Inspection on 23/10/07 for Tolverth House

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tolverth House 05/11/09

Tolverth House 21/10/08

Tolverth House 16/05/07

Tolverth House 11/07/06

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tolverth House Long Rock Penzance Cornwall TR20 8JQ Lead Inspector Lynda Kirtland Unannounced Inspection 23 and 30 October 2007 9.30 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.V349909.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.V349909.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 01736 710736 Vijay Enterprises Limited Position Vacant Care Home 14 Category(ies) of Dementia (4), Mental disorder, excluding registration, with number learning disability or dementia (4), Old age, not of places falling within any other category (14), Physical disability (1) Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following caregory of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP- maximum of 14 places Dementia - Code DE- maximum of 4 places Mental disorder, excluding learning disability or dementia- Code MDmaximum of 4 places Physical disability- Code PD- maximum of 1 place The maximum number of service users who can be accommodated is 14. 16th May 2007 2. Date of last inspection 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. 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 £310.00-£395.00 per week. Additional charges are made for newspapers, hairdressing, private chiropody and outings organised by the home. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspector visited Tolverth house for an unannounced key inspection on the 23 October 2007. As the registered manager and registered person were going away on a care conference it was agreed that the second day of the inspection would occur on the 30th October so that they could participate in this process. It lasted for approximately fourteen 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 person. 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. Since the previous inspection the registered manager and registered person have worked hard to comply with the statutory requirements identified at the last inspection. This report evidences that there has been an overall improvement in the service following new management systems being put in place. People who use the service echoed that the care they received was ‘good’ and were ‘satisfied’ with the facilities on offer. What the service does well: People who use the service said that their recent admission to the home was a positive experience, as staff made them feel welcome and relieved some of their anxieties. People who use the service 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. 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 Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 6 lifestyle the home provides. Some go out independently or with relatives and make use of the facilities in the local community. People who use the service 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? It was evident during this inspection that the registered manager and registered person has worked hard to improve the services that Tolverth House provide. Form the last inspection they have complied with 12 statutory requirements and seven recommendations, which evidences the seriousness of how they approached the concerns highlighted in the previous report. The improvements that have been made focus on consultation with people who use the service, documentation and implementing new management systems. People who use the service are provided with an up to date Statement Of Purpose and Service Users Guide. These documents give the person information regarding the facilities available in the home. These are available in each resident’s room and some commented that they found the information ‘helpful’. Pre admission assessments now occur prior to a service user being admitted to the home so it can be assessed whether Tolverth house has the correct facilities to meet an individuals needs. This in turn allows 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 discussion with people who were recently admitted to Tolverth House they confirmed that they had met with the registered manager prior to admission and had identified what care they needed and if Tolverth house would be able to provide this care. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 7 New care plan formats have been introduced which cover the person’s physical, emotional, social and diverse care needs. These care plans are informative but could do with further expansion to guide and direct staff in what caring interventions are needed so that consistent care can be provided to the individual. Daily records have been introduced so that staff are demonstrating their accountability for the care that they have provided to each individual resident. 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 that they were satisfied with the variety of food provided. Medication processes have improved and are more robust. The registered manager undertakes a monthly audit of medication and this has ensured that medication errors are kept to a minimum. A recent pharmacy inspection did not highlight any concerns in this area. The homes complaints policy has been expanded so that staff are provided with guidance if they receive a complaint as to the process in how to manage this. People who use the service said that they felt able to approach the registered manager if they had any concerns. The environmental issues have been addressed via the homes risk assessment process. The heating in a bathroom and access of the bathrooms upstairs have been risk assessed and appropriate actions taken. COSHH equipment is now stored securely. Due to not all parts of the home being accessible to people who use a wheelchair the registered person has amended the homes Statement Of Purpose to clearly identify this so that new enquiries to the home are aware of this restricition. Staff levels have been reviewed resulting in a increase in catering hours, plus on three days a week a increase in care staff hours to allow more intimate care to be provided on these days. During the inspection it was identified