Inspection on 11/03/09 for Torrwood Care Centre

This inspection was carried out on 11th March 2009.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Torrwood Care Centre Gilbert Scott Road South Horrington Village Wells Somerset BA5 3BW Lead Inspector Justine Button Unannounced Inspection 10:00 11 and 12 March 2009 th th 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 Torrwood Care Centre DS0000072587.V374674.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. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Torrwood Care Centre Address Gilbert Scott Road South Horrington Village Wells Somerset BA5 3BW 01749 675533 TBC torrwood@schealthcare.co.uk 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) Southern Cross OpCo Limited Margaret Ndanga Care Home 82 Category(ies) of Dementia (82), Mental disorder, excluding registration, with number learning disability or dementia (1), Old age, not of places falling within any other category (82) Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Mental disorder (Code MD) - maximum of 1 place The maximum number of service users who can be accommodated is 82. The MD category is in place solely for one identified person with mental health needs as their primary care need, who is transferring from a care home which is closing as part of the opening of Torrwood. This category will lapse when this person ceases to be accommodated at Torrwood. 2. 3. Date of last inspectionnew service Brief Description of the Service: Torrwood is a new service opened in October 2008. The home is a result of an amalgamation of two services Wookey Hole Nursing Home and Cathedral View Nursing Home. Initially all people moved into Torrwood from these services. Torrwood is a new purpose built home in South Horrington surrounded by countryside, situated 3 miles from the cathedral city of Wells. The home has been developed over three floors. The ground floor comprises of the reception area, laundry and catering departments. The ground floor also contains the managers office and staff training and rest room. The first and second floors are accessible by a lift. The first and second floors contain accommodation for people living at the home. One floor caters for people who have dementia and the other floor for people who have general nursing needs. Both of the floors contain a range of communal space including dining facilities and lounge areas. All the bedrooms meet the National minimum standards for space. All are ensuite some with shower facilities. The rooms vary in size dependant on the fees paid. In addition to the en-suite facilities each floor contains a range of accessible bathrooms and additional toilets. The home has a garden which is accessible from the floor which accommodates people who have dementia care needs. The garden is secure and accessible for those people who require the use of a wheelchair. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 5 During the inspection we were informed that the current fee levels are between £730 and £900 per week dependant on the size of the bedroom required. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This Key unannounced inspection was carried out over two days by one inspector. The Manager was available on the day of the inspection. The inspector would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. As previously stated the home is a result of the amalgamation of two services and as such this is the first inspection for this service. All people living at the previous homes moved to the new service, as did the majority of staff currently employed at Torrwood. Prior to the inspection we sent out a number of surveys for people living at the home. 14 of these were returned to us. Some people had been supported to complete the surveys by family or friends. In addition we have spoken to a number of visiting healthcare professionals to gain their views on the services provided at Torrwood. The home completed an Annual Quality Assurance Assessment (AQAA) prior to the inspection. Results from the surveys, feedback and AQAA have been used throughout the report. Records examined during the inspection were six care and support plans for people living at the home as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? This is the first inspection of this service. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 8 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. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 9 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 Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. The home will ensure that people are appropriately assessed before a placement is offered. All people living at the home have been provided with a copy of the terms and conditions of their stay. Trial visits are offered. EVIDENCE: Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 11 The home has developed a statement of purpose and information for people thinking of moving into the home. A copy of this information was viewed. This document provides all the necessary information and is supplemented with a range of photographs. The AQAA received prior to the inspection states that this information is also available on request in large print format and audio Cassette. Copies of these documents can be found in each bedroom. New placements at the home have been limited since the home was commissioned to ascertain that improvements have been made from the previous homes. Preadmission assessments were made by the home for the small number of people admitted who did not transfer from the old services. The documentation for the assessments were viewed and this contains all necessary information. This assessment will ensure that the home can meet the needs of the individual prior to moving in. In addition to the preadmission assessment the homes asks the individual (if possible) and or a family member to come to visit the home to ensure that all parties are happy for the placement to proceed. Assessments