Care Home: Tyrwhitt House

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Annual service review Name of Service: Tyrwhitt House The quality rating for this care home is: The rating was made on: three star excellent service 1 1 1 2 2 0 0 8 A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Lisa Johnson Date of this annual service review: 0 7 1 2 2 0 0 9 Annual Service Review Page 1 of 8 Information about the service Address of service: Oaklawn Road Leatherhead Surrey KT22 0BX 01372841634 01372841601 cmth@combatstress.org.uk Telephone number: Fax number: Email address: Provider web address:   Name of registered provider(s): Conditions of registration: Category(ies) : mental disorder, excluding learning disability or dementia Conditions of registration: Ex Services Mental Welfare Society Number of places (if applicable): Under 65 Over 65 30 0 1. The registered person may provide the following categories of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 2. The maximum number of service users to be accommodated is 30. Have there been any changes in the ownership, management or the Yes service’s registration details in the last 12 months? If yes, what have they been: Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service Tyrwhitt House is a large detached Victorian property located on the outskirts of Leatherhead Surrey. The service is operated by the registered charity Combat Stress the Ex Services Mental Welfare Society. The home caters for ex-servicemen and women (veterans) with a mental health need, primarily post traumatic stress disorder. The home is set in extensive grounds and has ample car parking. There are 30 single bedrooms, kitchen, servery, dining room, a main lounge, smoking room and an equipped activities department There are no fees charged directly to the veterans or Annual Service Review Page 2 of 8 Change of Responsible Individual 1 1 1 2 2 0 0 8 their families, where the veteran is in receipt of a war pension a charge of 274.00 per day is made to the awarding body. Where a veteran is not in receipt of a war pension the cost of care and treatment is met by charitable income. Annual Service Review Page 3 of 8 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: The annual quality assurance assessment( AQAA)that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. What other people have told us about the service. What has this told us about the service? The registered manager returned a clear, detailed and comprehensive annual quality assurance assessment( AQAA). The self-assessment identified areas that had improved in the last year and others where further developments were being planned, which would benefit people using the service. The last key inspection report was positive and resulted in no requirements being made. The service operates a structured pre admission assessment to ensure that the service is able to meet veterans needs, with a strong emphasis on client involvement . A welcome pack /service user guide is available to each person on admission. Information supplied in the AQAA states that the service have reviewed and strengthened their pre admission information pack and have developed and introduced a new discharge leaflet for all new veterans to be given during their first admission week. Thirteen veterans surveyed confirmed that they had been given enough information about the service before they were admitted. Information provided in the AQAA states that veterans continue to play an active part in planning their own care and all interventions are planned at their request or with their consent. The service works in partnership with other agencies to support the Annual Service Review Page 4 of 8 individual needs of veterans such as the Royal British Legion, Blesma, Queen Elizabeths Foundation (for employment retraining opportunities) and ex service charities. Over the last year the service has introduced a weekly activity planning record for veterans to enable them to participate in planning their week, directing them to appropriate therapeutic activities and they are provided with more written information to support the information that they are given in psych- educational groups. The service is planning to introduce individual folders for all veterans to enable them to keep all of their treatment information such as care plans and activity time tables. On admission each veteran is allocated a qualified mental health nurse who acts as a key worker. The service aims to support the psychological needs for ex service personnel who attend for treatment carrying out a range of detailed of recognised and validated assessment tools. Veterans are supported by a range of clinicians including, consultant psychiatrist and occupational therapy. There are now two occupational therapists working in the treatment centre . One of these has additional qualifications in health and fitness. A number of positive comments were received from veterans who use the service about the care and support provided including, The service looks after us, listening and helping us in any way they can; The service welcomes you and makes you feel comfortable; The OT is excellent; The service provide excellent one to ones ; Provides excellent care, provides an environment where I feel safe and secure, enables me to see to see the health professionals who further aid my recovery and I cant express how good a place this is. The service continues to provide a range of clinical, therapeutic, recreational, social and leisure activities. The clinical programme includes psycho- a educational groups, trauma focused groups, carer support groups, individual psychotherapeutic and supportive sessions, relaxation, alcohol education, anger management, relationships, self esteem and anxiety management. The service provides an activity centre , which provides a range of activities including photography, arts and crafts, wood work, computers, gardening and model making.. Over the last year the service have provided a well equipped Gym and are able to offer individual fitness assessments and programmes by an occupational therapist.Veterans also now have access to external fitness facilities and swimming pool at a local fitness centre. Further opportunities to participate in a number of creative therapy activities and a new creative