CARE HOMES FOR OLDER PEOPLE
Tolverth House Long Rock Penzance Cornwall TR20 8JQ Lead Inspector
Lynda Kirtland Unannounced Inspection 09:15 16th & 17th May 2007 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.V340442.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.V340442.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) 01736 710736 F/P 01736 710736 Vijay Enterprises Limited 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.V340442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th July 2006 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. Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A regulation inspector and regulation manager visited Tolverth House for an unannounced key inspection on the 16 May 2007. As there was no management team available on that day and the Commission was unable to access documentation, the Commission visited the home the next day in order to be able to complete the inspection process. In total the inspection lasted for approximately nine hours. Information about the home received by the Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that residents’ needs are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved interviews with residents living in the home and visiting relatives and observation of the daily life and care provided. There was an inspection of the home’s premises and of written documents concerning the care and protection of residents and the ongoing management of the home. Staff were interviewed and observed in relation to their care practices and there was a discussion with the home’s registered manager and registered provider. Another method used was case tracking, of which three residents were selected. This involves examining the care notes and documents for a select number of residents and following this through with interviews with them or their relatives and staff working with them. This provides a useful, in-depth insight as to how residents’ needs are being met in the home. The Commission approved Mr Vijay as registered provider for Tolverth House in June 2006. Mrs Burnett was approved as registered manager in April 2007, but has worked in this post for some months. Therefore it is acknowledged that this is a new management team for the home. Whilst residents commented that the care they received was ‘good’, ‘couldn’t be better’, there are a number of requirements to improve standards identified at this inspection. The management team are implementing new processes and due to staffing levels this has had an impact on the registered managers time and ability to focus on management tasks in the home. Therefore this has resulted in the documentation of the home being a poor standard. The Commission is working with the provider and the home’s registered manager to develop an action plan towards improvement. What the service does well:
Residents stated that their recent admission to the home was a positive experience, as staff made them feel welcome and relieved some of their anxieties. Tolverth House DS0000066175.V340442.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. There are facilities to ensure that residents can receive personal care in private. Visiting relatives 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. 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. Staff were observed in the main to promote privacy and respect for residents i.e. by knocking on bedroom doors before entering, mail received unopened and access to phones in private. Residents commented that they felt most staff treated them with ‘kindness’ and ‘respectful’. 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. The home manager ensures that relevant health and safety checks, such as fire equipment are maintained and regularly checked. What has improved since the last inspection?
Mrs Burnett application to be the registered manager of Tolverth House has been approved by the Commission. Residents are now provided with the Service Users Guide and information regarding the facilities available in the home, and the process of how to express concerns if they wish. These are available in each resident’s room and some commented that they found the information ‘helpful’. The homes Statement of purpose has been updated and is available to residents. The registered manager has consulted with residents’ focusing on the provision of food in the home. From this menu plans had been reviewed. The majority of residents commented that the food was ‘good’ and was ‘hot’. However they did express that they wished there could be more daily choices in the variety of food. This was relayed to the registered manager who will address this.
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 7 What they could do better:
On arrival at the home the Commission were informed that the staff member in charge of the home was unable to access relevant documents that by law must be available at all times. The Commission met with the management team the following day and explained the need for this documentation to be accessible at all times. This must be addressed. Pre admission assessments must occur prior to a service user being admitted to the home so that the home can assess whether it is able to meet an individuals needs. This in turn will allow the prospective service user to form a view as to if they believe the home can cater for their needs and make an informed choice about living at the home. From files inspected there was no evidence of pre admission assessments taking place. Some residents and their relatives confirmed that they had met with the registered manager before arriving at the home and had access to copies of the Service users guide. The homes manager is implementing new care plan formats. The current care plans do not inform, direct or guide staff as to the interventions needed to manage a particular element of care, therefore this could lead to inconsistent care practices, which in turn can be confusing for residents, especially those that experience confusion already. Staff stated that they are relying on verbal handovers to gain feedback on residents care needs as they found the document ‘unhelpful’. This format did not evidence participation of residents or their relatives in its formation or evidence subsequent reviews. The registered manager agreed to review this document. It was noted that some Service users did not have a care plan. Individual risk assessments need to be developed further so that staff are aware of what actions they need to take in the event of example a fall. Daily records must be reintroduced so that staff are accountable for the care that they have provided to each individual resident. In addition this will evidence the care provided and if there are any follow up actions needed i.e. with health colleagues this will be recorded and all involved in a individuals care will have guidance as to what actions are being taken, rather than relying, as is current practice, at verbal handovers. This will ensure that consistent messages of care needed, will be maintained. Medication processes must be robust. It was evident during the inspection that medication records were not being completed correctly and therefore the process is open to medication errors. A tablet count did not tally with records held and the registered manager agreed to address this immediately. The medication policy must be expanded and refer to the Royal Pharmaceutical Guidance. The medication is stored in a suitable cabinet but it needs to be fixed to a wall.
