Inspection on 16/03/06 for Torpoint Nursing Centre

This inspection was carried out on 16th March 2006.

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

Torpoint Nursing Centre 10/01/07

Torpoint Nursing Centre 06/09/05

Torpoint Nursing Centre 12/08/04

Torpoint Nursing Centre 15/04/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

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 Torpoint Nursing Centre Vicarage Road Torpoint Cornwall PL11 2BW Lead Inspector Philippa Cutting Unannounced Inspection 16th March 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 Torpoint Nursing Centre DS0000009252.V276194.R02.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. Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Torpoint Nursing Centre Address Vicarage Road Torpoint Cornwall PL11 2BW 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) 01752 813677 01752 816323 Torcare Limited Mrs Elizabeth Margaret Fourniss Care Home 57 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (57), Physical disability (27), Terminally ill (27) Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Service users to include up to 57 adults of old age (OP) Service users to include up to 27 adults with a physical disability (PD). Service users to include up to 27 adults with a terminal illness (TI) some of whom may have nursing needs. Service users to include up to 30 adults aged over 65 years with a mental illness (MD(E)). Service users to include up to 30 adults aged over 65 years with dementia (DE(E)). Total number of service users not to exceed a maximum of 57. Date of last inspection 6th September 2005 Brief Description of the Service: Torpoint Nursing Centre is one of two establishments owned by Torcare Limited. It provides nursing care for up to 57 people needing care and accommodation by reason of old age, some of who may be terminally ill, have a physical disability or be suffering from dementia or other mental disorder. Accommodation is provided mainly in single rooms, most of which are en suite. Although the home is divided in four areas these interlink and people can spend time in different parts of the home if this is to their advantage. There are however key pads at strategic points to safeguard people who might wander into an unsafe zone. The home is situated in the centre of Torpoint, accessible to shops and other facilities in the town. Outings are organised to take advantage of these as often as possible. Service users are encouraged to use the garden and patios where seating is provided when the weather is suitable. The home organises regular functions during the year to which family & friends are invited, regular contact being an important part of a persons care for the home. The home involves relatives of both past and present service users in discussing and reviewing the homes performance to measure how well it attains the standards & criteria that it has set for itself. Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place during the week between 9.45am & 4.30pm. The inspector spoke to staff and service users. Relatives were asked for their views although there were not many in the home on this particular occasion. A sample of service users’ and staff records were inspected. Records required by statute were perused and the premises toured. The atmosphere in the home was quiet and quite a few service users seemed sleepy. This was discussed with the matron. She said there were vacancies as there had been a number of deaths recently and the home had lost some of the more active or mobile service users. In general it was acknowledged that many of the service users are now all older and increasingly frail. Staff interaction is still effective but lower key when service users are resting. The overall impression was of a caring establishment that looks after some very frail and, in some cases, demanding people. It takes note of comments by service users, relatives and staff and reviews its practice and policies regularly What the service does well: What has improved since the last inspection? A review of the home’s induction programme has identified a need for the present system to be further upgraded. This has just started and is involving input from the nursing staff. Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 6 The self-audits by the different wings have proved to be an opportunity for staff to look at practices critically and make suggestions for improvement or change. The occupational therapy team are now starting to add their aims to care plans. 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. Torpoint Nursing Centre DS0000009252.V276194.R02.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 Torpoint Nursing Centre DS0000009252.V276194.R02.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): 3,4,5 Views expressed by a number of service users & relatives showed that they had made a positive choice by selecting Torcare and that the home had sought sufficient information before a placement. The care provided meets peoples’ needs. EVIDENCE: The matron visits prospective service users to gain essential information from all those concerned with their care. This is converted into an immediate care plan on admission, which is then reviewed as the service user settles. The care plan is updated as needed. Staff have designated specialities within the home, which are supplemented by specialist input from other professions ancillary to medicine as required. New service users are invited to visit the home but in reality many service users are too frail and this is usually delegated to relatives to make the choice. Torpoint Nursing Centre DS0000009252.V276194.R02.