medicines safe, they are stored in a secure way and the rooms where they are kept are clean and well ordered. Staff check the temperature of the medicine room and the medicine fridge to make sure that these are correct for the medication being stored. This will make sure the medicines concerned remain safe and effective. There is also secure storage for medicines in each bedroom, for those people who see to their own medication needs. When staff administer medication they tell the person concerned what medication they are receiving, and also follow good hygiene practices. There are clear records kept of the medicines administered by staff and the stocks held for all the medicines we checked corresponded to the stock records. Medicine records are accurate, and the reasons for medicines being missed is clearly recorded. To help ensure staff are aware of the importance of good record keeping, along with other aspects of medication management, they have been trained on this topic. Competency checks are also carried out to ensure staff are properly skilled to handle medicines safely. All medicines are administered from the manufacturer’s original containers, and all stocks are regularly counted to make sure errors don’t occur. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the 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 people staying here are not offered regular opportunities to participate in activities, but are well supported to maintain friendships and family contacts. People are enabled to express choice and control at meal times and receive varied, wholesome and well-presented meals. EVIDENCE: An important element of the care and support offered to people when staying in care homes is based around the activities and meaningful occupation that is offered. People stay here for a variety of reasons, usually for a short break or to regain or learn new skill to enable them to return home after a hospital stay. In these circumstances a structured, and individually tailored programme of activities would be beneficial, but has been an area identified as being in need of further development at previous inspections. We were informed that the management of the service are looking to develop this by the use of volunteers from the local Voluntary Organisation’s Council (GVOC). Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 16 At the time of this inspection (we visited on more than one day) there were no planned activities. Most people were spending their time in lounges; watching TV, receiving family visitors or asleep. There is no activities co-ordinator employed here, or staff member assigned to take a lead in planning coordinating and monitoring this aspect of care. Several people commented to us about the lack of activities on offer, and how events such as exercise groups no longer occur due to a loss of funding. Visits from relatives form an important part of many peoples day. Visitors can come and go freely, and those visitors we spoke with were all complimentary about the staff and care offered. People also commented positively to us about the food on offer. A choice of main meal and pudding is always offered. Staff were noted to be helpful at meal times, and took the time to sit down with those who need help with eating, supporting people in a dignified way. Routines are flexible here, and if someone wants to have a lie-in they can have their breakfast later in the day, to suit them. The dining tables here are nicely presented, and condiments are provided so that people can help themselves. A lunchtime meal was shared with several of the people living here. Staff were courteous, encouraging people to be independent. A choice of dilute juice, with tea or coffee was offered. One visiting family told us about how they can share a meal with their relative. This can help to ensure people settle-in and can be supported by people they know. We spoke to the cook who talked about his awareness of peoples individual needs and preferences. He informed us that special diets are catered for. Furthermore, regarding peoples dietary needs a risk assessment is carried out. This focuses on people at risk of malnourishment, but could be usefully extended to include areas such as hydration, diabetes, obesity, food intolerance and health conditions such as diabetes. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are arrangements in place here to protect people form abuse and to allow people to raise any concerns or complaints they have. EVIDENCE: A complaints procedure is available within the home with a copy placed on display. This informs the people staying here, and those acting on their behalf, how they can make their views known and how any complaints will be dealt with. The people we spoke with told us that they know how to complain and that they are confident that this would be looked into. A record of complaints and suggestions is maintained, and these were reviewed as part of this inspection. Details of the compliant are recorded, along with any actions taken and the outcome of this. One complaint has been made to the Commission since the last inspection, and this was referred onto the local Adult Protection team as it involved an unreported accidental injury. It was unclear if this had occurred at the home, or when the person was being transported home by the local patient transport service. As well as ensuring peoples views are listened to, staff have a responsibility to ensure service users are protected from harm and abuse. To make sure staff know how to identify and act upon suspected abuse, they have received Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 18 training on Adult Protection from the local Adult Protection Co-ordinator. This training was to help explain the role of adult protection, and to offer guidance to staff. The care provider has adult protection procedures, which are available in the home, should staff need guidance in this area. As part of the protection procedures used here, when injuries occur or are observed, a body map is completed. This is an outline drawing of the body, on which staff can mark injury or pressure ulcer sites. When we case tracked a sample of the people who have used the service we found that some have body maps on their files. Where this had been completed certain areas had been highlighted, but there was no detail or description as to what had been observed. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people staying here benefit form a clean, well equipped and warm accommodation. EVIDENCE: Tynedale is a purpose built care home that has been specifically designed and built to provide short-term accommodation for older people, including people who are physically frail and disabled. It is an airy, bright, modern building, set within it’s own grounds. Outside there is an enclosed, level garden. A small wooden summer house has recently been built. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 20 Accommodation is provided over two floors, with bedrooms for individual accommodation, each with an en-suite shower and toilet. Some of these are larger than others, to help meet the needs of service users who need to use wheelchairs and other mobility equipment. Communal areas are large and have homely decorations and furnishings. There is also a small lounge designated as a smoking area for service users. Several people commented to us that they were comfortable in their rooms. The home was noted to be clean and tidy throughout, and measures, such as the use of hand sanitisers and disposable paper towels, help contribute to effective infection control. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff working here are qualified, competent, and recruited in a safe and robust manner. EVIDENCE: Staffing levels are currently as follows: For the 27 service users there are no fewer than three care staff rotored on duty through the day, and two care staff at night. There is always a designated senior member of staff on duty, and the team is supported by a manager and three assistant managers. An on-call member of staff is available at night, to cover four homes across the Gateshead Area. Before staff are employed here they have to undergo a range of checks to ensure they are able to perform the work expected of them and have the right approach to working with people who at time will need extra help and support. Robust pre employment checks will help ensure unsuitable people are not employed here. On this occasion we were not able to see the staffing recruitment records as these are held elsewhere, however this has been agreed with us, and records are periodically checked on a random basis. These checks have found that Gateshead Council has robust pre-employment Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 22 checks in place, including checks for criminal convictions, against the Protection of Vulnerable Adults List, and reference checks from previous employers. Once employed in a care service, it is important that staff obtain the training they need to understand the needs of the people they provide care for, remain up to date with good practice, and work in a safe manner. We found that the majority of care staff working here are qualified, to NVQ level two or higher, and training is available to cover a range of care related topics. To aid planning and to monitor levels of training a matrix has been developed. This highlights what training staff have had and what gaps remain. Training provided over the past year has included: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Fire Safety Customer Care Dementia Awareness Equality and Diversity First Aid Medication Infection Control Stroke Awareness Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people here benefit from living in a well managed home. This can help make sure their views are sought and acknowledged, and that their health and safety is promoted. EVIDENCE: At the time of the inspection a permanent manager was employed here. She has been registered by us as a fit and proper person. This means that she has no adverse criminal record, and has the skills, knowledge, experience and competence necessary to undertake her role. She is qualified to NVQ level 4 in care and management and undertakes regular training to keep her knowledge Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 24 up to date. A ‘line manager’ undertakes regular monitoring visits, that form part of the quality assurance of the home. Age Concern carry out an external quality check, and have sought the views of service users once they have left the home. The home’s line manager also undertakes regular (monthly) quality inspections. From these visits plans of action are developed to address the comments made. Service users views are further sought at regular meetings and meetings are also held with staff. Dementia care mapping is also used as a tool to assess the quality of care offered to people with needs relating to their dementia. We found that the records kept at the home, that were inspected, were up to date, detailed, and held in a safe and secure manner. Financial records are subject to the scrutiny of the home’s line manager and the Council’s financial officers. Staff in the home do not usually hold or manage service users finances, but where these are left with staff for safe keeping they are securely stored, with clear records in place. The financial records we looked at were accurate. The home was found to be free of hazards to the safety of service users, with the exception of a cluttered storage area, and bathroom. These areas were tidied before the inspection ended. Staff receive regular health and safety related training, chemicals are securely stored, and equipment serviced at the specified intervals. Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 2 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 1 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 Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 26 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 OP3 Regulation 14(1 and 2) Requirement Except in exceptional, emergency situations, the registered person must ensure that detailed, accurate and up to date assessment information is sought for each person planning to stay here. This is so the manager ensures that each persons needs can be safely met here, and appropriate equipment obtained prior to admission. 2. OP6 12(1(a & b)) The registered person must ensure that programmes of care designed to promote rehabilitation, recovery and mobility are consistently implemented (with records kept). This is so people are supported to return home with maximum independence. Care planning and risk assessment documents must provide information relevant to each persons needs that is DS0000066634.V378744.R01.S.doc Timescale for action 31/01/10 31/01/10 3. OP7 15(2) 31/01/10 Tynedale Version 5.3 Page 27 accurate, up to date and person centred. This is so everyone is clear about what a persons needs are and how they are to be met. A range of activities and 31/01/10 occupation needs to be provided. This is to ensure the people staying here are offered opportunities to be engaged and stimulated in a meaningful way. 4. OP12 16(2(m & n)) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The registered manager should develop a programme of activities and occupation that reflects the purpose of the home and enables service users to maintain and reestablish the skills needed to return home. Where body maps are used, these should detail the site of each injury, the date observed, and a factual description of what has been observed. This is so injuries can be accurately described and contribute to the protection of people using this care home. The registered manager should explore the use of assistive technology to allow easily access for disabled and physically frail people to independently access and exit their rooms. The registered manager should arrange training on the causes, effects, culture and current good practice in the field of learning disability. 2. OP18 3. OP22 4. OP35 Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 28 5. OP35 The registered manager should arrange for those staff who have not so far participated in it training on Equality and Diversity to do so. The registered manager should establish joint working arrangements with local domiciliary care agencies. This is to help the smooth transition of people between care services. 6. OP6 Tynedale DS0000066634.V378744.R01.S.doc Version 5.3 Page 29 Care Quality Commission North East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@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. 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