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 8 The home has a complaints policy but this should be expanded further so that staff are provided with guidance if they receive a compliant as to the process in how to manage his. The registered manager agreed to introduce a complaints format so that the process of complaints and how they are managed can be clearly demonstrated. Residents have a summary of how to make a complaint, which is satisfactory. The homes adult protection policy is in the main satisfactory. One amendment is needed which was discussed with the registered manager who will do this. The registered manager has applied to attend the Multi disciplinary Adult Protection training and will ensure that her staff all receives training in this area. Copies of the Multi Agency Adult protection procedure should be obtained. Some environmental issues must be addressed. There needs to be safe and sufficient heating in the bathrooms, and a review as to the access of the bathrooms upstairs. A higher balcony needs to be installed in the landing area to prevent accidents when residents are using the stair lift. COSHH equipment was observed to be around various locations in the home, which should be looked away. All parts of the home are not accessible to wheelchair users. A portable ramp is available so that residents can access the lounge area of the home. However staff stated that it is ‘too heavy’ for them to use and shared concern regarding manoeuvring a resident on the steep slope means that this is avoided. The registered manager agrees that the home is unable to cater for Service users with a physical disability and therefore the Commission will review with the home this registration category. Staff levels need to be reviewed as residents, relatives and staff all commented that staff contact with residents is care task based and therefore no opportunity for socialising or activities. Care staff also helps with the preparation of breakfasts and tea, which again takes them away form caring duties. The management team agreed to review staffing levels. The recruitment of staff must be more robust. Form inspection of staff files it was evident that staff are employed before relevant CRB and POVA checks are approved. The consequence of this being that staff are not appropriately vetted and therefore could pose a risk when working with vulnerable adults. In addition it was observed that staff files do not have sufficient references and that staff qualifications are not present on files. A record of staff induction should be in place to ensure newly recruited staff are aware of the homes philosophy and policies. Individual staff training profiles should be produced so that the homes manager is confident about the skills that her workforce has. A team-training programme would also benefit the home so that the homes manager can ensure that up to date and refresher training is carried out. Formal supervision of staff should be in place and recorded.
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 9 Service users , their representatives and stakeholders views should be sought on the provision and facilities that the care home provides as part of the homes quality assurance process. Some of these areas for improvement were identified at the previous inspection. It is of concern that since that inspection only one out of six requirements and two out of eight recommendations have been complied with. Due to the level of concerns that this report has highlighted the registered manager will be requested to complete an action plan as to how theses areas will be addressed. The Commission would like to thank the residents, relatives, staff and management team for their assistance during this inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tolverth House DS0000066175.V340442.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.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Residents Guide enables residents and their representatives to be aware of the services and facilities that Tolverth House provide. There is no documentary evidence that pre admission assessments have occurred, this must happen so that the home can ensure that they can meet the individuals’ needs. From this residents can then make a informed choice that they can be assured the home will be suitable to meet their needs. Service users representatives confirmed they did visit the home prior to their relative’s admission to the home. Service users confirmed that they physical admission to the home was carried out sensitively by staff. The home does not provide intermediate care so this standard was not assessed EVIDENCE: Residents have a copy in their rooms of the homes statement of purpose and service users guide. Residents and their relatives stated they felt the Service Users Guide was an ‘informative’ document.
