CARE HOMES FOR OLDER PEOPLE
Tolverth House Long Rock Penzance Cornwall TR20 8JQ Lead Inspector
Lowenna Harty Unannounced Inspection 11th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Tolverth House Address Long Rock Penzance Cornwall TR20 8JQ 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) 01209 710736 01209 710736 Vijay Enterprises Limited Christina Page Care Home 14 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (14), Physical disability (1) Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection First inspection of new service 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 resident 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. It has two floors, the upper floor being accessible by stairs with a stair lift. Most of the bedrooms have en suite bathrooms. There is a spacious lounge downstairs and a separate dining room and conservatory. The registered provider lives on site and is actively involved in the management of the home. A manager who is registered with the Commission undertakes day-to-day management of the home, assisted by a team of staff. Most parts of the home are accessible to residents with physical disabilities and there are portable ramps to ensure that they can access areas that would only otherwise be accessible by steps. The upper floor is accessible via a stair lift. The new registered provider has published a statement of purpose to provide information about the home to prospective residents. Fees range from £350.00-£375.00 per week. Additional charges are made for newspapers, hairdressing, private chiropody and outings organised by the home. The registered manager provided this information at the time of the inspection. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 11 and 12 July 2006 and lasted for approximately eleven hours. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents’ placements in the home result in good outcomes for them. This involved observation of the daily life in the home, interviews with residents, their representatives and staff, inspection of records relating to residents’ welfare and an inspection of the home’s premises as well as discussions with the registered provider and manager of the home. The principle method used was case tracking. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. At this inspection, four residents were case tracked. The home has recently changed hands and is currently adequately meeting the needs of residents. Improvements are needed to raise the quality of care provided, which mainly reflects the situation in the home prior to the new registered provider taking it over. What the service does well:
There had only been two new admissions to the home since the new registered provider had taken charge of the home. These had been emergency admissions and the residents concerned were aware that an assessment of their needs was in progress. The home’s policy is for prospective residents to undergo assessment of their needs prior to their admission, where practicable. The registered manager or the senior carer undertakes this with the prospective resident and/ or their representatives, including relatives and health or social care professionals if they are involved. Assessments consider residents’ individual and diverse health, personal and social care needs so they can be confident the home will be suitable for them. The home does not provide intermediate care The statement of purpose provides clear information on the services and facilities offered, including short-term and respite care so that prospective residents have good information as to whether the home will be suitable to meet their needs. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 6 Residents interviewed at the time of the inspection said that they are satisfied that their healthcare needs are being met. Healthcare professionals were observed coming and going from the home at the time of the inspection. Some are able to manage their own medicines so that they maintain their independence in this respect. In situations where staff assist them, they can be assured that their medicines will be securely stored and staff helping them have undertaken training to manage medicines safely. There are facilities to ensure that residents can receive personal care in private and visiting relatives said that there are suitable arrangements to ensure they are treated with respect. They confirmed that they are able to visit when they wish and can meet with their relatives in private. The home has a range of communal facilities and a spacious garden, which residents can make use of. Most residents said that they are satisfied with the lifestyle the home provides. Some go out independently or with relatives and make use of the facilities in the local community, including a local day centre. There are no restrictions on visitors and residents are able to maintain relationships with friends and relatives if they wish. Residents are able to make choices over issues that are important to them. Most maintain control of their own finances or do so with the assistance of their relatives and they are able to personalise their bedrooms if they wish, for example. The home appears comfortable, well maintained and safe so that residents can enjoy attractive and homely surroundings. It was clean and tidy throughout at the time of the inspection, which was unannounced and relatives, staff and residents said that it is always kept clean. Most of the residents interviewed said that they are satisfied with the care and services provided to them in the home and would feel confident that any complaints would be taken seriously. There are systems in place to protect them from harm and abuse, including written guidance for staff on what they should do if they suspect abuse of a resident and recruitment practices to ensure that staff are suitable to work with vulnerable adults in a care setting. Staff are employed in different capacities and sufficient numbers to meet residents’ needs. Most of them have formal qualifications so that residents can have confidence in their knowledge and skills. They are recruited on the basis that they are suitable to work with vulnerable adults in a care setting. The home’s manager is registered with the Commission as a fit person to be in charge of a care home. The registered provider lives on site and assists her on a day-to-day basis. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 7 There are satisfactory systems in place to ensure that residents’ financial interests are safeguarded. Most of them manage their personal finances independently or with the assistance of their relatives. Where assistance is needed, the home maintains full and clear records. The home provides residents and staff with a safe environment to live and work in. There are satisfactory systems in place including staff training, written policies and procedures, accident records, regularly reviewed risk assessments and equipment tests and checks by suitably qualified people. What has improved since the last inspection? What they could do better:
Residents need to be provided with improved information about the home, including statements of the terms and conditions of their placements there and copies of their contracts so that they are clear about their rights and obligations. Assessment information needs to be improved in respect of assessing and acknowledging potential risks to new residents to ensure that their needs can be met safely. The home’s statement of purpose, which provides information about it should be more readily available and accessible to service users and their representatives so that they are better informed about what the home sets out to provide. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 8 Residents’ care plans were out-of-date and had not been regularly reviewed, so they could not be assured that their needs were fully recognised and met. Residents interviewed said that they would like to be more involved in the care planning process. Daily care records that show how their healthcare needs are being met lacked detail to show that this was happening. Some improvements are needed to medication records so that it is clear who is authorising them. Systems to ensure that confidential information about residents is kept private to them need to be strengthened so that they can be assured that their rights to privacy will be fully respected at all times. Residents are not currently provided with any formal activities to encourage them to remain active, social and stimulated so they are currently solely reliant on visiting relatives or their own devices. Although religious services take place at the home, there is no active consideration of residents’ various religious denominations, to ensure that they are suitable for them. Improvements are needed to ensure that residents’ nutritional needs are met, in ways that they like. This includes ensuring that there are published menus, that provide alternatives at each main meal and that clear records are maintained of food served to them. Residents should be provided with written copies of the home’s complaints procedure so that they are fully aware of the options open to them if they are dissatisfied with any aspect of their care. Copies of the multi-agency procedures for the protection of vulnerable adults from abuse should be made available to staff, in addition to the home’s internal procedures, so that they are clear about how different agencies work together to protect them. Some training, which needs to be undertaken on a regular basis, has become overdue for some staff and they should be provided with updates as necessary. Care staff should also undergo training on providing care to people with dementia and/or mental health care needs so that they have the necessary knowledge and skills to assist people who are admitted with these conditions. Formal systems for reviewing the quality of the services provided to residents need to be developed so that residents can be assured that their views will be fully taken into account in the ongoing improvement and development of the service. The registered manager should undertake regular supervision of care staff and maintain clear records in this respect so that staff have opportunities to reflect on and develop their practice for the benefit of residents. Please contact the provider for advice of actions taken in response to this inspection. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 9 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 10 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 Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 2, 3 & 6 Quality in this outcome area is adequate. Residents should be provided with clear statements of their terms and conditions, improved information about the home and assessment of risks so that they can be confident that it will be suitable to meet their needs. The home does not provide specialist intermediate or rehabilitative care, although residents are accepted for shortterm, respite care, which is stated in the home’s statement of purpose but this information needs to be made more readily available to prospective residents. EVIDENCE: The residents most recently admitted to the home said that they had not been provided with much information about it before they moved in because theirs was an emergency admission. Their relative, who was consulted during the admission process, said that they had not been provided with information beyond a verbal description of the home and there were no written contracts in place in respect of their admission at the time of the inspection. The registered manager said that she was in the process of completing assessments with the most recently admitted residents, which they confirmed. Staff said that the usual policy is for residents to be assessed by the registered