are also sought by the staff at the home from other health care professionals or social worker. The home provides each individual with the terms and conditions of their stay (contract). Some people who transferred from the “old” homes stated that they have yet to receive an updated contract although they did have a contract from the “old home”. The contract viewed clearly sets out the fees payable, payment terms, notice periods and any additional charges. Fees stated in the contract include any Registered Nurse Care Contribution (RNCC). This is a sum of money paid by the government for anyone with a nursing need. Fees do not include hairdressing, visitors meals, newspapers, alcohol, private treatments such as physiotherapy or chiropody, taxi fares, toiletries, dry cleaning and escort duties. A sum of money is paid to the home on admission to cover these costs. Invoices for these items are invoiced monthly and Notification is given when the monies are used up. The contract states that a trial period of four weeks is in place. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning process has improved since the move to Torrwood. Staff now need to ensure that these are consistently developed in all areas and for all individuals living at the home. The home is meeting the peoples health care needs although again this needs to be consistently delivered in all areas. Medication is on the whole well managed however the lateness of some drug rounds may place people at risk. EVIDENCE: The home was opened in November 2008 Consideration should be given to the fact that the home has only been opened for only six months and the Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 13 management and staff should be congratulated on the improvements made so far. Despite these improvements some areas require further developments and continued improvement. Four people were case tracked during the inspection and their care plans reviewed. An additional two care plans viewed but the care was not case tracked. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and or their representative. The majority contained a range of appropriate assessments and associated care plans. Some of the care plans were clear and detailed however some lacked clarity and did not give clear guidance to staff on how to meet the identified needs of the individual. For example, one care plan was viewed for one individual who had dementia. A range of assessments had been completed by staff. One of the assessments for nutrition had assessed the individual at high risk. No care plan however had been developed to identify how these needs would be met. This individual was also assessed at being at high risk of falling and had indeed fallen on several occasions. A care plan had been developed for this risk however the care plan did not link to the continence assessment and individuals need to use to the toilet. The continence care plan did not state how often the individual should be supported to access the toilet. Regular support to access the toilet may reduce the rate of falls. The falls care plan however did demonstrate that the GP had been involved in the care following the falls and that sedation had been reduced. It is well known that sedation can increase the risk and likelihood of increased falls. This individual also had a long-standing wound to the leg. A care plan had been developed for this however this did not contain and tracings or photographs. Tracings and photographs are tools used to assess the effectiveness of any treatment given and aid the nursing staff to ensure that the correct dressings are being used. The care plan for night care clearly stated the individual abilities with regard to their personal hygiene and how they liked the care to be given. This also clearly stated such things as what time the individual liked to go to bed. What time they like to get up. The plan clearly stated that the individual liked to have a cup of tea with milk and sugar before going to bed and first thing in the morning. This demonstrated a “person centred” approach to the care given at this time. The care plan for another individual was seen. This individual had poor mobility and as such was chair bound. People who sit in one position for long periods are at risk of developing pressure ulcers, sometimes called bed sores. The assessment detailed that this individual was at medium risk of developing such ulcers. During the course of the day this individual was not supported to Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 14 change position by staff. This could significantly increase the risk of pressure damage. The continence assessment and associated care plan stated that this individual should be supported to access the toilet at two hourly intervals. This was not seen to be completed on the day of the inspection. Other assessments and care plans for this individual were clear. The plans however could be more person centred for example stating what toiletries the individual liked to use. Has she got a perfume she likes to wear. Does the individual like to wear make up. Another care plan for an additional individual was viewed. This showed that this individual had pressure damage. The assessments and the care plans however were not consistent. One area of the plan stated that no dressing was required and yet other documentation showed that the wounds did require dressings. Tracings and photographs were in place for these wounds however these had not been completed for a period of two months. It was difficult to assess therefore if the wounds were improving and if the prescribed treatment was appropriate. The remaining plans for this individual were very clear and person centred clearly stating the individual likes dislikes and abilities. The plans stated that this individual was at risk of loosing weight and had indeed lost a small amount over recent months. The care plan for this area was very clear and stated the supplements and staff support