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 12 From inspection of two recent admissions to the home, there were no pre admission assessments present or care plans and therefore there was limited or no information as to the care needs of a service user prior to and on admission. This means that for the service user they are unable to make an informed choice as to whether or not the home will be able to meet their individual needs. Staff confirmed that due to the lack of assessments and care plans, they rely on verbal information as to how to deliver care to individuals, as they have no written guidance as to the individuals needs. This could lead to inconsistent or inappropriate care being provided to residents. In discussion with residents and their representatives, they confirmed that staff lessened their anxieties when moving into Tolverth house and that this was a positive experience for them. Some relatives confirmed they had visited the home prior to their relative being admitted. One Resident did confirm she met with the registered manager prior to moving into Tolverth House. Both residents and the relatives did not feel that the actual process of moving into the home could be improved upon. Tolverth House DS0000066175.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some Service users did not have a care plan implemented. The home is introducing a new care plan format, but this did not clearly inform, guide or direct staff in the caring interventions that they need to undertake with individual service users. Evidence of reviewing care plans was lacking. There are satisfactory arrangements to ensure service users have access to healthcare service. The storage and disposal of medication is satisfactory. However improvements must be made to ensure that the administration of medication is conducted in a safe manner. Service users stated that most staff are respectful and their privacy is promoted. EVIDENCE: The homes manager is implementing a new care plan format, which was discussed. The care plan must ensure that residents personal, health and social care needs, including needs relating to their culture, religion, physical and sensory disabilities and personal relationships are included. The care plan must be informative, guide and state what interventions are needed so that staff are able to provide the individuals basic and more complex care needs in a
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 14 consistent manner. Staff stated that they found the new care plans held little ‘useful’ information and they were therefore relaying on verbal handovers as to what care should be provided for individuals. Some residents did not have a care plan. There was a lack of evidence of participation in the care planning process on the part of residents and/or their representatives and of recent reviews, to provide staff with clear and up-to-date written guidance on how residents need to be cared for. In discussion with residents they were unaware of their care plans. Residents told the Commission that they felt that in the main staff at the home met their care needs. All stated that they are confident about their ability to access external NHS healthcare services when they need them and staff will contact resident’s doctors on their behalf in response to specific needs. Staff confirmed that relevant calls to health professionals are made. However there was little documentary evidence to support this. Records of contact with health agencies should be maintained as should daily logs of the individuals care. Medication is stored in a suitable metal cabinet, but it does need to be fixed firmly to the wall. The home uses the Monitored Dose System of medication. From inspecting the medication it was evident that an audit was not possible as medication had not be recorded as checked in. The MAR sheets were not completed accurately and on occasions there was no signatures gained to confirm if medication had been given and if not the reason why. In one instance it was found that medication had been administered but records did not tally with this, in another the medication had been signed for but the tablet was still in the pack. An audit of medication must be undertaken immediately to ensure that no medication errors occur for the safety of residents. The medication policy needs expanding for example to include disposal of medication, drug errors, use of oxygen, insulin and refer to the Royal Pharmaceutical Guide. If oxygen is in use, appropriate signage must be displayed where used or stored. The registered manager said that she was returning a number of medical dressings to the pharmacist. The registered manager said that the majority of staff has completed medication training. She will ensure that medication processes are addressed with some urgency. Most of the residents interviewed stated that they are satisfied with the arrangements in place to ensure their privacy and dignity. The majority commented that staff treats them ‘kindly’ and with respect. Residents confirmed that they have access to small lockable storage facilities for storage of small valuables if they wish. Residents can make telephone calls in private. Tolverth House DS0000066175.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 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 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. Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 16 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. 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. Since the previous inspection the registered manager has undertaken an audit of food with residents. From this menus have been reviewed. Residents recalled the audit and remembered that at one time there was two choices of main meal a day, but this has now gone leaving no choice of main meal. 