that a member of the catering staff would be responsible for providing afternoon activities that has been lacking. The registered manager confirmed that she has recruited new staff and from inspection of staff files it was evident that staff are employed when their CRB and POVA checks are approved. However there is some documentation that remains lacking which the registered manager is aware of and addressing. Formal supervision of staff has been introduced and is recorded. Views have been sought from people who use the service about the facilities that Tolverth house provide via the use of a questionnaire. This is in the early stages of development and it would be beneficial to expand this further by gaining views from relatives and professionals who use the service. The Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 8 registered manager agreed to send a copy of their quality audit findings with any planned action to the Commission. The registered person has ensured that relevant documents that by law must be available at all times are now accessible. What they could do better: It is recommended that people who use the service, plus their representatives/advocates views are recorded in the pre admission, care plan and subsequent reviews, as this is not evidenced. As stated above the care plans would benefit from further expansion so that they inform, direct and guide staff as to what caring interventions are needed in order to provide consistent care to the individual. Currently there is no documentary evidence that a review of the care plans occur and this needs to be demonstrated so staff are up to date with any recent changes to the 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. A risk assessment in respect of storing eye drops in the main fridge needs to be undertaken to ensure that appropriate safety measures are in place. It is recommended that a member of the catering staff gain the Intermediate Food Safety course. It is further recommended to promote infection control in the kitchen area that fly screens are purchased. The homes adult protection policy needs to be reviewed. Currently the home has three policies that refer to adult protection with differing guidance for action. One policy and procedure needs to be introduced which follows the Multi Agency Adult protection guidance. It is further recommended that members of the management team attend this course and then cascade the training to the staff team. Currently fewer than 50 of the staff team have achieved NVQ level 2, which is below the national minimum standards. As the registered manager has employed some new staff this can account partially for the low numbers who have gained this qualification. The registered manager is keen for staff to gain this certificate and during the inspection some NVQ training was in process. The registered manager is aware that staffing files need to be updated to ensure that documentation is in line with legislation. This continues to be addressed. Individual staff training profiles should be produced so that the homes manager is confident about the skills that her workforce has. A team-training Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 9 programme would also benefit the home so that the homes manager can ensure that up to date and refresher training is carried out. The homes policies and procedures need to be reviewed and updated. In particular the adult protection policy, use of restraint, management of Service users monies need to be reviewed as a priority. The homes fire risk assessment needs to be reviewed to ensure that it meets recent legislation. The Annual Quality Assurance Assessment must be completed and forwarded to the Commission. The Commission would like to thank the residents, 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.V349909.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.V349909.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, 2, 3, 4, 5 Tolverth House does not provide intermediate care as set out in standard 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A contract of care is provided to people who use the service so that they are aware of their rights whilst resident at Tolverth House. The needs of prospective service users are assessed prior to admission so that they can be assured that the home can provide adequate care and meet their individual care needs. People who use the service are invited to meet with staff and visit the home that will assist them in making the decision about living at Tolverth house. EVIDENCE: Since the previous inspection the homes Statement Of Purpose and Service Users guide have been updated so that they accurately reflect what services and facilities the home provides to people who use the service. People who use the service have a copy of these documents in their rooms. Since the previous inspection the registered manager has implemented a formal record of pre admission assessments and any queries that she receives Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 12 from prospective residents. The manager visits prospective residents and complete a needs assessment, which takes into account service users physical, emotional, social and diverse, needs. All the residents’ records case tracked contained needs assessment, which recorded their care needs in detail and included their views and preferences. The home’s assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. Residents felt that the home involved them in their care arrangements. Records from relevant professionals are also gained as part of the assessment process. In discussion with residents they confirmed that staff lessened their anxieties when moving into Tolverth house and that this was a positive experience for them. One resident did confirm she met with the registered manager prior to moving into Tolverth House. People who use the service did not feel that the actual process of moving into the home could be improved upon. A contract of care is provided to each resident which stipulates their terms and conditions of the placement. Tolverth House DS0000066175.V349909.