CARE HOMES FOR OLDER PEOPLE
Torr Home For The Blind The Drive Hartley Plymouth Devon PL3 5SY Lead Inspector
Megan Walker Unannounced Inspection 15th February 2006 12:30 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 Torr Home For The Blind DS0000003514.V283056.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. Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Torr Home For The Blind Address The Drive Hartley Plymouth Devon PL3 5SY 01752 771710 01752 782300 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) Devonport & Western Counties Association for Promoting the General Welfare of the Blind Mrs Joan Collins Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Sensory Impairment over 65 years of age of places (40) Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Age 60 yrs One named individual under 65 years Date of last inspection 23rd June 2005 Brief Description of the Service: Torr Home For The Blind is a large care home developed in 1926 from a former large country house and is located in Hartley, Plymouth. The home is on a bus route and is near Mutley Plain shops and amenities. The home is able to accommodate up to forty service users. Its primary role is to provide care for service users who have sight impairment or total sight loss. The home also provides care for service users who require personal care and accommodation due to old age and/or infirmity. Additionally the home offers Respite Care for older people to have a short break; Convalescent Care for older people recuperating from hospital admission; and Day Care three days per week for older people living in the local community. The home does not provide Intermediate Care, and it is not registered to provide nursing care. Torr Home For The Blind DS0000003514.V283056.R01.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 on Wednesday 15th February 2006 between 12h30 and 16h45. Part of the time was spent talking with Mrs Joan Collins the Registered Manager, and part of the of the inspection was divided between talking to other staff, residents in the home (permanent and on respite), people attending for day care, and visitors. Six people spoken to offered an opinion about the home and its provision of care, and two staff members about working in the home. Individual Care Plans and other records were looked at, and there was a brief tour of the inside of the premises. During the afternoon the Activities Coordinator was observed playing a “Trivial Pursuits” style quiz with residents and day care attendees who wished to join in; the hairdresser was at the home for the day and was doing hair for both residents and day care attendees; and the monthly Trust Committee was held in the building during the afternoon of this inspection. The home is currently applying for a variation of its registration to permit it to provide accommodation for up to forty-one residents. It aims ultimately to apply to the Commission for a registration of up to forty-four residents by the end of 2006. It is planned that two rooms would be kept solely for the use of people on respite care. On the day of this inspection the home had thirty-nine permanent residents, one person staying for respite care, and five people attending the day care service. The Commission for Social Care Inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. As a consequence of this inspection there are four Requirements and three “Good Practice Recommendations”. What the service does well:
Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 6 The home aims to offer a “country house hotel” style of care to its residents. Each of the residents and visitors spoken complimented the staff and their commitment to meeting individual needs. The Registered Manager has endeavoured over the past three years to bring about change in a timely manner without rushing staff and losing their trust and confidence. There have been a number of significant practice methods introduced to break away from the more institutional style of care provided in the past. The Registered Manager and the home’s staff have achieved this as well as striving to meet the National Minimum Standards. Staff are provided with paid breaks and meals during their shifts. What has improved since the last inspection? What they could do better:
A resident who has recently moved into the home stated that she had experienced difficulties with her clothes being muddled when they went to the laundry. She had also lost some clothing and on several occasions been returned items she had identified as not being hers. Comments were received from residents about food all arriving at the same time, i.e., the main course, pudding and a cup of tea. The Deputy Manager confirmed that this was the case for people eating in their rooms although she was surprised about those eating in the dining room. It was agreed that staff would be asked to ensure that residents were allowed to eat their meals in a relaxed manner, without feeling that they were being rushed from one course to the next.
Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 7 There were discrepancies between people attending for day care and those who were residents about choice of meals. From the different conversations it would seem that newcomers to the home are not made fully aware of the options available at mealtimes. One communal area at the rear of the building smelt strongly of cigarette smoke. A bedroom in this area had the door open and the room smelt of stale tobacco. 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. Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 8 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 Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 9 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 Prospective residents are assessed before coming into the home. Intermediate care is not provided by the home. EVIDENCE: Samples of Individual Care Files for residents who have moved into the home since the last inspection were seen. Each file contained a Pre- Assessment although the most recent were more detailed as a new Pre-Assessment Form devised by the Deputy Manager was in use. There were also Assessments and Care Plans compiled by Local Authority Social Workers and/or from other care homes. Information about the individual including a Family history and Client history (when the information was available), and Medical history was seen on each file. On admission there was a GP diagnosis and a list of all current medication for each individual at that time. There was also an Inventory of all clothing, furniture and miscellaneous items brought in by the resdient. For those able to self-medicate, the files had disclaimer forms signed by the individual. Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 10 There was no evidence on any of the files seen that prospective residents had received written confirmation that the home could meet their assessed needs. Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 11 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): 10, 11 Residents’ dignity is respected most of the time. Residents can be assured that staff will endeavour to meet their last wishes. EVIDENCE: A resident who moved into the home recently stated that she had experienced difficulties with her clothes being muddled when they went to the laundry. She stated that she had lost some clothing and on several occasions been returned items she had previously informed staff as not being hers. Each of the Individual Care Plans seen had details of preferred funeral directors. The Registered Manager stated that new residents are asked at the earliest possible time after moving into the home for their preferences and wishes when they are dying and after death. She also stated that as far as it is possible, residents are kept at the home, if that is their wish, during their last stages of life. This is achieved with the consent of the individual’s GP and support of District Nurses. If required, the home will employ extra staff for that period of time. The home does not currently provide palliative care for individuals who are staying for short periods of either respite or convalescence.
Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 12 Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Residents are encouraged to maintain their religious practices if they so choose. EVIDENCE: At the time of this inspection all the residents were white and of British nationality. They were all of a Christian faith, predominantly Protestant, Church of England denomination, or Catholic. Residents spoken to stated that Morning Prayers for residents are held daily in the dining room. The Deputy Manager stated that the Catholic Priest visits to give Holy Communion and there was evidence of the “Host” in the Reception hall. She also confirmed that other local vicars and priests visit. Residents are encouraged to continue attending their church for as long as it is feasible. In some cases the churches arrange transport to collect and return residents wishing to attend church. One resident spoken to confirmed that she still attends her “home” church regularly, and if she informs the home she may be late, her lunch will be kept back for her. Comments were received from some residents about food all arriving at the same time, i.e., the main course, pudding and a cup of tea. They also described feeling rushed through their meals.
Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 14 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): 17 Residents’ legal rights are protected. EVIDENCE: The Registered Manager confirmed that all residents are on the Electoral Register. If they wish to vote the home enables this with provision of taxis and using its own minibus to transport residents to the polling station. Residents are encouraged to use advocacy services such as Age Concern or solicitors. The Registered Manager stated that the home “is aware of the fine line” that can sometimes require independent advice and/or representation on behalf of a resident. Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 15 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, 26 The home has a comprehensive plan of maintenance and refurbishment to ensure a well-kept and safe environment for all residents. One area of the home had offensive smells. EVIDENCE: Since the last inspection all the door locks have been changed to thumbnail style locks that are accessible in case of emergency from the outside. The maintenance report showed this had been completed by the 18th January 2006. A resident spoken to commented that that her lock had been changed. The Minutes seen of a meeting of the Maintenance Team/Design Development/Property Refurbishment groups on the 8th February 2006 confirmed plans to remove the “stall” toilets. There were also other plans to convert the Committee Room into two bedrooms, move the laundry, replace the bathrooms, and to provide sluices on each floor. A corridor at the rear of the home smelt strongly of cigarette smoke. In this same part of the home a resident’s bedroom door was open and on entering the room it had a lingering tobacco odour.
Torr Home For The Blind DS0000003514.V283056.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): These standards were inspected on the previous inspection. EVIDENCE: Torr Home For The Blind DS0000003514.V283056.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): 33, 36 The home is run in the best interests of the residents by staff that are appropriately supervised. EVIDENCE: The Registered Manager stated that regular Residents’ meetings are held to ensure that no changes are made without residents being fully involved. She explained that, for example, there is currently a proposal from staff to change times of meals and this will be taken to a Residents’ Meeting in the near future. The Registered Manager has compiled a questionnaire seeking residents’ views and this was seen during this inspection. It was agreed that this would extended to include families and/or representatives of residents, anyone using the facilities of the home such as respite care or day care, staff, and anyone coming into the home regularly including the hairdresser, vicars, GPs and District Nurses.
Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 18 The Registered Manager is planning to introduce a system of formal supervision in the near future. She explained that Senior Staff are already aware of this and it is to be discussed at the next care staff meeting. The Registered Manager intends to delegate responsibility to Duty Officers to be supervisors for groups of care assistants, and she in turn will supervise the Duty Officers. The Registered Manager stated that in the first instance she only wants to introduce supervision for care staff although once it is up and running, she would look to introducing it with the Kitchen, Ancillary and Maintenance staff. The Registered Manager is aiming for supervision for each member of staff every six to eight weeks, and there will be an annual appraisal for each staff member twelve months (approximately) after this has started. At present the Registered Manager holds staff meetings bi-monthly for separate groups of staff, i.e. senior staff, day carers, night carers, ancillary staff and kitchen staff. These are all minuted and examples of minutes were seen. At the time of this inspection the home employed fifty-four members of staff, including the Registered Manager. Torr Home For The Blind DS0000003514.V283056.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 X 8 X 9 X 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X X Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP26 OP15 OP33 Regulation 16 (2k) 12 (3) 24 Requirement The home must be kept free of offensive smells. Staff must ensure that residents are allowed to eat their meals without feeling hurried. A quality assurance system must be developed for the home and must be extended to include health and social care professionals and other stakeholders to establish their level of satisfaction with the care services being provided in the home. This requirement has been partially met since the last inspection. The results of all the surveys undertaken must be published and available to prospective service users and interested parties. A copy must be provided to the Commission. A system of formal supervision must be developed for staff and the Registered Manager at the home. A formal recorded staff supervision system must be set up whereby staff receive
DS0000003514.V283056.R01.S.doc Timescale for action 28/02/06 28/02/06 30/04/06 4. OP36 18 30/04/06 Torr Home For The Blind Version 5.1 Page 21 supervision at least six times a year. This requirement has been partially met since the last inspection. 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. Refer to Standard OP10 OP15 OP21 Good Practice Recommendations Staff should ensure that residents have their own clothes returned from the laundry. Staff should ensure that residents are aware that they have a choice of meals and may have an alternative if they so wish. Stall like toilets should be replaced with toilets that offer increased privacy. The home intends to meet this recommendation by early summer 2006. Existing bedroom door locks should be lockable from the inside of the bedroom to ensure privacy if required. This recommendation was met by 18/01/2006. 4. OP24 Torr Home For The Blind DS0000003514.V283056.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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