CARE HOMES FOR OLDER PEOPLE
Tolverth House Long Rock Penzance Cornwall TR20 8JQ
Lead Inspector Lowenna Harty Announced 19 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tolverth House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Tolverth House Address Long Rock Penzance Cornwall TR20 8JQ 01736 710736 01736 710736 myellop@hotmail.com Mr Dennis Yellop Mrs Mary Yellop Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 14 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding lerning disability or of places dementia - over 65 years of age (4), Old Age, not falling within any other category (14) Physical Disibility (1) Tolverth House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22/11/04 Brief Description of the Service: Tolverth House is a registered home providing accommodation and personal care for up to 14 older people aged 65 years or over. Of these up to 4 may have dementia and a further 4 may have mental health care needs. There are facilities to provide for up to 1 servcie user who has a physical disability. The home is situated in the village of Long Rock on the outskirts of Penzance. It is close to shops and public transport routes and is set in its own grounds, slightly off the main road. The home has two floors, the upper floor being accessible by stairs with a stair lift. All of the bedrooms are single occupancy and most have en suite bathrooms. There is a spacious lounge downstairs and a separate dining room and conservatory. The registered providers are actively involved in the day-to-day running of the home and are assisted by a team of staff. Most parts of the home are accessible to service users with physical disabilities and there are portable ramps to ensure that they can access areas that would only otherwise be accessible by steps. Tolverth House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection as part of the home’s annual inspection programme on 19 May 2005 starting at 9.30 am. The inspection took five and a half hours and consisted of the following activities: 1. Inspection of records, including assessment information and care plans 2. A detailed review of the records and care practices relating to a selected number of service users, including interviews with them held in private 3 Discussion with the Registered provider and enior carer of the home on how it operates on a day-to-day basis 4 Inspection of the premises 5 Individual interviews with eight service users held in private, 6. Observation of the daily life of the home. The registered provider kindly submitted information in advance of the inspection to assist the process. The inspector would like to thank the service users, staff and Registered Provider for their kind assistance in the conduct of this inspection. What the service does well:
Most of the service users interviewed during the inspection stated that the home meets their needs well. The Registered provider encourages them or their relatives to visit the home and have a look around before they are admitted to it and personally ensures that she has enough background information to be confident that the home is suitable for them. This information is used to develop individual care plans with them, which they are invited to sign up to. The home is relatively small, and staff are able to get to know the service users well. There are good links to local health and social care services outside of the home and service users are able to manage their own medication if they wish. Trained staff assist those who require help and one service user expressed praise for them in the way in which they help him in this respect. Most of the service users said that staff respect their privacy and they are satisfied with the activities provided both in and out of the home. There are regular church services held for them. Some of the service users make use of day centres in the local community. There are no restrictions on visitors to service users. Most of them said that they enjoyed their meals, which are freshly prepared on the premises. Service users are offered a choice of meals, which are served either in the dining room or their own rooms if they prefer. The home is well situated for access to the local village and nearby town of Penzance. It has a large garden and is very attractively decorated. Furniture is of a good quality throughout and there are suitable adaptations for people with disabilities. It was clean, tidy and pleasant throughout at the time of the inspection and has a calm, restful atmosphere. It was warm and
Tolverth House Version 1.10 Page 6 provides service users with plenty of natural light. All of the service users said that they feel safe in the home and most expressed positive comments about the staff. Male and female carers are employed, they are well trained and there is a low rate of staff changes. The registered provider is actively involved in the day-to-day running of the home and encourages service users and their relatives to make comments about the quality of the care provided in order to improve it. There are good arrangements in place to ensure the health, safety and welfare of service users and staff working at the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Tolverth House Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Tolverth House Version 1.10 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 5 Service users are admitted to the home on the basis of a comprehensive assessment of their needs. They and/or their representatives are encouraged to visit the home prior to moving in. EVIDENCE: The registered provider and senior carer undertake an assessment of all prospective service users prior to their admission to the home, using the home’s comprehensive assessment format and records are available in the home to evidence this. The assessment usually takes place in the service user’s own home if possible, hospital or current placement. Comprehensive assessment information was available on the case files of the service users most recently admitted to the home, including information from health and social care professionals where relevant. The assessment information is used as a basis for subsequent care planning with service users. Service users and/or their representatives are encouraged to visit the home before they are admitted to enable them to make a decision as to whether the home is suitable to meet their needs. Tolverth House Version 1.10 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Service users have written care plans although the home’s format should be amended to ensure that service users needs are fully recorded. They have access to a range of healthcare professionals according to their individual needs. The home has good working practices in respect of medication but the Registered provider should update the home’s written policies. Service users are satisfied that their rights to privacy are respected but door locks should have facilities to enable staff to over-ride them in an emergency to give them a safe choice of whether or not to use their keys. EVIDENCE: There were written care plans on each of the service users’ files selected for inspection. These now consider risks and have photographs of each service user attached to them. Some key issues relating to their health, personal and social care needs were not specifically addressed and it would be useful for the Registered provider to review the home’s format against National Minimum Standard 3.3 to ensure that all the necessary fields are considered as routine practice. Service users and/or their representatives are encouraged to sign their care plans as evidence of their participation and agreement with them. There are individual profiles of each service user on their personal files. The home has good links with local healthcare providers, particularly the District Nursing services who visit service users who need their services on a regular
