Inspection on 15/01/07 for Torkington House

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Torkington House 09/09/08

Torkington House 12/01/06

Torkington House 14/07/05

Torkington House 07/01/05

Torkington House 04/06/04

Torkington House 26/11/03

Torkington House 20/06/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Torkington House Creswick Road Acton London W3 9HF Lead Inspector Mrs Clare Henderson Roe Key Unannounced Inspection 15th January 2007 10:40 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 Torkington House DS0000027744.V326048.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. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Torkington House Address Creswick Road Acton London W3 9HF 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) 0208 992 5187 0208 992 5187 sharnbrook@greensleeves.org.uk Greensleeves Homes Trust Mr Chris Ghoorunsing Surnam Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 Brief Description of the Service: Torkington House was established in 1947 as a residential club for older people. It was later registered as a residential care home. The home is situated on a quiet street in Acton. There are no shops or services in the immediate vicinity, however Acton High Street is accessible by bus or car. The property is a large attractive detached Edwardian house, dating from 1899. The home had an extension built in recent times, and the accommodation provision throughout is of a good standard. The home is registered to provide personal care for thirty-two older people. Torkington House is owned and managed by Greensleeves Home Trust. The home has a Registered Manager and a Deputy Manager. The fees range from £465 to £525 per week. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 12 hours was spent on the inspection process. The Inspector carried out a tour of the home, and service user plans, medication records, staff records, financial records and maintenance & servicing records were viewed. 6 service users, 6 staff and 2 visitors were spoken with as part of the inspection process. The pre-inspection questionnaire and comment cards from service users, representatives/visitors and healthcare professionals have also been used to inform this report. What the service does well: The home is being effectively managed. Service users and their representatives are provided with information about the home and encouraged to visit prior to admission, allowing them to make an informed choice. Prospective service users are assessed prior to admission to ensure the home is able to meet their needs. Specialist care needs to include cultural and religious needs are being met. Service users are involved in the review of the service user plans and comprehensive review records are kept. Service users healthcare needs are met, and clear records of input from healthcare professionals are kept. CSCI comment cards completed by healthcare professionals indicated good care provision at the home. Staff care for service users in a courteous, gentle and professional manner, respecting their privacy and dignity. Service users religious and cultural needs are being met. Service users spoken with plus those who completed CSCI comment cards praised the home for the good standard of care they receive. Procedures and health care professional input for service users end of life care are in place, and service users can stay at the home during their final days if they so wish. The activity provision at the home is good, and service users are consulted regularly about their interests and asked for suggestions for activities and outings. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said they are made welcome at the home. Information regarding advocacy services is available in the home. The food provision is of a very good standard, offering variety and choice and catering for individual dietary needs. Particular mention was made on several of the CSCI service user comment cards about the excellent food provision and the chef is to be commended for this. Robust procedures are in place for the management of complaints and POVA. The home is being well maintained, providing service users with an attractive, good quality, homely environment to live in. The home is clean and fresh and there are good systems in place for infection control. The home is appropriately staffed to meet the service users needs. Robust systems are in place and being adhered to for staff recruitment. Overall the training provision in the home is good, to include NVQ in care and induction training, plus topics relevant to the diagnoses and needs of the service users. There are good systems in place for Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 6 quality assurance and for the management of any service users monies. Health & safety is being well managed in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The 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. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 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 Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives are provided with the information about the service, thus allowing them to make an informed choice about the home. Service users are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. Service users’ care needs, to include specialist needs, are identified to ensure that they are being met. Service users and their representatives are encouraged to visit the home prior to admission, thus giving them the opportunity to make an informed choice. EVIDENCE: The home has a Statement of Purpose and a Service User Guide, and these documents are updated following any relevant changes. The Registered Manager said that a copy of the documentation plus other relevant information is provided to anyone making enquiries regarding a placement at the home. Copies are also available in the reception area. