Care Home: Tynefield Court

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What the care home does well Health services were called in when required and specialist help and advice was sought as necessary. Care needs were reviewed regularly with a health professional. This ensured that health needs were met and healthy living promoted.Tynefield CourtDS0000002169.V377348.R01.S.docVersion 5.2Satisfactory records were maintained on each person using in the service. People using in the service were pleased with the assistance provided by staff and praised them saying they were ‘helpful’ and ‘can’t fault them’. There were clear procedures for dealing with complaints and responding to concerns that ensured people were safe and their concerns were listened to and dealt with objectively. What has improved since the last inspection? Quality assurance processes had improved and the providers were completing records of visits and identifying areas for improvement. Staff training had improved to ensure mandatory health and safety training was up to date and additional courses were provided on care related issues. People using the service were signing their records and were aware that these records were available to them. Some improvements had been carried out to the building such as repairing the wood panelling at the rear of the home, providing new carpets in the quiet area and corridors and providing radiator guards. The heating system had also been repaired. What the care home could do better: Additional details on care and support records were needed to make them more person centred and inclusive. A much wider range of activities and occupation was needed to improve the quality of life of people using the service, particularly for those in the younger age range. Menus need to be changed more regularly and need to address individual tastes of people using the service. The alternative to the main course should be detailed on the menu board on display. Better use of the outdoor facilities should occur to offer people a wider range of activities and there should be greater efforts made to enable people to use external facilities such as colleges and community buildings. Further improvements to the building should be made to ensure it is well maintained, i.e. to the external gardens, decoration of bedrooms, repair of potential hazards. All overseas staff must have a Criminal Record Bureau check undertaken in this country as well as their country of origin before commencing employment.Tynefield CourtDS0000002169.V377348.R01.S.doc Version 5.2 The manager should be assured that all overseas staff have a competent grasp of the English language. There should be an up to date copy of the Royal Pharmaceutical Society guidelines on handling medicines in social care and an up to date medicines reference book for staff to utilise. Staffing levels should be reviewed to enable staff to support people in activities outside of the home. Further training on care related issues should be made available to all staff. Formal staff supervision operating on a one to one basis and covering training and career development should occur at least every two months. The service’s annual development plan to assure the quality of the service should include forward planning for the next twelve months. Key inspection report CARE HOME ADULTS 18-65 Tynefield Court Blakeley Lane Egginton Road Etwall Derby DE65 6NQ Lead Inspector Janet Morrow Key Unannounced Inspection 25th August 2009 09:30 Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 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 home adults 18-65 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. Tynefield Court DS0000002169.V377348.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 Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tynefield Court Address Blakeley Lane Egginton Road Etwall Derby DE65 6NQ 01283 732030 01283 734550 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) Tynefield Care Limited Mrs Shirley Hall Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (13), Physical disability (27) of places Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 27 places for younger PD aged 18 years and over included in the total above 13 places for OP aged 65 years and over included in the above total Date of last inspection 29th August 2008 Brief Description of the Service: Tynefield Court Care Home is a home with 40 places that provides both nursing and personal care. The service cares for older people, as well as young adults with physical disabilities. It is purpose built and resident’s accommodation is located in three single storey wings, with central communal areas. The service has 36 single and 2 shared rooms. A total of 27 rooms have en-suite facilities, 10 of which also have en-suite showers. The service is located outside the village of Etwall. The site also accommodates a children’s nursery and a number of bungalows for independent living. Information provided by the Manager, on 15th September 2009, stated that the weekly fees ranged between £380.00 and £720.00 and are dependent on the needs of the person. Additional charges are made for hairdressing, chiropody personal newspapers and toiletries. Details of previous inspection reports can be found at the service, or on the Care Quality Commission’s website: www.cqc.org.uk Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. This inspection visit was unannounced and took place over one day for 8 hours. An expert by experience assisted with the inspection process. 