Tolverth House Version 1.10 Page 10 basis. There are records of visits by other healthcare professionals including a chiropodist, dentists, opticians and Community Psychiatric Nurses. One service user manages their own medication and nearly all the staff have undergone safe handling of medicines training at a local college. The home has a contract with a local pharmacist and is evidence of regular checks by them on the home’s working practices. The written procedures would benefit from a full review against the Royal Pharmaceutical Society June 2003 Guidelines, however. At this inspection Patient Information Leaflets with information on service users’ medication were available. Most of the service users interviewed stated that their rights to privacy are respected and the inspector observed that staff always knock on their doors before entering their rooms. The Registered provider said that their bedroom doors have keys but in practice none of the service users retain them and the locks cannot be over-ridden in an emergency. Suitable locks should be fitted as standard when resources permit and in the meantime, the current facilities need to be clearly explained to service users before they are admitted to the home as they are at variance from the National Minimum Standards. Tolverth House Version 1.10 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, & 15 The activities and daily life in the home are suitable to meet the needs and expectations of most of the service users. There are no restrictions on visitors, who are encouraged to maintain contact and service users go out if they wish. Service users are provided with a choice of home-prepared foods and enjoy a varied and balanced diet. EVIDENCE: Most of the service users interviewed during the inspection stated that the home provides suitable activities for them and some were out of the home at the time. Their individual care plans and profiles record their hobbies and interests and some go out to a local day centre during the week. They are able to come and go from the home, either alone or with family and friends as they wish. A local priest visits the home to provide communion and there are church services held each month. The visitors’ book provides evidence of a range of visitors to the home at various times. Most of the service users spoken to at the time of the inspection said that they are very satisfied with the food provided to them. There are individual records of food provided to each service user and the home’s menu plan was sent out to the Commission as part of the pre-inspection information submitted by the Registered provider. Tolverth House Version 1.10 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a written complaints procedure and most of the service users are aware of how to make a formal complaint should they need to. There are good safeguards in the home to protect service users from harm and abuse. EVIDENCE: The home’s written complaints procedure is given to service users as part of the statement of purpose and service users’ guide when they are admitted to the home and most of the service users interviewed said that they would know how to make a complaint if the need arose. They all said that they feel safe in the home and most are very satisfied with the care provided to them by the staff. The Registered provider has updated the home’s written policies in respect of the protection of vulnerable adults to reflect current best practice. The home has a stable staff team, with a relatively low turnover. The registered provider and some of the staff have undergone training in the prevention of abuse and applications for more to attend external training have been sent to local training providers. Tolverth House Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home is very well maintained, comfortable and safe. It was clean, hygienic and pleasant throughout at the time of the inspection. EVIDENCE: A visual inspection of the premises provided evidence that it is well maintained, tastefully decorated and suitably adapted to meet the needs of service users. The registered provider has employed a firm of external consultants to review and provide advice on the home’s policies and procedures in all aspects of health and safety in the home and there are records of satisfactory safety and equipment checks. The home’s fire safety risk assessment is complete, records of equipment checks, tests and drills are up-to-date and the fire brigade has carried out a recent inspection, which was satisfactory. A fridge has been replaced on the recent recommendation of the environmental health officer following an inspection that was otherwise satisfactory. There are written policies and procedures for the prevention of the spread of infection in the home. It was clean and tidy throughout and completely free of unpleasant odours at this inspection.
Tolverth House Version 1.10 Page 14 Tolverth House Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 There are sufficient numbers of staff employed to work in the home and nearly all the care staff are qualified to NVQ level 2 or above. There is a senior carer, domestic and catering staff and the care staff team consists of male and female carers, reflecting the service user population. EVIDENCE: Most of the service users interviewed at the time of the inspection stated that they are well cared for by the staff team. There were male and female care staff on duty at the time of the inspection. The cook was also there. Staff work according to clear job descriptions and have been provided with copies of the GSCC Code of practice. The home’s duty rotas are available for inspection and appear to be accurate and up-to-date. There is a stable staff team in the home, with a low turnover. New staff undergo detailed and thorough induction training with records kept and all are provided with employee handbooks and written contracts of employment. According to the pre-inspection information submitted by the Registered provider, 75 of the home’s team of care staff are qualified to NVQ level 2 or above, in excess of the National Minimum Standards. Tolverth House Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 38 The registered provider is very experienced in running the home, is in active daily control of it and undergoes regular training to update her knowledge and skills. The home has a formal quality assurance programme the home is safe for service users, staff and visitors. EVIDENCE: The registered provider has been running the home since 1990 and there is evidence of continuing improvement in the home, all of the recommendations of the previous inspection having been met. The registered provider has now started training towards achieving NVQ level 4 and the Registered Managers’ Award. Most of the service users provided very positive comments about the overall quality of care and services provided to them in the home during interviews held in private with them. The home has a quality assurance system in place. Satisfaction questionnaires are sent out to service users and/or their representatives. The results are analysed and records maintained for inspection. The Registered provider retains copies of letters sent to the home
Tolverth House Version 1.10 Page 17 by satisfied relatives. The home’s environmental risk assessment is complete and full records of all health and safety checks were available for inspection. Tolverth House Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x x x 3 Tolverth House Version 1.10 Page 19 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 Regulation Requirement Timescale for action 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 7 Good Practice Recommendations The Registered provider should review and amend the homes care planning format to ensure that all the headings listed under National Minimum Standard 3.3 are fully and clearly considered and addressed. The Registered provider should review the homes written procedures for the safe management of medication against the Royal Pharmaceutical Society Guidelines of June 2003. Service users bedroom doors should be fitted with doorlocks of a type that can be over-ridden in an emergency when resources permit. In the meantime new service users should be fully informed of arrangements in respect of door locking arrangements in the home. 2. 3. 9 10 Tolverth House Version 1.10 Page 20 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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