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. Some residents said they felt able to ask for an alternative if they did not want the main meal, others stated they felt unable to request this. Inspectors saw a week’s menu plan in the information provided to prospective residents at the home, but this was not being followed. It is acknowledged that the cook is on sick leave and therefore care staff has to undertake this duty. 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. The Environmental health Inspection occurred on 02/08/06 and did not identify any concerns regarding the facilities. It is recommended that the home obtain the ‘Safer food better business’ pack as required by the Environmental agency. Tolverth House DS0000066175.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some Service users feel their 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. The majority of residents said that they had confidence in the home’s manager to address their concerns with the exception of a few who felt unable to express concerns as they believed staff response to them may be negative. Residents have a summary of how to make a complaint in their rooms. It is recommended that the homes complaints procedure be expanded so that for example it includes more information to guide and inform staff on how to respond to complaints expressed to them. The home has received an official complaint regarding food, which the registered manager stated has been addressed. The Commission advised that a documented complaints log and formal procedure is followed so that it can be seen how complaints are managed and how the complaint is resolved. The
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 18 registered manager stated she would devise a complaints form so that this information can be maintained in the one place. 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. An amendment to this policy is needed, as the registered provider is required to notify the CSCI of all incidents of abuse, this does not constitute a referral. Copies of the local multi-agency procedures should be obtained so that they are fully informed of how different statutory bodies work together to protect vulnerable adults. Some of the staff has undertaken multi-agency training on protecting vulnerable adults from abuse and the registered manager is applying for it. 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 setting. Records checked at this inspection showed that staff currently working in the home had not undergone the necessary checks – please refer to staffing section. Tolverth House DS0000066175.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. Bathroom areas need to be improved to ensure sufficient, safe heating and access reviewed. All parts of the home are not accessible to wheelchairs and therefore this category of registration must be reviewed. EVIDENCE: The home appeared well decorated and attractively furnished throughout. Residents commented that they were ‘satisfied’ or ‘happy’ with the accommodation provided and could not think of any areas of improvement in this area. The Commission observed on the whole the home was maintained to a satisfactory standard. The following observations for improvement were noted: the upstairs bathroom facilities need to be improved upon to ensure that safe heating of the room is in place, and to review the access for those with
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 20 mobility difficulties and that the bathrooms can be locked safely. It was also recommended that a higher balcony be installed on the landing to further protect residents when getting on/ off the stair lift. The home appeared clean and tidy throughout at the time of the inspection, which was unannounced. Staff and residents 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 provided with and were observed making use of, suitable equipment to maintain hygiene in the home. It was observed throughout the inspection cleaning products were not locked away in a various locations. There are parts of the home that are not accessible for wheelchair use. One part of the home has three steep steps to enable residents to visit the lounge, some bedroom and toilet facility. The home have purchased portable ramps but staff told the Commission that these are ‘too heavy to use’ and that they are only used when a male carer is in the home. Staff were concerned by the steepness of the ramp and a resident on manoeuvring the ramps was felt to be high risk. Therefore residents do not have access to all parts of the home. The home is registered for one person with a physical disability, the registered manager acknowledged that if a person needs the use of a wheelchair they are unable to accommodate for this persons care needs completely and would not be able to offer them a placement at the home. Therefore the registration for this category of care needs to be reviewed. Tolverth House DS0000066175.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels need to be reviewed to ensure that there are suitable, qualified and sufficient staffs on duty at all times. Recruitment policies and practices need considerable improvement so service users can be sure that staff are suitable to work with vulnerable adults in a care setting. Staff training is needed to assure service users that they are skilled and competent to work with them. EVIDENCE: The majority of residents commented that they felt the staff team were always ‘busy’ and therefore contact with staff was to undertake care tasks, and no time for socialising or activities. Relatives and staff agreed with this view. Residents commented that the majority of staff is ‘kind’ and ‘helpful’. Staffing rotas demonstrated that two carers are on duty from 8am to 6pm, one carer from 6pm to 7pm and then from 7pm till 8am one waking night carer on duty. The registered provider stated as he lives on site he is available for cover during the night if needed. In addition there is a cook employed for 5 hours Monday to Friday who cooks the lunch and does some preparation for tea. This means that staff are taken off caring duties to help with the preparation of tea and breakfasts. A domestic is employed 4 hours Monday to Friday. Due to recent staffing shortages the registered manager has needed to participate on the rota, which has meant that this has taken her away from management duties. The registered manager must have allocated time to undertake