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 12 manager or senior carer prior to their admission to the home and that this involves meeting with them and discussing their needs with people involved in their care such as social or healthcare workers and relatives. Assessment formats include consideration of prospective residents’ diverse needs relating to their cultural and ethnic backgrounds, religion, age, gender, abilities and some consideration of their sexual orientation. There was assessment information relating to all the residents who were case tracked on their personal files but little evidence of risk assessments beyond basic moving and handling The home’s statement of purpose provides information to state that admission for short-term respite care is provided. There is a clear description of the services provided so that prospective residents are made aware that there are no facilities for specialist rehabilitation but this was not made readily available to the most recently admitted residents or their relative. Residents admitted for respite care said that they expected to return to their own homes. Staff interviewed said that they help them to maintain their independence and skills by enabling them to mobilise and attend to their own personal care if they are able, for example. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 7,8,9 & 10 Quality in this outcome area was poor. Residents’ care plans were out of date, had not been regularly reviewed and residents themselves were not actively encouraged to participate in the care planning process. They have good access to healthcare services, but daily care records and care plans need to back this up, so that residents can be fully assured that their needs are being properly monitored. Arrangements for managing medicines in the home are mainly satisfactory although some improvements to records are needed to ensure residents’ protection. There are satisfactory systems in place to ensure that residents are treated with respect and that their right to privacy is upheld. EVIDENCE: Residents who were interviewed at the time of the inspection were not aware of their care plans and most said they would like to be involved in the care planning process. Records of their care plans were out-of-date and lacked evidence of regular review. The home’s manager said that she is in the process of drawing up new care plans for all of the residents and is gradually getting to know them all individually, so that she can draw up care plans that are sensitive to their individual and diverse needs.
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 14 Visiting health professionals were observed coming in and out of the home at the time of the inspection and residents who were interviewed said that they are helped to access the healthcare services they need. A visiting relative confirmed this. Residents’ care plans and daily care records did not provide sufficient detail to show that their healthcare needs are fully recognised and met. Some residents are able to manage their own medicines and are provided with secure storage facilities in their rooms so that they can do this safely and maintain their independence. There are secure storage facilities for medicines managed on behalf of residents. All staff handling medicines have undertaken training in their safe handling and are guided by clear written policies and procedures. Records of medicines administered appeared to be up-to-date and accurate but hand-written instructions were not counter-signed so it was unclear as to who had authorised them. Most of the residents who were interviewed were satisfied with the arrangements for ensuring their privacy. The home has lockable office facilities and residents are able to lock their bedroom doors if they wish. There are suitable facilities to ensure that they receive personal care in private, including some bedrooms with en suite bathrooms. A visiting relative confirmed that they are able to visit whenever they wish and can see their relatives in private. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area was poor. Residents lack opportunities to take part in activities appropriate to their needs and wishes to maintain a good quality of life. They are able to receive visitors in private, when they wish and maintain relationships with the local community. There are systems in place to enable them to maintain choice and control over important aspects of their lives. Improvements are needed to ensure that their dietary and nutritional needs are fully met, in accordance with their individual preferences. EVIDENCE: The home has good communal facilities, including a large lounge, spacious gardens and separate dining room so that residents can meet and socialise together if they wish and most who were interviewed were satisfied with the services provided to them. Observation, interviews with staff and the registered manager confirmed that some attend day centres outside of the home on a regular basis and go out independently, but there are no formal activities provided to enable and encourage residents to keep active and socialise in the home. There are religious services held in the home, but these are not sensitive to the various religious denominations of the residents, which became apparent during interviews with them. Residents and visiting relatives confirmed that they are able to receive visitors when they wish and in private. The home’s well-used visitors’ book confirmed this.