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): 7,8,10 Service users’ needs are assessed and set out in individual care plans that are regularly reviewed and used by all care staff. The daily entries would be improved by ensuring that they include social and emotional comment as well as functional events. Service users are treated with kindness and respect. The staff assist people who can present with difficult problems and behaviours, with tact and diplomacy in order to retain their (the service users) dignity. EVIDENCE: Care plans are prepared for each service user. The home has been trialling pre printed care plans. These have the basic care aims for mainly personal care. There is scope to add additional goals and aims or supplement those that are printed. So far they appear to be satisfactory but it is important to ensure that staff do continue to add additional information to keep the plans pertinent. The Occupational Therapy staff said that they were now starting to add their aims to the care plans. Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 10 All staff contribute to the daily notes. Some of the entries sampled were losing the social and psychological input that has been commended on previous inspections and are reverting to functional entries. It would be a pity to lose this. There was evidence that care plans are reviewed monthly. The home has also started a pilot scheme whereby the notes of service users who remain stable are not updated on a daily basis but a weekly summary is made. Monthly reviews are continuing for these people and if there has been any significant event during the week this is added at the time. The inspector felt that for these people the weekly records should be more of a résumé of the week and not just an entry for the day of recording. There was little evidence that service users or relatives are signing care plans to show their acknowledgement and accord with them. As the matron said she felt that relatives did not quite understand why they were asked to do this, the inspector suggested that the wording needed revising. All medication issues remain the responsibility of the trained staff with the home continuing its policy of minimal medication for service users as far as possible. Torpoint Nursing Centre DS0000009252.V276194.R02.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): 12,13,14,15 Staff pay particular attention to service users’ social needs and provide stimulation in the form of company, conversation and activities. Whilst there are dedicated staff who undertake this role specifically, all care staff assume responsibility for providing quality time with service users. Families and friends are encouraged to remain in contact with their relatives. Staff provide advice and support for them as well as the service users. Service users’ nutrition is well provided according to their need and preference. EVIDENCE: The occupational therapy team work with service users daily, including weekends. They arrange various activities more on a one:one basis rather than as group sessions - although these may be organised as well. The home plans regular events, usually to celebrate occasions such as Easter, summertime etc. with staff and relatives being included as well as the service users. Opportunities to go out, either shopping locally, or a trip in the home’s bus etc are provided. The staff with whom the inspector spoke showed a good knowledge of people’s individual needs and circumstances so they were able not only to respond Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 12 appropriately but were aware of a service user’s previous life or experiences and could thereby share conversations that sometimes seemed muddled. Families and friends can visit as they wish. On the day of this inspection there were no spouses spending the day with their partner. Sharing time with one’s husband or wife in the home can be a regular occurrence. Meals are presented in a way that is easiest for the service user to manage. For some this may mean meals to be cut up, for others sandwich and finger food is preferable. Kitchen staff are flexible and responsive to need. Meals are served in different settings, again according to individual need. An environment where the social setting for a meal prevails is provided for those who benefit from this whilst a quieter area, for people who require help, is arranged. The home has a trolley shop that visits each unit. The inspector noted that staff chose sweets and treats on behalf of service users (where they were unable to do this for themselves), which showed thoughtfulness. Torpoint Nursing Centre DS0000009252.V276194.R02.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): 16,18 Awareness of vulnerable service users’ needs is regularly updated through training for staff. Any complaints are taken seriously. EVIDENCE: The home’s complaints procedure is displayed at various points in the home. It is likely that many of the service users would be unable to initiate a complaint on their own behalf but staff all felt that for those people, their behaviour would show that something was amiss. Staff receive regular training and updates relating to the prevention of abuse (PoVA). All staff are checked re their suitability to work with vulnerable adults before starting work. Torpoint Nursing Centre DS0000009252.V276194.R02.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): 19,20,21,22,23,24,25 Torcare provides a well kept environment that is maintained in a satisfactory manner to meet the needs of service users. Service users’ rooms are personalised and contain the equipment needed to provide high quality care. Plans are being prepared to change two rooms currently in multiple occupancy. EVIDENCE: The home is well maintained and kept decorated to a good standard. The communal areas & corridors where new carpets have been laid are attractive because – in the inspector’s view - the contrast that is provided helps with service users’ orientation. A new conservatory has been built to provide additional sitting space on the ground floor. It has been designed so that it can link two areas, be accessible to one area or the other, or provide a private space. Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 15 Plans are being prepared to change the rooms currently shared by three service users. The inspector felt that the signs on these doors (Ward 1, Ward 2 etc) should be removed as their institutional impression now outweighs their historical interest. There are adequate numbers of toilets and baths in the home but it appeared that not all are in use. The matron agreed that some were not used, as service users did not like the raised baths. There are thoughts of converting one to a shower room. A variety of furnishings and equipment in the home is available to suit need. Staff are versed in the use of hoists and specialist items. Walking aids need to be checked, as some frames needed new ferrules because the metal ends had protruded through the rubber. Service users’ rooms were personalised to a greater or lesser degree according to personal preference. A number of service users are being nursed on mattresses on the floor. Where this has occurred families have been consulted, following an assessment of the risk of alternatives. The reasons have been documented. The home was seen to be clean and tidy. Odour problems were well controlled; the home has an efficient housekeeping staff as well as carers. The laundry was not inspected on this occasion. There is a greenhouse in the front of the home, which is available for staff who wish to smoke. If this is its purpose, it might be better sited away from the entrance from the point of view of first impressions. Torpoint Nursing Centre DS0000009252.V276194.R02.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): 27,28,29,30 The suitability of staff and their training needs is afforded a high priority. Procedures are in place to provide a good staff balance in all disciplines so that service users’ needs are met both by number and skill mix. EVIDENCE: The staff group are recruited following a full application and interview, with written references & statutory checks being taken up. Trained nurses and care staff work together in sufficient numbers to provide care for service users. They are supplemented by catering, housekeeping and maintenance staff. The nursing staff have specialities – such as tissue viability, infection control and medication etc – which keeps the home’s knowledge base updated. One member of staff has the responsibility for reviewing training needs and arranging appropriate sessions for all staff. As a result of a recent review the induction course for carers is being revised and amplified. The home has a good record for National Vocational Qualifications training with more than 50 of carers having either attained or being enrolled for this. Training is regarded as a priority by the home and staff with whom the inspector spoke were enthusiastic about the courses and training that were available. Mandatory training is repeated annually and consideration will be given to any other relevant courses that interest staff. Torpoint Nursing Centre DS0000009252.V276194.R02.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): 31,32,33,35,36,37,38 This home has achieved a good standard of open management and administration, which benefits service users, staff and relatives. Importantly it demonstrated that it does not stand still in that systems are reviewed and improved with new ideas being sought and implemented. The safety of all people with in the building is considered. EVIDENCE: The registered manager is a registered nurse with significant experience of caring for elderly people with mental health & problems of dementia. The home’s matron, who has now completed her registered manager’s award and deputy matron, support her. The atmosphere within the home is good. Interaction between families and staff is encouraged with a representative committee who visit the home to assist with quality audits of the services provided. The different units are, in Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 18 turn, involved in a self-audit programme, a copy of which is forwarded to the Commission for Social Care Inspection. The matron said the staff had been nervous of this prospect initially but had actually found the opportunity helpful and they had made some positive comments for action. The home prefers not to involve itself with service users’ money but has an arrangement whereby any necessities needed by service users are either supplied by the family or supplied & billed. Fees & contracts are handled by one of the home’s administration staff who is available to answer any queries families may have. Staff appraisals and supervision have been established and take place regularly. The records required by statute are well kept. All accidents, falls or events are recorded and reviewed by the matron prior to being filed. Any points that need addressing are highlighted and dealt with. The work practices within the home promote health & safety with moving and handling techniques in evidence; first aid & fire training etc taking place and being recorded. Torpoint Nursing Centre DS0000009252.V276194.R02.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 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 3 3 Torpoint Nursing Centre DS0000009252.V276194.R02.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. Standard Regulation Requirement Timescale for action 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 3 4 5 6 Refer to Standard OP7 OP7 OP8 OP19 OP19 OP22 Good Practice Recommendations Service users, or a relative, should be asked to read and sign care plans to show their understanding and agreement with the care planned. If care plans are written up on a weekly basis, rather than daily, the entries should comprise a résumé of that person’s week and not just an entry for the day. Recording comments about a person’s social and emotional welfare as well as their functional and physical health would enhance entries in the care plans. The site of the greenhouse should be re considered according to its use. The ‘ward’ signs on service users’ room doors should be removed. Walking and mobility aids should be checked and worn parts replaced. Torpoint Nursing Centre DS0000009252.V276194.R02.S.doc Version 5.1 Page 21 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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