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 22 management tasks as this report has shown that many systems are of a poor standard and need to be addressed urgently i.e. care planning, recruitment of staff. The Commission require that staffing levels are reviewed to ensure that at all times there are sufficient staffs on duty at all times. Staff confirmed that there is access to NVQ training and statutory training for example moving and handling and infection control. The registered manager acknowledged that some staff training is out of date and that she is in the process of addressing this. Examination of recruitment records showed that recruitment practises are insufficiently robust to ensure that staff are recruited fairly and on the basis that they are suitable to work with vulnerable people in a care setting. There was a lack of completed application forms, interview records, evidence of checks conducted with the Criminal Records Bureau and references on staff files inspected. There was a lack of evidence of staff training and qualifications on their files or assurances from staff working in the home that they regularly undertake training so that they have the necessary skills and competences to work effectively with residents. New staff said that their induction training consisted of working alongside more experienced staff, but there were no records of formal induction training. The registered manager is aiming to implement a new induction process. The registered manager acknowledged that formal supervision of staff has not occurred and will address this. Tolverth House DS0000066175.V340442.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. 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 dayTolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 24 to-day charge of the home. The registered provider lives on site and is also 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 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 has received views from residents regarding food due to a particular issue, but this needs to be developed further and relatives and stakeholders views should also be sought. 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 confirmed that supervision has not occurred. New staff commented that they have worked alongside other staff as part of their induction. Individual risk assessments of service users need to be developed further and incorporated in their care planning process, with particular regard to those who are at risk of falls, the use of bed rails and environmental risks. 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. Staff have undertaken training in fire safety awareness, which is upto-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.V340442.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 3 X 1 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X 1 2 2 Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1)(a)(b)( c)(d) Requirement ‘The registered person shall not provide accommodation to a Service user at the care home unless, so far as it has been practical to do soa) needs of the service user has been assessed by a suitably qualified or suitably trained person: b) the registered person has obtained a copy of his assessment c) there have been appropriate consultation regarding the assessment with the service user or a representative of the service user d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare.’ ‘The registered person shall ensure thatDS0000066175.V340442.R01.S.doc Timescale for action 01/07/07 2. OP3 13(4)(b) (c) 01/07/07
Version 5.2 Page 27 Tolverth House (b) any activities to which service users have access are so far as practicable free from avoidable risks: and (c)Unnecessary risks to the health and safety of Service users are identified and so far as possible eliminated.’ Service users’ assessments must include full consideration of their personal safety and risks. This is the 2nd notification, previous timescale for compliance was 01/09/06 3. OP7 15 (1) (2) (a)(b)(c) (D) (1) ‘Unless it is impracticable to carry out such consultation the registered person shall after consultation with the Service user, or a representative of his, prepare a written plan (the service users plan) as to how the Service users needs in respect of his health and welfare are to be met. (2) the registered person shall(a) Make the service user’s plan available to the Service user (b) Keep the Service users plan under review (c) Where appropriate and, unless it is impracticable to carry out such consultation, …..revise the Service users plan: and (d) Notify the Service user of any such revisions’ 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
Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 28 01/07/07 3 OP9 13 (2) their health and welfare. This is the 2nd notification, previous timescale for compliance was 01/09/06 13(2) ‘the registered person 01/07/07 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medication received into the care home.’ Medication records must be completed accurately at all times. 4. OP15 12(3)16(2 )(i)17(2) Sch 4 (13) 01/09/07 12(3) ‘The registered person shall for the purpose of providing care to Service users and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. 16(2)(i) provide in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by Service users Sch 4 (13) a record of the food provided for Service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual Service users:’ Service users must be provided with a choice of meals with adequate records maintained to show that their nutritional needs are being met. This is the 2nd notification, previous timescale for compliance was 01/09/06 Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 29 5 OP16 17 (2) Sch 4 (11) ‘A record of all complaints made by Service users or representatives or relatives of the Service users or by persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint.’ 01/09/07 6 OP18 13(6) Documentation showing the complaint process followed must be completed. The complaints policy must inform and guide staff as to what actions they must take when made aware of a complaint. The registered person shall make 01/09/07 arrangements by training staff or by other measures to prevent Service users being harmed or suffering abuse or being placed at risk of harm of abuse. The adult protection policy must be amended to guide staff in how to manage allegations of abuse. Training of abuse should be gained for all staff. 7 OP19 23(2)(a) 8 OP25 23 (2)(p) The registered person shall 01/09/07 having regard to the number and needs of Service users ensure that(a) the physical design and layout of the premises to be used as the care home meet the needs of Service users’ The category of physical disability needs to be reviewed as the layout of the home is not designed to provide access to all parts of the home for Service users who are dependant on wheelchair use. ‘The registered person shall 01/09/07 having regard to the number and
DS0000066175.V340442.R01.S.doc Version 5.2 Page 30 Tolverth House needs of Service users ensure that(p) ventilation, heating and lighting suitable for Service users is provided in all parts of the care home which are used by Service users.’ The heating in the bathrooms need to be reviewed and appropriate action taken to ensure that Service users are not placed at risk. ‘The registered person shall 01/07/07 having regards to the size of the care home, the statement of purpose and the number and needs of Service users(a) ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of Service users’ A review of staffing levels must occur. The registered person shall not 01/08/07 employ a person to work at the care home unless; (a) the person is fit to work at the care home (b) subject to para 6 he has obtained in respect of that person the information and documents specified in – (i) paragraphs 1 to 7 of Schedule 2 (c) he is satisfied on reasonable grounds as to the authenticity of the references referred
DS0000066175.V340442.R01.S.doc Version 5.2 Page 31 9 OP27 18(1)(a) 10 OP29 19 (1)(a)(b)( c) Tolverth House to in paragraph 5 of Schedule 2 in respect of that person. The recruitment process must be robust and the following documentation specified above must be gained. ‘The registered person shall establish and maintain a system for- (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home… (2) the registered person shall supply to the Commission a report in respect of any review….. (3) the system referred to in paragraph (1) shall provide for consultation with Service users and their representatives.’ Formal systems to consult with service users to review and improve the quality of the services provided must be set up. This is the 2nd notification, previous timescale for compliance was 01/09/06 ‘the registered person shall ensure that persons working at the care home are appropriately supervised’. The registered manager must ensure that staff receive formal supervision, with records kept, on a regular basis. This is the 2nd notification, previous timescale for compliance was 01/09/06 The registered person shall ensure that the records referred to in paragraph (1) and (2) are(a) kept up to date and (b) are at all times available for
DS0000066175.V340442.R01.S.doc 11 OP33 24 (1-3) 01/10/07 12 OP36 18(2) 01/09/07 13 OP37 17 01/07/07 Tolverth House Version 5.2 Page 32 inspection in the care home by any person authorised by the Commission to enter and inspect the care home. 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 OP8 Good Practice Recommendations Daily care records should provide evidence that service users’ healthcare needs are being adequately met. This is the 2nd notification, from previous report dated 11/07/06 Handwritten medication records should be counter-signed and referenced back to the original prescription. This is the 2nd notification, from previous report dated 11/07/06 The medication cabinet should be fixed to a wall. Service users should be offered a programme of activities based on their preferences and with reference to their diverse religious backgrounds. This is the 2nd notification, from previous report dated 11/07/06 Service users should be given copies of the home’s complaints procedure. This is the 2nd notification, from previous report dated 11/07/06 Copies of the local multi-agency procedures for the protection of vulnerable adults should be made available in the home. This is the 2nd notification, from previous report dated 11/07/06 The balcony rail should be made higher on the landing to promote safety when Service users are using the stair lift. Care staff should receive training updates on a regular basis and before they become overdue. This is the 2nd notification, from previous report dated 11/07/06 Staff should be provided with training in caring for people
DS0000066175.V340442.R01.S.doc Version 5.2 Page 33 2. OP9 3 4. OP9 OP12 5. OP16 6. OP18 7 8. OP19 OP30 9. OP30 Tolverth House 10 OP38 with dementia and/or mental health care needs. This is the 2nd notification, from previous report dated 11/07/06 COSHH equipment should be stored in locked cabinets when not in use. Tolverth House DS0000066175.V340442.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Devon Office Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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