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 16 Residents are able to personalise their rooms in accordance with their own tastes, which was observed at the time of the inspection. Most maintain control of their own personal finances, which they and visiting relatives confirmed. The registered manager takes active steps to enable residents to exercise choice over important aspects of their lives, which residents and a visiting relative confirmed at the time of the inspection. Most residents who were interviewed said that they were satisfied with the meals provided to them, but others said that they would like more choice. At the time of the inspection there were no clear menu plans and residents were not offered alternatives at main meals. Records of food provided lacked detail to show that residents’ nutritional needs are being met adequately and in accordance with their preferences. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. Residents’ complaints are taken seriously and acted upon but they should be provided with clear information on the home’s formal complaints procedure so that they are aware of the options open to them if they are dissatisfied with any aspect of their care. There are systems in place to protect residents from harm and abuse but some improvements are needed so that staff are fully informed of the action they are expected to take if they suspect a resident is being abused. EVIDENCE: Most of the residents who were interviewed at the time of the inspection stated that they are satisfied with the care and services provided to them at the home. Some said that they had confidence in the home’s manager to address their concerns and she was observed to take action at the time of the inspection to address issues raised by them before they became formal complaints. Residents are not currently routinely provided with written copies of the home’s complaints procedure. Residents interviewed at the time of the inspection said that they felt safe in the home. There are written procedures in place to guide staff on the action to take if they suspect abuse of a resident but there should also be copies of the local multi-agency procedures in place so that they are fully informed of how different statutory bodies work together to protect vulnerable adults. Some of the staff have undertaken multi-agency training on protecting vulnerable adults from abuse and the registered manager is applying for it. No new staff have been recruited since the new registered provider took over, but the home’s recruitment procedures state that new staff must be recruited on the basis that they are fit and safe to work with vulnerable people in a care
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 18 setting. Records checked at this inspection showed that staff currently working in the home had undergone the necessary checks. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The home’s environment is safe and well maintained so that residents enjoy comfortable and homely surroundings. There are systems in place to ensure the home is kept clean and tidy so that residents are protected from infection. EVIDENCE: The home appeared well decorated and attractively furnished throughout. The registered manager is in the process of reviewing written risk and fire safety risk assessments and making improvements, for example arranging for window restrictors to the downstairs bedrooms to improve security in the home, at the time of the inspection. The home appeared clean and tidy throughout at the time of the inspection, which was unannounced. Staff and service users confirmed that it is kept clean. The registered manager and some of the staff have undertaken training in infection control and there are written policies and procedures in place to guide staff on how to prevent infection from spreading in the home. Staff are
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 20 provided with and were observed making use of, suitable equipment to maintain hygiene in the home. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Staff are employed in varying capacities and in sufficient numbers so that residents’ needs are met. Nearly all of the staff have formal qualifications in care, in excess of the National Minimum Standards so residents can have confidence in the people caring for them. Staff are recruited on the basis of fair, safe and effective policies and procedures so that residents can be confident that they are suitable to work in a care setting. Staff should be provided with training updates where necessary and access to training in dementia care and mental health so that they have the necessary knowledge and skills to work with residents in accordance with the home’s registration. EVIDENCE: Residents interviewed said that there are sufficient staff to care for them. A visiting relative confirmed this. At the time of the inspection there were enough staff to ensure prompt attention when call bells were activated. Staff interviewed said that they feel they are employed in sufficient numbers to be able to provide effective care. Additional staff are employed to undertake cleaning, maintenance and catering tasks, so that care staff are free to provide direct care to residents. The registered manager said that all but one of the home’s care staff is qualified to at least NVQ level 2 and records confirmed this. This is in excess of the 50 recommended according to the National Minimum Standards. No new staff have been recruited since the new registered provider took over the business. Staff who were interviewed said that they were recruited fairly,