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 9 A new pre-admission document has been devised and is in use. This is comprehensive and provides a good picture of prospective service users and their needs. Those viewed had been completed appropriately. The home is registered to accommodate service users over the age of 65 years. The Registered Manager is aware that the home is not registered to accommodate service users with a diagnosis of dementia. Where service users develop dementia a referral for review is made with a view to a plan of action being agreed for future management, which may in some cases involve a move to alternative suitable accommodation. As part of the pre-admission process the Registered Manager said that he ensures the home is able to meet the prospective service users religious and cultural care needs. For one service user, signage in their own language has been put up in the home, plus a list of relevant words and their meanings is available to staff. The service users own language is spoken by two members of staff, which aids communication. The Registered Manager said that representatives from the Church of England and Roman Catholic church attend regularly to bring communion to service users. Representatives from other religious groups also visit service users and several service users are taken by relatives to attend Sunday church services. Service users spoken with and comments received on the CSCI comment cards evidenced that service users and/or their representatives had been given the opportunity to visit the home prior to admission to make an informed decision as to whether they wished to live there. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 10 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 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the service user plans were well constructed, however updating of some information areas would provide a clear, current picture of service users needs. Good information regarding input from healthcare professionals is recorded, thus evidencing that each service users healthcare needs are being met. Medication management in the home is fair, but shortfalls identified could potentially pose a risk to service users. Staff care for service users in a gentle and professional manner, thus respecting their privacy and dignity. Systems are in place for end of life care, thus respecting service users wishes. EVIDENCE: The Inspector viewed a sample of service user plans. Overall these were well completed and there was evidence of monthly reviews involving each service user, which were comprehensive. However, in some instances where the condition of the service user had changed, this had not been reflected in the core care plan. There were also areas where information needed to be expanded, for example, for service users with continence care needs. Risk Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 11 assessments were in place for most risks identified, to include for service user outings, but had not been formulated for the risk of falls. Also, some of the moving & handling risk assessments needed expanding to clearly identify all the service users needs in this area and how they are to be met, for example, use of the bath hoist. The Registered Manager said that the service user plans would be reviewed and updated to reflect the service users current condition. Where service users have been identified as having specific healthcare needs they are referred to the GP and district nurses for treatment. This had been cross-referenced in the service user plan, and there were clear entries for each district nurse visit and what treatment had been carried out. One service user had a pressure sore, acquired in hospital, and the district nurses were managing this and specialist equipment had been provided. There was evidence of input from the Macmillan Nursing Team, the GP’s and other healthcare professionals, and a record of each visit is made. The medication management and recording was viewed. The home is using the Boots monitored dosage system (MDS). There are 7 GP practices providing medical care for service users accommodated at the home. It has so far proved difficult to arrange the medication orders to coincide from each practice so that the home can have medications for each service user commencing on the same day of the month, for a 28 day cycle. In some instances, medications for the same service user had differing start days. The current situation could pose a risk to service users, and staff are working diligently to prevent any errors occurring. It is strongly recommended that communication take place between the home, the GP practices and the dispensing chemist to streamline the system. Receipts, administration and disposal records had all been completed correctly, and there is a robust system in place for disposal of unwanted medication. Some service users are self-medicating, and risk assessments are in place for this. A lockable space is provided in each service users room and the risk assessment process includes ensuring each service user understands the importance of locking any medication away. Some prescription creams were being stored in the service users rooms and the need to store these in the medication trolley was discussed. Some service users were on medications where the dose varied, and this needed to be written up clearly on the medication administration record (MAR) to show the actual strength of each tablet and to state how many are to be given to make up each prescribed daily dose. Variable doses for service users on analgesia had been clearly identified, and where service users are always taking the same dose, the Inspector recommended that this be discussed with the GP and the prescription altered accordingly. Some discontinued medications had been printed on the MAR even though they had not been ordered for the month, and this was to be discussed with the dispensing chemist, to have these entries discontinued. For medications supplied in boxes the inspector recommended that the start date be written on each box in order to assist with stock checks. Most liquid medications had been dated when opened, with some omissions noted. One service user was on a controlled drug, being administered by the District Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 12 Nurse. Clear entries had been made in the CD register, with a member of staff from