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has introduced a new care plan format, but this would benefit form further expansion as it does 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. EVIDENCE: All the residents’ case tracked had written care plans. The care plans would benefit from further expansion so that care staff are informed, guided and directed as to what caring interventions are needed to ensure consistent care to residents. The care plans did note peoples personal routines and preferences and their religious beliefs. Staff commented that they found these care plans to be more informative. The care plans should be dated and there is currently a lack of evidence that they are reviewed on a monthly base. It is recommended that when residents or their representatives are consulted in the care planning or review process that this be recorded so that the home can evidence their participation more fully. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 14 Risk assessments would also benefit from further expansion so they direct staff as to what interventions are needed if for example a resident falls what action staff should take. The daily records for residents summarised if care had been provided that day. It is recommended that the registered manager monitor the detail of these records to evidence what care the resident has experienced during the day plus any activities that they have participated in. People who use the service are registered with local GP practices. People who use the service felt that their health care needs were monitored and attention obtained promptly when needed. Residents are weighed regularly. Since the previous inspection improvements have been made in the storage and administration of medication. Medicines are stored in a locked medicines trolley and stored securely. The medication trolley was tidy and well organised. The Monitored Dose System (MDS) is in use. The registered manager has introduced monthly monitoring of medication to ensure that it is being received, administered and that records are accurate. A recent pharmacy inspection highlighted one issue regarding the storage of eye drops in the main fridge. The Commission advises that the registered manager undertakes a risk assessment of storing eye drop medication in the fridge if this practice continues. The medication policy was not inspected on this occasion as the registered manager stated that the pharmacist was satisfied with it. People who use the service made positive comments on the skills and caring qualities of staff. Residents felt well cared for and reported that staff delivered care sensitively, respected their privacy and dignity and listened to their concerns. Residents said that staff were “lovely” and “kind”. Residents felt safe when staff assisted them with personal care. Examples of staff providing skilled and sensitive care were observed during the inspection. Tolverth House DS0000066175.V349909.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 and 15 Quality in this outcome area is good This judgement has been made from evidence gathered both during and before the visit to this service. Residents are supported in a lifestyle, which accords as far as possible with their own expectations and preferences. People who use the service stated they are satisfied with the range of activities that takes place that meets their social, religious and recreational interests. The diet provided is varied and nutritious with attention to individual preferences EVIDENCE: In discussion with people who use the service they felt they had control over their daily lives and were supported to make choices about their routines and activities. The majority felt that there was ‘enough to do’. The registered person and manager are attempting to promote activities in the home and during the inspection identified a staff member to provide a activity each afternoon. The home has transport if residents wish to go out. People who use the service reported that they found the visiting arrangements open and flexible. They felt that visitors were made welcome and choose where they meet their guests. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 16 People who use the service confirmed they have a lockable facility for small items of value. Residents can bring in possessions and furniture at admission by agreement with the provider. Many residents and their families had personalised their bedrooms. The registered person stated that if a resident requested to lock their rooms this would be considered. Since the last inspection an audit of food has occurred and menus have been reviewed in light of residents feedback. People who use the service said there is now a choice of two main meals, and if residents felt unable to eat main meal a ‘snack’ lunch was offered to them. Residents said they were satisfied with the standard of and variety of food. They confirmed that they were aware of the meals provided each day. Each resident’s preferences and choices are recorded. Residents confirmed that lunch is a social and unrushed occasion with staff providing sensitive support in a pleasant manner. Breakfast can be taken in the dining area or in the resident’s room and residents were very happy with the choices available. Staff knew residents’ likes and dislikes. Hot and cold drinks are served between meals. The cook was aware of residents dietary needs and caters for them. The catering staffs have gained the basic food and hygiene course and one has just completed a course in healthy eating. It is recommended that one of the catering staff gain the intermediate food and safety certificate. A recent environmental health inspection was satisfactory. It is recommended that fly screens be purchased for the kitchen windows, as these were open during cooking. Records of fridge/ freezer temperatures are being kept and a copy of the ‘safer food better business’ was seen. Tolverth House DS0000066175.V349909.