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. The expert by experience was present for three hours and spoke with eight people living in the home, five relatives and two members of staff. She toured the building and watched what life was like for people in the home. Her findings are incorporated into the report. Care and support records and staff records were examined. Three members of staff, five people using the service and the manager were spoken with. Two visiting professionals and one relative were contacted by telephone following the inspection visit. Case tracking methodology was used which means that the records of three people were looked at in detail and the people concerned and relevant staff were spoken with to find out what impact the service had for those peoples well being and quality of life. Twenty-four surveys were received in total prior to the inspection visit; seven from people living in the home, five from relatives, seven from staff and five from visiting professionals. A partial tour of the building was undertaken. Written information in the form of an Annual Quality Assurance Assessment was provided by the service prior to the inspection and informed the inspection process. What the service does well: Health services were called in when required and specialist help and advice was sought as necessary. Care needs were reviewed regularly with a health professional. This ensured that health needs were met and healthy living promoted. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 6 Satisfactory records were maintained on each person using in the service. People using in the service were pleased with the assistance provided by staff and praised them saying they were ‘helpful’ and ‘can’t fault them’. There were clear procedures for dealing with complaints and responding to concerns that ensured people were safe and their concerns were listened to and dealt with objectively. What has improved since the last inspection? What they could do better: Additional details on care and support records were needed to make them more person centred and inclusive. A much wider range of activities and occupation was needed to improve the quality of life of people using the service, particularly for those in the younger age range. Menus need to be changed more regularly and need to address individual tastes of people using the service. The alternative to the main course should be detailed on the menu board on display. Better use of the outdoor facilities should occur to offer people a wider range of activities and there should be greater efforts made to enable people to use external facilities such as colleges and community buildings. Further improvements to the building should be made to ensure it is well maintained, i.e. to the external gardens, decoration of bedrooms, repair of potential hazards. All overseas staff must have a Criminal Record Bureau check undertaken in this country as well as their country of origin before commencing employment. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 7 The manager should be assured that all overseas staff have a competent grasp of the English language. There should be an up to date copy of the Royal Pharmaceutical Society guidelines on handling medicines in social care and an up to date medicines reference book for staff to utilise. Staffing levels should be reviewed to enable staff to support people in activities outside of the home. Further training on care related issues should be made available to all staff. Formal staff supervision operating on a one to one basis and covering training and career development should occur at least every two months. The service’s annual development plan to assure the quality of the service should include forward planning for the next twelve months. 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. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 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. Sufficient admission information was in place to ensure needs could be met. EVIDENCE: The Annual Quality Assurance Assessment provided by the service stated that a full assessment was undertaken prior to admission to the home. Three peoples’ care and support files were examined and all had an assessment in place. Information from external professionals was available and the background information compiled by the home gave a clear picture of individual needs. All seven surveys received from people living in the home responded that they received enough information before deciding to move in. Feedback on surveys indicated that generally needs were met, as follows: Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 10 Three of the five surveys received from visiting professionals responded that the service’s assessment arrangements ‘always’ ensured accurate information was gathered and two responded that they ‘usually’ did. Five of the seven staff surveys received responded that they ‘always’ received up to date information about peoples’ needs and one responded that they ‘usually’ did. One did not provide a response. Four surveys responded that ways of passing information between the care team ‘usually’ worked well, two responded that they ‘always’ did and one that they ‘sometimes’ did. Two of the five relatives’ surveys received stated that needs were ‘always’ met, two responded that they ‘usually’ were and one that they ‘sometimes’ were. However, communication issues were raised as an area that had the potential to affect how needs were met. One staff survey commented that ‘communication is poor, lack of understanding because of language barriers between multi-cultural workers’. The annual quality assurance assessment also stated that language issues were an area for improvement by ‘recruiting staff with a better knowledge of English’. Two surveys from visiting professionals also commented on language issues and the impact on meeting peoples’ needs. One said there was ‘relatively poor spoken English of some of the care staff causes communication problems with residents who have language impairments’ and the other said the service could improve by ‘consideration of communication barriers and cultural differences in the care team and how this impacts on care received.’ This feedback was discussed with the manager who stated that she felt improvements had occurred recently and the majority of staff were competent in the English language. No one living in the home raised communication as a problem during the inspection visit and those staff spoken with whose first language was not English spoke English well. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6,7 and 9 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. A lack of information on individual care plans did not always ensure that consistent patterns of support were given and that independence was promoted. EVIDENCE: Three peoples’ care files were examined and showed that a care plan was in place that demonstrated how individual needs would be met. However, they contained minimal detail for staff and concentrated primarily on how to deal with specific medical areas of need and there was less information on social needs; for example the care plan for social and family needs only covered keeping in touch with relatives on the three plans examined and the all three Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 12 plans tended to concentrate on areas of need and not any strengths or abilities the person had. It was also not clear how people had contributed to their own plans although they had signed to say they were aware they could access them. The records were easy to read, and all of the files were well organised. Risk assessments were available in individual care files that showed how identified risks were minimised. For example, on one file, a tissue viability risk assessment indicated a need for this to be undertaken on a monthly basis and examination of the record showed that this was occurring and on another file a mobility issue was addressed. However, one file had a risk assessment for falls that indicated this was an issue and it had not been updated since 2007. Staff spoken with said that they encouraged people to make decisions about their daily lives, although those decisions were generally about meals and activities within the service. A survey from a visiting professional commented that the home allowed ‘people to live as ordinary as possible’ and that the service adopted an ‘individual approach’. There was evidence from general observation and discussion with people living in the home and staff that they were involved in decisions about their life and able to make decisions, with assistance, as required. However, some people did not feel they were consulted about the running of the home or have any input into decisions such as choosing décor. Two of the surveys received from people living in the home responded that they ‘usually’ made decisions about what to do each day and four responded that they ‘sometimes’ did. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 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. A lack of appropriate and sufficient activities did not ensure a good quality of life. EVIDENCE: People using the service were observed to have their own routines as far as possible, with some choosing to go out and others choosing to stay in their rooms. There was an activity co-ordinator employed and records showed she arranged sessions of arts and crafts events, cooking, bingo and external entertainers and provided one to one support for some people to go out, have manicures etc. The co-ordinator was employed for twenty hours per week. However, the activity board needs to be pictorial for ease of communication. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 14 The Annual Quality Assurance Assessment also stated that ‘the routine of the home is flexible in order to make it as relaxed as possible’. All six surveys from people using the service responded that they could do what they wanted during the day, in the evening and at weekends. One survey suggested that something the service could do better was to ‘do more activities if possible’ and another said ‘do not have things for my age group’. Three visiting professional surveys commented that more activities were an area where the home could do better; one said ‘provide more support to enable residents to engage in social activities both within the home and the wider community’. It was also observed that some people were despondent and felt their social life and quality of life was in decline. The annual quality assurance assessment acknowledged that an area for improvement was in social activities. It stated that the service hoped to improve over the next twelve months by encouraging people to be ‘more involved in the community’ and ‘to source community groups to visit’. Suggestions for people to be more involved in gardening were made, such as having a greenhouse, being able to choose what to grow and watering flower beds. People were encouraged to maintain links with family and friends. One survey from a person using the service commented ‘I go out with my family’. However, there was little contact with the local community and some people said that they had not been out on social visits or holidays since they entered the home 2 – 4 years ago. One person spoken with had not been into the local village for four years. The rules on smoking were understood by people, and a smoking room was available, although a survey from a visiting professional commented that its location in the centre of the building, which they felt may put people off choosing the service. People using the service said that a choice of meal was provided at breakfast, dinner and tea time. Menus were seen that showed that nutritional meals were provided, although the option from the main meal was always the same i.e. baked potato, salad or omelette and was not displayed on the menu board. Staff spoken with said that they went round to individuals and asked them their preferences. Curries, pasta and sweet and sour options were on the menus although the majority of meals were traditional ‘english’ fare. Some people spoken with during the inspeciton visit described the food as ‘good’. Some people said that they had a say in choosing meals and setting the menus but some said that they were not consulted in choosing meals at all. It was Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 15 noted that there were no fresh fruits readily available on the day. A meal was sampled and seemed to be processed rather than cooked from scratch. Some people said that they were able to have snacks and drinks upon request. One person using the service commented that ‘more variety’ would be an improvement in the meals and a staff survey commented that changing the food menu would be an improvement as ‘food is the same all the time, people have to buy their own food if they want to change something’. Kitchen staff confirmed that menus had not been changed recently. An internal quality assurance survey had highlighted issues about the food, with one survey describing it as ‘bland’. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18, 19 and 20 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. Peoples’ health and personal care needs were well managed, which ensured that good health was maintained. EVIDENCE: The Annual Quality Assurance Assessment provided by the service stated that high standards of nursing care were promoted and maintained and that pressure sores were prevented in a high risk group of people. Three peoples’ care and support records were examined. These showed that attention was paid to nutritional needs and skin condition needs with risk assessments for nutrition and tissue viability being undertaken and having appropriate interventions detailed. Weight was also recorded on monthly basis Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 17 on the files examined. There were regular reviews of care held with other health professionals that ensured changing needs were addressed. Four of the six surveys received from people using the service responded that staff ‘always’ listened and acted on what they said, one responded that they ‘usually’ did and one responded that they ‘sometimes’ did. One survey commented that ‘all staff are helpful’ and another that ‘everyone looks after me, I am so happy’. Three of the five surveys received from relatives responded that they were ‘always’ kept up to date with important information and two responded that they ‘sometimes’ were. One survey commented that the service ‘look after the care and needs of my husband, keep me informed regarding his welfare and have developed a caring relationship with him’. Another survey commented that the service did well at ‘one to one care, calming people down’. Feedback from people during the inspection visit was positive about the care received and said staff were responsive, helpful and willing to meet their social care needs requests. Records showed that access to health professionals was made available and showed visits to dentists, opticians and General Practitioners took place. This was confirmed by those people spoken with. A survey received from a visiting professional commented that ‘senior nursing staff demonstrate a high level of competence and caring’ and another said staff were ‘very knowledgeable about clients at review, very aware of their individual needs’. Two of the five surveys from visiting professionals responded that the service ‘always’ sought advice and acted on it to meet needs and improve well-being and three responded that it ‘usually’ did. Feedback from a visiting professional spoken with was positive about the care and support provided, stating that their client was ‘very comfortable’ and that staff interactions with them were ‘good’. They also felt they had developed well emotionally since using the service. Another felt that staff ‘understood’ difficult needs and that they were ‘patient’. It was observed that personal support was offered sensitively and people spoken with stated that they found staff helpful. General observation showed that there were warm relationships between staff and people using the service. People spoken with made favourable comments about the care; one said it ‘couldn’t be better’ and another indicated through signs and gestures that they were happy with the care provided. A random sample of four medication administration record (MAR) charts was examined to check for accuracy of recording. These were found to be in generally good order with amount of medication received recorded, two signatures where charts were handwritten and identity information being available. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 18 Three peoples’ MAR charts were then examined in more detail and were completed accurately, with signatures and codes being used appropriately. Stocks of medication were in good order and those examined showed that medicines were within expiry dates. There was a copy of the Royal Pharmaceutical Society Guidelines on Handling Medicines in Social Care and a medicines reference book available for staff to use, but neither were the most up to date version. Six of the seven staff surveys received responded that they received training that gave knowledge about health care and medication and one did not provide a response. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22 and 23 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. A clear complaints procedure and comprehensive safeguarding information and procedures ensured that people in the home were listened to and safeguarded. EVIDENCE: The Annual Quality Assurance Assessment provided by the service stated that ‘complaints are dealt with promptly and effectively’ and ‘we use a complaint as constructive criticism and would never victimize anyone because of it’. The complaints procedure was examined. This was clear and stated that complaints would be responded to within twenty-eight days. The record was examined and showed that one complaint had been received during the last twelve months and a full and proper response had been given that indicated whether or not the complainant was satisfied with the outcome. There had been no complaints received at the office of the Care Quality Commission (previously the Commission for Social Care Inspection) since the previous inspection in August 2008. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 20 All six surveys received from people living in the home responded that they knew how to make a complaint and four of the five relatives’ survey received also responded that they knew how to make a complaint. One relatives’ survey said they did not know how to complain. Two of the five relatives’ surveys responded that the service ‘always’ responded appropriately if concerns were raised, two responded that it ‘usually’ did and one that it ‘sometimes’ did. Feedback from people using the service was that they felt able and safe to complain. They said they would speak to the nurse or the manager to complain should they have any concerns. There was a Safeguarding Adults procedure in place that included a ‘Whistle Blowing’ policy and staff spoken with were aware of this and said that training on safeguarding procedures had been provided. The Annual Quality Assurance Assessment supplied by the service stated that there had been no incidents of abuse in the last twelve months. Staff spoken with were aware of their responsibility to report any suspicions of abuse and training records showed that safeguarding training had occurred in March 2009. All seven staff surveys received responded that they knew what to do if concerns were raised about the service. There were financial procedures in place to ensure that peoples’ personal money was dealt with properly and cash was stored securely. Two peoples’ financial records were examined. One was accurate and the cash held corresponded with the written record and one had more cash available than the record indicated. The manager could not explain why there was an error. There was also a brief policy that stated staff must not accept gifts or be beneficiaries in wills. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24, 26 and 30. 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. A lack of maintenance in some areas did not ensure the premises were comfortable and pleasant for people to use. EVIDENCE: The premises were pleasantly decorated throughout, and the lounges and dining room were comfortable to sit in. People spoken with said that they were happy with their bedrooms and the lounges within the building. The building was spacious and light. The Annual Quality Assurance Assessment supplied prior to the inspection stated that ‘considerable refurbishment’ had been undertaken that included Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 22 refurbishing the area behind the conservatory. It also stated that ‘we have lovely views and grounds’. However, further improvements were needed in certain areas, particularly in the garden. There were some uneven paving slabs on the patio area at the entrance to the home and the gardens to the rear of the building were still in need of clearing and planting. Carpets were frayed, being stuck down by ageing tape. This could pose a hazard for some. There were no railings outside peoples’ rooms where there was a potential trip hazard. The access at the entrance of the home was also in need of improvement as there was no clear signage from the road or the car park and the window of the office reception was obscured by posters so it was not possible to see if anyone was available. Signs on internal doors were not in black, bold large print and could not be read with ease. Access to items in the garden area such as bird tables could also be improved for people using wheelchairs. The bedrooms seen provided limited space and provision for each person, although those people spoken with were satisfied with their bedrooms. Records were maintained of repairs required. The laundry was viewed and the service had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. The laundry was neat and tidy and information was available on infection control procedures. Staff spoken with knew how to control the spread of infection and confirmed they had received training in this area. They also stated there was a plentiful supply of protective equipment such as gloves and aprons. The kitchen was neat and tidy and had been awarded 5 stars for hygiene by the Local Authority in June 2009. Four of the six surveys received from people using the service responded that the building was ‘always’ fresh and clean and two responded that it ‘usually’ was. However, a relatives’ survey commented that ‘I think the service could do the room cleaning more often’. - Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): 32, 34, 35 and 36 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 were sufficient, well-trained staff available to ensure peoples’ needs were met. EVIDENCE: Examination of the staff rota for 24th – 30th August 2009 showed that there were two trained nurses on duty during the day and one at night. There were six care staff on duty in the mornings, four in the afternoons and evenings and three at night. The Annual Quality Assurance Assessment provided by the service stated that the service provided ‘adequate staffing at all times with the appropriate skill mix’. However, one relatives’ survey received commented that something the service could do better was to ‘employ more staff to relieve the heavy workload of the present staff’. Staff spoken with confirmed that there were enough staff to meet health and personal care needs but that there was insufficient time to assist people with social activities such as going out. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 24 Three of the seven staff surveys received responded that there were ’always’ enough staff to meet available and four responded that there ‘usually’ were. One survey commented that something the home could do better was to have ‘more staff on duty’ and another stated that there were ‘not enough staff to take residents out on transport etc.’ Staff confirmed in discussion, and certificates verified, that they had undertaken mandatory health and safety training as well as in other areas applicable to the job, such as end of life care. However, there was mixed feedback on staff surveys about training; four of the seven surveys received responded that relevant training was given and one commented that the service ‘provides training in relation to the job’. Two responded that training relevant to the role was not given and one responded that they were not kept up to date with new ways of working. One survey commented that ‘more courses are needed not just for basic things like fire and infection control but more information about diseases that people have’. Two of the five surveys from relatives’ responded that staff ‘always’ had the right skills and experience and two responded that they ‘usually’ did. One survey did not provide a response. The Annual Quality Assurance Assessment supplied by the service stated that three of sixteen care staff had achieved a National Vocational Qualification (NVQ) at level 2 or above and ten were working towards it. This meant that although the home was not yet meeting the target of having 50 of care staff with an NVQ2 qualification, it was striving to do so. Three staff files were examined and showed that most of the information required by Schedule 2 of the Care Homes Regulations 2001 was in place, including identity information, Criminal Record Bureau (CRB) checks, verification of license to practise for qualified staff and two written references. However, one person had been employed with a police check from overseas and had not completed a CRB check in this country. This was brought to the attention of the manager who stated that she would address this straight away. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37, 39 and 42 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 service was well managed in peoples’ best interests. EVIDENCE: The manager was a registered nurse and had twenty years managerial experience at Tynefield Court. She was described as ‘knowledgeable’ and ‘supportive’ and was able to demonstrate her knowledge of individual needs in discussion. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 26 Quality assurance processes had improved but were not yet fully developed. The owners visited on a weekly basis, and had started to complete reports of their visits during 2009, as required by Regulation 26 of the Care Homes Regulations 2001. They had developed an annual plan for the home and examination of this showed that staff supervision and a meeting for people using the service were planned for September and October 2009. However, there was little evidence of forward planning as it did not show what was planned for the next twelve months. Satisfaction surveys were undertaken in February 2009. Surveys from people using the service and visiting professionals were seen. Comments were generally favourable although several people commented that the food needed improving. Visiting professionals comments included ‘advice left is followed’ and ‘staff are helpful’. Staff spoken with confirmed that health and safety training was undertaken in food hygiene, moving and handling, infection control and first aid and this was verified in their files, which showed the training had occurred in 2009. The Annual Quality Assurance Assessment provided by the service also confirmed that maintenance checks were undertaken regularly; for example, it stated fire equipment and alarms had been tested in April 2009 and hoists and portable electrical appliances had also been checked in April 2009. A random sample of the hoist certificate and portable electrical appliances confirmed this. Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Version 5.2 Page 28 Tynefield Court DS0000002169.V377348.R01.S.doc NO Are there any outstanding requirements from the last inspection? 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 YA9 Regulation 13 (4) Requirement Risk assessments must be updated at least annually. This is to ensure staff have up to date knowledge of a person’s needs and to minimise any identified dangers. 2. YA12 16 (2) (n) People using the service must be consulted about social and leisure activities and a wider range must be organised. This is to ensure peoples’ quality of life and self esteem is improved. 3. YA17 16 (20 (i) The menus must be reviewed and people using the service must be involved in the changes and help to develop them. This is to ensure that peoples’ preferences for meals are addressed. 4. YA24 23 (2) (a) Improvements to the accessibility of the entrance area and replacement of damaged carpets must be made. DS0000002169.V377348.R01.S.doc Timescale for action 01/12/09 01/12/09 01/12/09 01/03/10 Tynefield Court Version 5.2 Page 29 This is to ensure there are no hazards for people using the service and that their safety is maintained. 5. YA34 19 (1) (b) All overseas staff must have a Criminal Record Bureau check undertaken in this country. This is to ensure that suitable people are employed and people using the service are safeguarded. 01/11/09 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 YA3 Good Practice Recommendations The manager should always be satisfied that staff are able to communicate well enough in English to ensure needs are met. Care plans should be written in a more person centred way that includes peoples’ social needs and their goals and aspirations. The activity board should be pictorial to make communication about events suitable for all. Better use of the garden area should be made to make it inclusive for people to use and be involved in gardening activities. The service should endeavour to be more involved in the local community and make best use of community facilities. Consideration should be given to providing transport such as a minibus to enable people to access the community more easily. DS0000002169.V377348.R01.S.doc Version 5.2 Page 30 2. YA6 3. 4. YA12 YA12 5. YA13 6. YA13 Tynefield Court 7. YA20 There should be an up to date copy of the Royal Pharmaceutical Society guidelines on handling medicines in social care and an up to date medicines reference book for staff to utilise. Staffing levels should be reviewed to enable staff to support people to go out and use community facilities. 50 of care staff should be trained to NVQ Level 2 or equivalent. The staff training programme should include more courses on care issues relevant to the people using the service. Supervision should be provided for all care staff in the home on at least a two monthly basis. The quality assurance annual development plan should include areas for improvement for the next twelve months. 8. 9. 10. 11. 12. YA33 YA32 YA35 YA36 YA39 Tynefield Court DS0000002169.V377348.R01.S.doc Version 5.2 Page 31 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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