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 22 in accordance with equal opportunities. The home’s recruitment procedures ensure that staff are recruited on the basis that they are fit and suitable to work with vulnerable adults in a care setting. Records held in the home show that these have been followed in respect of staff currently employed there. Staff said that they have been provided with improved access to training lately. The new manager is in the process of drawing up training plans because she acknowledges that training updates are overdue for some staff. They should also be provided with training on the care of older people with dementia and/or mental health care needs, in accordance with the home’s registration. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36 & 38 Quality in this outcome area is adequate. The home’s manager is registered with the Commission as fit to be in charge of it on a day-to-day basis so that residents can be confident that the home is in safe hands. Systems need to be set up to ensure that residents are able to contribute their views to the ongoing improvement and development of the service. There are satisfactory safeguards in place to protect residents’ financial interests. Staff need to be appropriately supervised on a regular basis so that they have opportunities to reflect on and improve their practice. There are satisfactory systems in place to ensure that the home is a safe place to live and work in. EVIDENCE: The home’s manager has recently registered with the Commission and demonstrated her fitness to be in charge of a care home. She is in active dayto-day charge of the home. The registered provider lives on site and is also actively involved in the management of the home. There are currently no formal systems in place to take residents’ views on the quality of the services provided into account in the ongoing planning and
Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 24 development of the service. This may be through the care planning process, residents’ meetings, anonymous questionnaires and/or suggestion boxes, for example. The registered manager was in the process of considering options for this at the time of the inspection and had taken steps to make improvements in response to residents’ individual needs as they had become known to her, which residents confirmed at the time of the inspection. Most residents manage their own personal financial affairs either independently or with the assistance of their relatives, which they confirmed during interviews. Only the registered manager or senior carer assist residents who need help with their finances, which staff confirmed during interviews and there are full and clear records to support this. Staff who were interviewed said that there are now more regular staff meetings and the registered provider has set up a staff association. The registered manager works alongside staff, but needs to arrange formal 1:1 supervision with them so that they have opportunities to reflect on and develop their practice. Staff and residents said that they feel safe in the home. It appears to be well maintained. There are written environmental and fire safety risk assessments in place, which the registered manager is currently reviewing to ensure they are satisfactory. Staff have undertaken training in fire safety awareness, which is up-to-date and there is always someone qualified in first aid on duty. There are clear records of accidents to residents and staff so that potential risks and hazards can be monitored. Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 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 2 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5 (1-3) Requirement Service users and/or their representatives must be provided with service users’ guides, including clear statements of the terms and conditions of their placements in the home. Service users’ assessments must include full consideration of their personal safety and risks. Service users must be provided with up-to-date care plans, that are regularly reviewed, which they and/or their relatives have been consulted on. Care plans must set out clearly how their needs will be met in respect of their health and welfare. Service users must be provided with a choice of meals with adequate records maintained to show that their nutritional needs are being met. Formal systems to consult with service users to review and improve the quality of the services provided must be set up. The registered manager must
DS0000066175.V304169.R01.S.doc Timescale for action 01/09/06 2. 3. OP3 OP7 13(4) 15 (1-2) 01/09/06 01/09/06 4 OP15 12(3) 16(2)(1) 17(2) 24 (1-3) 01/09/06 5. OP33 01/09/06 6. OP36 18(2) 01/09/06
Page 27 Tolverth House Version 5.2 ensure that staff receive formal supervision, with records kept, on a regular basis. 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 OP6 Good Practice Recommendations The home’s statement of purpose, which provides information relating to respite and short-stay care provided in the home should be made readily available to service users and their representatives. Daily care records should provide evidence that service users’ healthcare needs are being adequately met. Handwritten medication records should be counter-signed and referenced back to the original prescription. Service users should be offered a programme of activities based on their preferences and with reference to their diverse religious backgrounds. Service users should be given copies of the home’s complaints procedure. Copies of the local multi-agency procedures for the protection of vulnerable adults should be made available in the home. Care staff should receive training updates on a regular basis and before they become overdue. Staff should be provided with training in caring for people with dementia and/or mental health care needs. 2. 3. 4. 5. 6. 7. 8. OP8 OP9 OP12 OP16 OP18 OP30 OP30 Tolverth House DS0000066175.V304169.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection St Austell Office 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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