expression group has been introduced. The AQAA has identified that further improvement is needed to further increase the therapeutic programme for veterans at weekends. The service is also planning to introduce a new occupational therapy kitchen. Two veterans expressed their satisfaction with the meals provided and two other veterans thought that further improvement was needed. One person commented, The service could organise low dietary meals much better, if we ask for this prior to admission,It is rarely followed through and they could be more attentive and respectful to individual needs. Twelve out of thirteen surveys received from veterans indicated that they can make decisions about what they do each day. Comments included, The service allows me to decide which sessions I attend, there is never any pressure to take part. Two veterans said that there were good trips out that are well organised, although two veterans said Annual Service Review Page 5 of 8 there could be more trips and external activities and three veterans said that more minibus drivers would be beneficial. Information supplied in the AQAA confirms that that equality and diversity are promoted in the service The service provides a complaints procedure, which is provided to veterans, their families, carers and advocates and it is also displayed on the notice board. The procedure includes details of the timescales for responding to any complaints. Complaints are analysed by the services clinical governance processes. In the last year the service have received eight complaints, which the service has acted upon. Eleven out of thirteen veterans surveyed said that they know how to raise a concern and whom they could speak to if they were unhappy. Most surveys confirmed that staff listen and act on what they say. Information supplied in the AQAA states that all staff attend annual safeguarding vulnerable adults from abuse training and procedures are in place including the local authority multi agency safeguarding procedure. Since our last visit to the service three matters were referred to the local authority following safeguarding vulnerable adults from abuse procedures, which resulted in one matter being accepted by them. The service is continuing to demonstrate that continuous improvements are being made to the service ensuring that veterans have a well maintained, safe, comfortable and clean environment to stay in. Since our last visit the activity centre has been fully refurbished and extended, a new fully equipped gym has been provided and the AQAA states that the service has improved their infection control procedures through the introduction of enhanced hand sanitation facilities throughout the treatment centre. The service is accessible for people who may have physical disabilities and provides specialist bathing equipment, electric scooters , wheelchairs and other mobility aids and a loop system is available in one of the lounges. Thirteen veterans surveyed said that the service is clean and fresh. Two People said that the beds could be improved. The service has also commenced an extensive development programme to enhance the physical environment, which includes building a new wing to provide all living accommodation plus four additional bedrooms. Once this work is complete this will result in remodelling of the ground floor to take place to provide therapy, treatment and consulting rooms. All new staff complete induction and care staff also complete the Skills for Care core induction standards. All qualified staff undertake the preceptorship programme and there is a three month probationary period for all new staff. Out of twelve care staff employed three have obtained National Vocational Qualifications (NVQ) and six members of staff are currently completing NVQ (Level 3). Staff continue to be supported to to access internal and external training, which includes mandatory and specialist training. Six members of staff surveyed confirmed that they had received induction, that their manager gives them enough support and meets with them to discuss how they are working. Staff usually feel that they have enough support, experience and knowledge Annual Service Review Page 6 of 8 to meet the differing needs of people who use the service, although one member of staff commented, The service could improve by more proactive in offering/finding suitable training for staff. Staff surveyed said that usually there are enough staff , although one member of staff said, Sometimes shortage of staff can be problematic. Comments received from people using the service included, The staff are excellent, and will join in; The care staff are always very helpful and they are there for you and The staff with one or two exceptions are pleasant and courteous. The service continues to gain the views of veterans using the service, which includes two weekly veteran meetings . Minutes are taken and a copy is displayed on the veterans notice board. Exit satisfaction surveys are completed after each admission by veterans and the results are analysed and review through their clinical governance processes. Monthly quality monitoring visits are conducted and programmes are in place for audit and review. A new head of services has been appointed and an application is in process with the Commission for this person to become the registered manager. Health and safety has been considered in the AQAA that has identified that all routine servicing and maintenance of equipment is up to date. The service continues to inform the Care Quality Commission of any relevant events that have occurred in the service since the last inspection and they have show that they have managed issues well. They work well with us and have shown that the service continues to provide excellent outcomes for the people living there. What are we going to do as a result of this annual service review? We are not going to change our inspection plan and we will do a key inspection by 11/12/2011 However we can inspect the service at anytime if we have any concerns about the quality of the service or the safety of people using the service. Annual Service Review Page 7 of 8 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. The content of which can be found on our website. 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