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 and 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse but further 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: The complaints procedure is appropriate. The majority of people who use the service said that if they had any issues of concerns they felt able to approach the management team and believed they would be listened too. People who use the service have access to a summary of the process of how to voice concerns via the Service Users guide and posters on display. Tolverth house received two concerns recently that were investigated appropriately. The home has received a number of compliments recently. People who use the service said that they felt safe in the home. As per the previous requirement the registered manager is aware that she needs to review the homes adult protection policy and procedure to make it clearer in what actions staff must take when they are alerted to or have a suspicion of abuse. The policy needs to state that the registered person is required to notify the CSCI of all incidents of abuse, this does not constitute a referral. In addition the home has three policies which refer to adult protection policies and procedures and the information in them is different the consequence being there is no clear directive of what actions or processes they want staff to take. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 18 Since the last inspection the registered manager is addressing that the home’s recruitment procedures are more robust so that new staff are recruited on the basis that they are fit and safe to work with vulnerable people in a care setting. Please refer to staffing section. Tolverth House DS0000066175.V349909.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 good. This judgement has been made using available evidence including a visit to this service. The home is accessible, well maintained and safe. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: The home appeared well decorated and attractively furnished. People who use the service 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. A damp patch on a bedroom ceiling was noted and the registered provider stated that this had been painted but would re do this. Since the previous inspection the registered manager has undertaken a risk assessment of the balcony area and the upstairs bathroom facilities to ensure that safe heating of the room is in place. The registered person confirmed that if residents requested keys to their bedrooms that this would be considered. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 20 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 are now locked away. Tolverth House is registered for one person with a physical disability. However there are parts of the home that are not accessible for wheelchair use. 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. The homes Statement Of Purpose has been updated to reflect this. Tolverth House DS0000066175.V349909.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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels ensure that there are 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: Staff are employed in a variety of capacities for the smooth running of the home. There is one senior carer/ manager on duty plus two carers during the day, in the evening this is reduced to one carer. There is one waking night member of staff plus the registered person sleeps on site. There is a manager on call system in place. There is sufficient domestic staff on duty. Since the previous inspection the catering hours have increased so they now prepare tea. In addition on three days of the week three carers are on duty to undertake more intimate care tasks. During the inspection it was announced that the cook would also take on responsibility for organising activities in the afternoons. The registered manager believes this review of staffing levels is able to safely meet residents’ needs. Rotas confirmed this level of staffing. Staff commented, echoed by residents that they felt there was sufficient staff on duty. People who use the service said that staff responded to call bells promptly and spoke positively regarding staff commenting they are ‘so kind’, ‘helpful’, ‘nothing is too much bother for them’ and ‘couldn’t ask for better’. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 22 Since the previous inspection the registered manager has recruited new staff. This has allowed the registered manager to have more time to undertake her management responsibilities rather than being on shift. The registered manager is aware that staff recruitment files need to be improved to ensure that recruitment practises are sufficiently robust so 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 documentation as per legislation requirements. The home has now ensured that Criminal Records Bureau checks are gained prior to commencing employment at the home. Under 50 of care staff have achieved a minimum of NVQ at level 2. member of staff has just commenced this training. It is acknowledged since the last inspection the registered manager has recruited new staff they have not gained this qualification. The registered manager stated new staff members would be asked to undertake this qualification. One that and that The registered manager is aware that staff training in the areas for example of medication, moving and handling and infection control need to occur. It is recommended that the registered manager complete an overall training programme for all staff at the home so that she is able to monitor what training is needed and when refresher courses need to be organised. Tolverth House DS0000066175.V349909.