Inspection on 06/02/06 for Toray Pines

This inspection was carried out on 6th February 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Toray Pines 10/07/06

Toray Pines 14/09/05

Toray Pines 16/03/05

Toray Pines 01/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Toray Pines School Lane Coningsby Lincs LN4 4SJ Lead Inspector Jean Cope Unannounced Inspection 6th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 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. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Toray Pines Address School Lane Coningsby Lincs LN4 4SJ 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) 01526 344361 01526 343294 Tanglewood (Lincolnshire) Limited Mrs Gillian McLellan Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52), Physical disability (8) of places Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Any service users within the category PD will be aged between 50 and 65 years. All of the following rooms may be used to accommodate people within the category PD: numbers 15, 16, 17, 18, 40, 41, 42 & 43. Occupancy When used by service users within the category PD, these rooms will be used on the basis of single occupancy and the overall occupancy will be reduced proportionately. 14th September 2005 Date of last inspection Brief Description of the Service: Toray Pines is a purpose built home situated in the village of Coningsby, which has a range of local services and facilities. It is one of a group of homes operated by the same company, Tanglewood (Lincolnshire) Limited. It is set in its own well-maintained gardens with a patio area. Gardens are accessible for those service users with mobility difficulties or who need wheelchairs. Accommodation is provided on two floors, which can be accessed through a shaft lift or stairs. The majority of rooms are for single occupancy. Lounge and dining areas are located on both floors. There is car parking available to the side of the property. Toray Pines is registered as a care home to provide care and accommodation for up to fifty-two service users in total. The main registration is for older service users who are aged sixty-five years or over. Conditions of registration have been varied to enable the home to cater for up to eight service users with physical disabilities aged between 50 to 64 years of age in designated rooms which, when used for this category are used for single occupancy. At the time of inspection only two persons were requiring care in this category. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place with the assistance of the manager, Gillian McLellan. One inspector undertook the inspection over a four and a half hour period. The inspector toured the building, spoke with three members of staff and residents. The main method of inspection used was called ‘case tracking’ which involved the selecting of two residents and tracking the care that they receive through discussion with them and the care staff and observation of care practices. What the service does well: What has improved since the last inspection? What they could do better: The home admitted a number of new residents over a very short period of time when the Primary Care Trust purchased rooms in the home for patients to have time to recover. This has put some strain on the staffing levels in the home and has increased the overall dependency of residents, some of whom who are quite frail. A number of the temporary residents have moved into the home with numerous medications which has also had an impact on the amount of staff time given to checking and administering medications. This has been recognised by the manager who is advertising for staff and using agency staff when necessary. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 6 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. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents’ benefit from knowing that the manager of the home is sure that the home will be able to meet their needs. EVIDENCE: The manager assesses new residents prior to them moving into the home and normally writes to them to confirm that the home is able to meet their needs. The local Primary Care Trust has purchased thirteen rooms in the home on a short term basis for some patients discharged from hospital, who need time to convalesce. These residents come on a short-term basis and were assessed prior to them moving in to the home by the multi-disciplinary team in the hospital. The manager is provided with the resident’s assessment document. A member of the multi-disciplinary team visits the home to check their progress and arrange their discharge. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Medicinal preparations, such as creams, used communally pose a risk of cross infection from one resident to another. For residents to have the best benefit from their prescribed medications they must be given at the right time. EVIDENCE: Each resident has a plan of care, which is regularly reviewed. The residents admitted for short-term care from the hospital are reviewed and their plan of care changed by the Primary Care Trust multi-disciplinary team. One member of the team interviewed, said that their patients were making good progress and it was working well. One resident was identified as at risk of falling but there was no risk assessment which documented how to reduce the risk. Residents who permanently reside in the home have their medications packed into a monitored dosage system by the home’s pharmacist. The residents who are placed by the Primary Care Trust bring their medications in the packaging provided by the hospital on their discharge. Medication sheets have been written by hand and countersigned by a second staff member to reduce the risk of errors. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 10 A member of the district nursing team said that medications were taking so long to administer that some residents were receiving their medications quite late in the morning, which may not be in accordance with the medication instructions. A senior member of staff working in the home confirmed that a medication round could take from one and a half hours to two hours in the morning. During a tour of the building a prescribed medicinal cream was found in a bathroom on a trolley indicating it was being used communally. This cream belonged to a resident who no longer resided in the home. Another cream was also in the bathroom, but had had the label with the resident’s name removed. The manager said that eight staff members are about to commence a distance learning course on safe handling of medicines. The community pharmacist checked the storage, stock control and medication disposal arrangements in the home on the lst February 2006, which were found to be satisfactory. Since the last inspection, the so-called ‘nursing station’ where care notes are written and the telephone is situated, has had the layout changed. Several notices were on the wall, which named some of the residents living in the home, and described some of their specialist needs. This did not respect the residents’ confidentiality or promote their dignity and privacy. This was discussed with the manager during the inspection. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 15 Residents are encouraged to maintain contact with their friends and relatives and with their local communities. The home provides nutritious food with a range of menus for residents to choose from. EVIDENCE: Since the last inspection the activities co-ordinator has resigned and the manager is currently advertising for a new co-ordinator. The notice board was advertising a Valentine’s coffee afternoon with the help of some residents’ relatives. A church service was also advertised. The manager said that residents could come and go as they please and several residents enjoy attending the local Wednesday and Thursday Club in the village, where they can stay for lunch if they wish. Residents’ relatives were seen to be visiting and taking their relatives out. Several residents said that they had enjoyed their midday meal. The catering team are able to provide for a range of specialist diets, which include, diabetic, soft and pureed diet and gluten free. Specialist diets are indicated on a colour coded diet sheet which is checked by senior staff. A four weekly menu is Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 12 operated in the home which offers two choices at midday and residents are asked the day before the meal is served what their preferences are. Some residents had been provided with specialist cutlery and plate guards to enable them to eat independently. One carer was feeding a resident and was talking kindly to them and offering drinks in between. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These outcomes were not inspected. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Residents live in a comfortable, homely environment and are encouraged to bring their own small items of furniture with them as well as their personal belongings. EVIDENCE: The home was cleaned and maintained to a high standard. It was comfortable and homely and odour free throughout. Residents are encouraged to bring their own personal possessions with them and arrange their rooms as suits them. During a tour of the building a raised toilet seat in one of the downstairs toilets was unstable and need to be re-fitted or removed. The fastening mechanism had been damaged. This was brought to the attention of the manager immediately. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 15 A resident also suggested that a call bell was needed in the upstairs reception area where residents sit together to chat, as up to twenty minutes could pass without them seeing a staff member and they were unable to call for assistance easily themselves. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 Staff are recruited safely, but there was a general consensus that residents would benefit from extra staff being on duty, particularly at busy times of the day. EVIDENCE: A visiting community nurse commented that she felt that there were not enough staff on duty to meet residents’ needs. Some residents recovering from surgery needed more input from staff to enable them to practice walking on a regular basis. Residents also said that they had to wait longer for staff to answer their calls for assistance. This was discussed with the manager at length who said that she was advertising for more staff and using agency when necessary. Staff spoken with also said that they were extremely busy, one saying that they were ‘run off their feet’. Please see the comments made in the outcomes for Standard 9. The manager said that the organisation is committed to ongoing training for staff at National Vocational Level 2. Personnel records were inspected and there was evidence that staff are recruited safely. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 38 The home is run by an experienced and qualified manager and residents feel able to talk openly and freely with one of the proprietors of the home when he visits. EVIDENCE: The manager is registered with the Commission and has now achieved her registered manager’s award. One of the residents commented that the proprietor often visits the home and talks to residents and that they felt able to discuss their concerns with him. Please see the comments in the outcomes for standard 22. Many of the beds are fitted with bedsides, which were uncovered. A risk assessment must be undertaken to ensure that their usage is safe and that residents’ limbs cannot be trapped in them. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 18 It was noted that a self closing fire door did not close completely, when pushed to close on two separate occasions leaving only a marginal opening. This was identified to the manager who said that this would be dealt with. Fire bells are tested every week and the manager holds a fire drill approximately once a month; these are recorded. Hoists and electrical equipment in the home are regularly tested. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 3 Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 13(4)(b) Requirement Risk assessments need to be undertaken when there is an identified problem, such as risk of falling, to reduce any possible risk. Medications must be administered at the appropriate time. Staffing levels must be reviewed to ensure that this is done on time. All prescribed medicines, lotions and creams must be used only for the person named on the label with immediate effect. This requirement remains outstanding from the previous inspection. Timescale for action 31/03/06 2 OP27OP9 13(2) 31/03/06 3 OP9 13(2) 31/03/06 4 OP10 12(4)(a) 5 OP22 23(2)(n) The arrangements for alerting 31/03/06 staff to important notices regarding residents must be made more discreet to protect residents’ privacy and dignity. Calls bells must be left within the 31/03/06 reach of every resident. The upstairs reception area where residents meet together has no accessible call bell. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 21 6 OP38OP22 23(2)(n) 7 OP27 18(1)(a) 8 OP38 23(4) A raised toilet seat placed on a 06/02/06 toilet was found to be unsafe and not properly fixed down. This was identified to the manager and needed to be refitted or removed. Staffing levels need to be 06/02/06 reviewed in relation to dependency levels of residents to ensure that their needs can be met. A self closing fire door was not 06/02/06 completely closing. Fire doors must be checked on a regular basis. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP33 Good Practice Recommendations It is recommended that the home that each resident is consulted on their choice as to whether they like the piped music being played through the home and if so what choice of music they would prefer. Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Toray Pines DS0000002558.V282265.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!