the home signing as witness to the administration. Entries had also been made in the District Nurses notes and the service user plan. The need to enter this on the MAR as good practice and record the days on which it is administered was discussed. Medications are securely stored in the home. The minimum/maximum/actual fridge temperatures are checked daily, and the need to ensure the thermometer is reset after every reading was discussed and addressed. The thermometer being used to record the room temperature was not clear, and the Registered Manager said that he would get a room thermometer so that the temperature could be accurately monitored. The room does get quite warm and it is important that this is checked daily. For two medications staff signatures were incorrectly entered, and this had already been identified by senior staff and checks made to ensure the medication had not been incorrectly administered. The Registered Manager said that the District Nurses would carry out any blood glucose monitoring for diabetic service users, and carries out any nursing tasks required by service users. The shortfalls identified in the management of medications should be easily addressed with the co-operation of the GPs and dispensing pharmacist. Staff were seen caring for service users in a gentle, courteous and professional manner. Service users spoken with plus those who completed CSCI comment cards expressed their satisfaction with the care provision at the home. Service users personal clothing is labelled and service users were well dressed to reflect their own individuality. Service users can bring in personal belongings to the home in line with fire safety. Policies for the care of the dying and care after death are in place. Information regarding the wishes of service users in respect of their end of life care was available, and some was to be expanded to ensure their wishes are clear. The home has input from the Macmillan Nursing Service and service users can stay in their own rooms for their final days if that is their wish. It was clear that the staff work hard to care sensitively for service users at each stage of their life at the home. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. The activity provision is varied and service users are consulted about their interests, thus ensuring individual wishes are catered for and respected. The home has an open visiting policy, thus encouraging service users to maintain contact with family and friends. Advocacy arrangements are in place, thus ensuring the service users rights and opinions are heard and respected. The food provision in the home is of a high standard, offering variety and choice, with menus tailored to meet the service users preferences. EVIDENCE: The home has an activities co-ordinator and it was clear that she is enthusiastic and enjoys her work. Information about service users individual interests is recorded in the core care plan. The activities co-ordinator said that she speaks with each new service user and gains a good picture of their hobbies and interests. Meetings are also held to discuss what activities and outings service users would be interested in, and trips are then planned. The activities co-ordinator keeps a daily record of all outings and activities and also of her meetings with service users. An activities programme is in place. On the day of inspection a quiz plus an exercise session took place. Service users are asked how they would like to celebrate their birthdays and the home works to Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 14 fulfil their wishes. Service users had expressed their satisfaction with the activities provision on the CSCI comment cards received, and also indicated that if they did not wish to join in activities then this is respected. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home. Service users can choose to receive visitors in one of the communal rooms or in their bedroom, whichever they prefer. Details of the Ealing Borough ‘First Voice’ advocacy service were clearly on display in the reception area. The kitchen was clean and tidy and all the records to include cleaning schedules, fridge/freezer/food cooking and delivery temperatures and stock rotation were up to date. There is a 3 week menu with choices, which is reviewed on a very regular basis so that the menu is varied. Records are kept of all service users meal options. The chef has a list of any service users food dislikes, and also of any specialist dietary requirements. This includes 2 service users with cultural dietary needs, which are being met. The chef explained that the food supplies are purchased from local producers where possible. There was a good supply of fresh, frozen, tinned and dry goods available. Service users are very happy with the food provision, with many positive statements included on the CSCI service users comment cards in relation to the food. The kitchen is quite small and old, but was being well managed. There are plans to extend the kitchen and appropriate arrangements are being made to ensure the continuation of satisfactory food provision for service users during the building works. Service users were seen partaking of their lunch and there was a social atmosphere in the dining room. The Inspector sampled the lunchtime meal on the first day of inspection and it was well presented and tasty. The chef is to be commended on the high standard of food provision in the home. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. There are robust procedures in place for the management of complaints and adult protection allegations, thus safeguarding service users. EVIDENCE: The home has a complaints procedure with timescales for completion of investigations, a copy of which is on display in the home. They have received 3 complaints since the last inspection, one of which is ongoing. Complaints are being appropriately managed at the home. Since the last inspection there has been one protection of vulnerable adults (POVA) allegation. This was appropriately reported, investigated and addressed. Staff had received POVA training and those spoken with were clear to report any concerns and understood the ‘Whistle Blowing’ procedures. The home has POVA procedures in place, and the Registered Manager said that they follow the Ealing Borough safeguarding adult procedures also. Policies and procedures are in place for financial arrangements, gifts to staff, management of aggression and restraint. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 16 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, 20, 21, 22, 24 & 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 being well maintained, thus providing a clean and homely environment for service users to live in. Infection control within the home is good, thus safeguarding service users. EVIDENCE: The Inspector carried out a tour of the home. The home is being maintained to a good standard throughout. A book is kept for recording all redecoration, refurbishment and building works carried out, with dates of completion. There was evidence of inspections from the Fire Safety Officer and Environmental Health Officer, and action had been taken to address any findings. There are two sitting rooms and one dining room, providing a good amount of communal space for service users to utilise. There is a well-maintained Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 17 enclosed garden, with a decked area and a patio area for service users to walk and sit out in. The home has assisted bath and shower facilities available, and the most recently built bedrooms have en suites with toilet, wash hand basin and assisted shower facilities therein. Toilet facilities are situated near to communal areas, and 22 of the rooms have en suite facilities. There are handrails along each corridor and also grab rails in the toilet facilities. Where service users require specialist equipment, for example, pressure relieving equipment, then this is discussed and purchased. If there is a specific nursing need, then equipment can be provided by the District Nurses. Service users have equipment such as walking frames to meet their assessed needs. The home has ‘stand on’ scales, and the possibility of investing in a weighing scale seat so that service users who find it difficult or impossible to stand for any length of time can have their weight monitored was discussed. The Inspector viewed several bedrooms and these were personalised and had a nice outlook. The bedrooms are appropriately furnished to meet the service users needs. Service users can bring in some items of furniture in line with fire safety. There is a call bell system throughout the home. Each bedroom has a lockable drawer facility for any valuables or medications. It was noted that the locks on the bedroom doors in the ‘old wing’ are old style locks, and there is a risk of service users getting locked in their rooms and staff being unable to gain access in an emergency. The Registered Manager explained that these doors were due for replacement in line with fire safety guidance, and this should take place in the next few months at which time suitable locks would also be provided. It was agreed that in the interim period a risk assessment would be carried out and each service user given a clear explanation regarding the locks, in order to minimise any risk to service users. There is a very homely atmosphere throughout. The home was clean and tidy throughout and smelled fresh. Personal laundry plus some other items are laundered at the home, with bed linen and towels being contracted out. Systems are in place for the storage laundry, to include any soiled items, prior to collection. There was a good supply of all linens and towels available in the laundry room. There is one washer with a sluice programme for disinfection purposes, plus one tumble dryer. Protective clothing to include aprons and gloves are available in the home, and good practice guidance plus policies and procedures for infection control are available. There is a risk assessment in place for legionella and water testing is carried out 3 monthly. Clinical waste collections are made weekly from the home. There are good systems for infection control being practiced in the home and staff had received training in this area. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to ensure that the needs of the service users can be met. Systems for vetting and recruitment practices are in place and protect service users. There is an ongoing training programme, providing staff with the knowledge and skills to meet the needs of service users. EVIDENCE: On the day of inspection the home was appropriately staffed to meet the needs of the service users. Care staff were available to care for service users, and domestic, kitchen and ancillary staff are employed in such numbers to meet the needs of the service users and the home in general. Clear rosters are maintained to reflect the staffing of the home. The Registered Manager reported that 65 of care staff are qualified to NVQ level 2 in care or above. Staff spoken with had a good knowledge of their area of work. The Inspector viewed 3 staff employment files for recently employed staff. These contained all the information required under Schedule 2 of the Care Home Regulations 2001. A new health questionnaire form has recently been introduced for staff, which is comprehensive. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 19 All new care staff undergo induction training. For any new staff without an NVQ in care qualification, a full induction using the new Skills for Care common induction standards booklet is undertaken, copies of which were viewed at the home. Copies of the previous induction training were seen, and this too followed a full induction process. There is a training matrix evidencing training undertaken and planned. Staff spoken with said that they had undertaken training in various topics relevant to the service users needs and to their specific area of work. Copies of training certificates were seen in the staff files viewed. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 20 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the experience to manage the home, and does so effectively. Systems for quality assurance are in place, thus providing an ongoing process of system and practice review. Service users monies are well managed and securely stored. Overall systems for the management of health and safety throughout the home are good, thus safeguarding service users, staff and visitors. EVIDENCE: The Registered Manager is a second level registered nurse with a certificate in management. He has experience working in Social Services and in the Elderly Care Sector. He has undertaken periodic training in topics relevant to his job. The Registered Manager has been in post for 12 years. The Registered Manager said that he has enrolled to undertake the Registered Managers Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 21 Award, NVQ level 4 during 2007. The home has a Deputy Manager and it is clear that the management of the home work well as a team. Staff spoken with said that the managers are approachable and supportive, and the Inspector also witnessed this during the inspection. The home has a Quality Manual, which is comprehensive and covers all the information required under each National Minimum Standard for Older People. Annual satisfaction surveys are carried out for service users, representatives and stakeholders, and the need to collate and publish the results of this was discussed. Staff meetings and service user meetings each take place every 3 months, with minutes being taken. Suggestions made are followed up, for example, the introduction of recycling for the home. A document and system review form for 2006 was viewed, and this included dates for equipment and system servicing, audits, meetings, staff supervision, care plan reviews, medication audits and fire drills, giving a very clear plan for quality assurance. The home holds some monies for service users. There is an individual wallet and record book for each service user for whom monies are held. Clear entries are made for all income and expenditure and receipts are retained. Policies and procedures for the management of service users monies are in place. Three sets of service users monies were checked, and one slight discrepancy was identified and addressed. The home has a safe facility. Servicing and maintenance records were sampled and those viewed were up to date. Information provided on the pre-inspection questionnaire evidenced that the servicing of equipment and systems was up to date. Risk assessments are in place for equipment and safe working practices, and new risk assessments are completed for any areas of risk noted, for example, if the dishwasher breaks down. The date on which the risk is resolved is clearly recorded. Some staff had not undergone an annual update for some areas of health & safety training, for example, moving & handling and fire safety, in 2006. The importance of ensuring such training updates are undertaken at the required intervals was discussed with the Registered Manager. Several staff had undertaken First Aid training. Fire drills had been undertaken on a regular basis and a clear record kept, to include an evacuation drill for staff and service users. A fire risk assessment had been carried out in June 2006 and there was evidence of action having been taken and ongoing to address any shortfalls identified. Hot water temperature checks are done monthly and the records showed that action is taken at the time to rectify any problems identified. Overall health & safety is being well managed at the home. Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 22 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 23 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 15(2) Requirement Each service user plan must be kept up to date and provide an accurate picture of the service users current condition and needs. All assessments must be completed in full and clearly identify the risks and how these are to be minimised. Risk assessments for falls must be in place for all service users. When a variable dose of a medication is prescribed, the strength of tablet must be clearly recorded and the instructions for administration must include the number of tablets to be given to make up the required dose. Prescriptions creams must be securely stored. All liquid medications must be dated when opened. Where a bedroom door does not have a suitable lock to allow staff access in an emergency, a risk assessment must be carried out and action taken to minimise the risk until the doors and locks are replaced. DS0000027744.V326048.R01.S.doc Timescale for action 01/02/07 2. OP7 13(4)(5) 01/02/07 3. OP9 13(2) 19/01/07 4. 5. 6. OP9 OP9 OP24 13(2) 13(2) 13(4) 16/01/07 16/01/07 01/02/07 Torkington House Version 5.2 Page 24 7. OP38 13(4)(5) There must be evidence that all staff have undertaken training and updates to include moving & handling and fire safety at the required intervals. 16/02/07 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. 2. Refer to Standard OP7 OP9 Good Practice Recommendations It is strongly recommended that all entries made in the service user plans be signed and dated. It is strongly recommended that the home liaise with the GP’s and with the dispensing chemist in order to streamline the start dates for each 28 day cycle of medication so that they commence on the same day for each service user. It is strongly recommended that the date of opening be written on boxed medication to aid with stock checks and control. It is strongly recommended that when a medication is discontinued then the dispensing pharmacist no longer print this medication on the MAR. The room temperature in the medications room should be accurately monitored to ensure it does not exceed safe storage temperature for medications. It is strongly recommended that the home invest in weighing scales that allow for all service users weight to be monitored at appropriate intervals. 3. 4. 5. 6. OP9 OP9 OP9 OP22 Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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. Extracts may not be used or reproduced without the express permission of CSCI Torkington House DS0000027744.V326048.R01.S.doc Version 5.2 Page 26 - 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. 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