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, 35, 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 so that residents can be confident that the home is in safe hands. Residents and staff are able to contribute their views to the ongoing improvement and development of the service. There are satisfactory systems in place to ensure that the home is a safe place to live and work in. The homes policies and procedures need to be reviewed so that staff are aware of what is expected of them, and that relevant legislation is being adhered too. EVIDENCE: The home’s manager is registered with the Commission and demonstrated her fitness to be in charge of a care home. She is nearing completion of her Registered Managers Award. The registered manager is in active day-to-day charge of the home. Staff and residents commented positively about the registered manager and all stated they felt able to approach her if they had Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 24 any concerns. The registered person lives on site and is also involved in the day-to-day management of the home. The registered person has not completed the Annual Quality Assurance Assessment (AQAA) as he was awaiting the legal reference before completion. This has been provided to the registered person and will again be supplied. The AQAA must be completed and forwarded to the commission. A questionnaire has been developed to ask residents for their views on the facilities the home offers. Feedback from these questionnaires has been positive. The home needs to send a summary of its findings plus any actions it plans to take to the Commission. This quality assurance system would benefit from expansion to include relatives and professionals views. Most of the current residents manage their own financial affairs or do this with the assistance of their relatives or representatives. The registered persons do not act as agents or appointees for the majority of service users. The home must implement an up to date policy and procedure in the management of residents’ money so that all staff are aware of how to manage this process. Records of money kept on behalf of a resident tallied with paperwork kept. The paperwork would benefit from review plus it is recommended that a financial audit of this system is put in place. Whenever the home is managing monies for Service users this should cross reference with the individuals care plan. New staff said that their induction training consisted of working alongside more experienced staff. The registered manager is aiming to implement a new induction process. The registered manager acknowledged that formal supervision of staff has just commenced so that they have opportunities to reflect on and develop their practice. 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. 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. It is recommended that the homes fire risk assessment be reviewed alongside recent legislation. Records reviewed at this inspection indicate that they are appropriately maintained and held, to ensure the welfare and safety of residents. The handover records were discussed to ensure that in future they are in line with the requirements of the data protection act and promote confidentiality. There are suitable storage facilities and records are kept in ways that protect their confidentiality. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 25 The homes policies and procedures need to be reviewed to ensure they accurately inform staff of their accountability and the homes expectations of them. Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 3 3 2 Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1)(2) Requirement Timescale for action 31/12/07 2 OP7 15 (2)(b)(c) 13(4)(a)( b)(c) Care plans must be expanded further to inform, direct and guide staff as to what caring interventions are needed to meet service users individuals care needs. Care plans must be reviewed 31/12/07 monthly and any changes to the care plan must be recorded. Individual risk assessments must be developed further so that staff are aware of what actions they need to take to ensure the health and safety of Service users . 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. This is the second notification, the first had a timescale for compliance by 01/09/07 The registered person shall not employ a person to work at the care home unless; the person is fit to work at the DS0000066175.V349909.R01.S.doc 3 OP38 31/12/07 4 OP18 13(6) 31/12/07 5 OP29 19 (1)(a)(b)( c) 31/12/07 Tolverth House Version 5.2 Page 28 care home subject to para 6 he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2 he is satisfied on reasonable grounds as to the authenticity of the references referred 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. 6 OP35 20(1a)(1b ) A policy in respect of the management of Service users monies must be implemented plus a system for recording expenditure and deposits. The registered manager must review and update the homes policies and procedures to ensure that Service users health and welfare are paramount. The registered provider must complete the Annual Quality Assurance Assessment and return it to the Commission 31/01/08 7 OP38 13 (2)(3)(4)( 5)(6)(7)(8 ) 17(2) 24 31/03/08 8 OP33 15/12/07 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 OP3 OP7 Good Practice Recommendations Service users, plus their representatives/advocates views should be sought and recorded in the pre admission, care plan and subsequent reviews. DS0000066175.V349909.R01.S.doc Version 5.2 Page 29 Tolverth House 2 3 OP9 OP12 4 5 OP15 OP18 .A risk assessment in respect of storing eye drops in the main fridge needs to be undertaken to ensure that appropriate safety measures are in place. Service users should be offered a programme of activities based on their preferences and with reference to their diverse religious backgrounds. This is the 3rd notification, from previous report dated 11/07/06 ad 16/05/07 A member of the catering staff should gain the Intermediate Food Safety course. Members of the management team should attend the Multi Agency Adult Protection Training and then cascade the training to the staff team. 50 of the staff team should achieve a minimum of NVQ level 2 as per the national minimum standards guidelines. Care staff should receive training updates on a regular basis and before they become overdue. This is the 3rd notification, from previous report dated 11/07/06 and 16/05/07 Staff should be provided with training in caring for people with dementia and/or mental health care needs. This is the 3rd notification, from previous report dated 11/07/06 and 16/05/07 The homes fire risk assessment needs to be reviewed to ensure that it meets recent legislation It is recommended that to promote infection control in the kitchen area that fly screens be purchased. 6 7 OP28 OP30 8 OP30 9 10 OP38 OP38 Tolverth House DS0000066175.V349909.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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