the individual required in this area. Both the individual and the individuals relatives were spoken to during the inspection. The relative stated that they visit on a daily basis and confirmed that supplements were regularly given by staff. The individual also had difficulties with swallowing and required a sift diet. The relative stated that this was always available and was of a good quality. These discrepancies in the care planning process was discussed with the home manager at the end of the inspection visits. It was agreed that some staff had taken on board recent training on care planning more easily then others. It was agreed that the management would do additional work to ensure that all the care plans were completed in a consisting manner. It was clear from the care plans seen that staff had improved their communication with other health care professionals. Staff are now seeking the help and advise of GPs, Community Nurses, dieticians and speech and language therapists. Feedback from health care professional confirmed this. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The majority of the charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. The charts to record dietary intake need to be developed further. Currently these are just a tick list for main course and pudding. It would be good practise to actually specify how much of each course was eaten. This Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 15 could then be used by the nursing staff to assess if they require additional snacks or supplements were required. It was noted during the case tracking process that staff had supported individuals to meet personal hygiene needs including oral hygiene. A number of surveys were received in addition people living at the home were spoken to during the inspection. All the surveys returned stated that the staff were “excellent” and “I find the staff very warm and caring” “My mother always receives good care from the staff”, “I am very happy here. All of the staff are kind and I am well looked after. A significant number however stated that they felt the home was short staffed. Fourteen surveys were received. Ten of which in some way commented on what they feel is a lack of staffing numbers which was compromising the care and support that was being given. This was confirmed on the day of the inspection during discussions with both staff and people living at the home. (This is discussed in more detail in the outcome group for staffing). Staff were seen interacting kindly to people living at the home and were seen knocking on doors before entering. People living at the home spoken to during the inspection confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. The homes procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individuals bedrooms, had been marked with an expiry date the MAR chart had been signed to confirm that the creams had been applied as per the Prescription. The pre printed MAR charts are delivered by the pharmacy on a monthly basis. There may be occasions during the month that these have to be amended say for example when a GP visits and changes the dose required or introduces a new medication. When this occurs staff have to hand write the new drug onto the medication record. It is good practice that when this occurs the hand written entry is checked by another person to ensure it is accurate. This reduces the risk of drug errors. This had been completed. During one of the days of the inspection it was noted that Registered Nurse did not complete the morning medication round until 12:45. The lunchtime medication round commenced soon after this. This resulted in medication being given at incorrect intervals. The insufficient time between the drug rounds may have increased the level of the medication in the blood stream and thus compromised the health of the individuals living at the home. The delay in completing the morning medication round was mainly as a result of not having Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 16 enough staff on duty to attend to both the medication round and people’s care needs at the same time. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. There is a range of activities on offer at the home however some aspects of the environment could be developed to ensure that this range is increased. Visitors were seen to be visiting the home on the day of the inspection. All stated that they are made welcome at any time. Choices are available to people living at the home. The standard of food is good with mealtimes on the whole being a pleasant experience. Staffing levels may compromise this experience. Staff need to develop how they offer choices to people who have difficulty in expressing an opinion. EVIDENCE: The home currently employs two staff responsible for the organisation and delivery of activities. One staff member for the people who live on the floor Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 18 which caters for people with dementia and the other for people who have general nursing needs. Both of these staff members were previously employed at the two old services. Due to this both staff members have experience within the field of providing activities for the group of people currently living at the home. Both of the activities organisers were on duty on both days of the inspection. Activities were on offer on both days of the inspection. This included time for 1:1 social interactions for those people who did not or could not join in with any group events. Some people spoken to during the inspection stated that they would like to see the range of activities on offer extended. Two people stated that they would like to “go out more”. Research has shown that people who are living with dementia benefit from undertaking appropriate activities including everyday activities such as helping with the washing up or doing some gardening. It is disappointing therefore to see that some aspects of the design of the building did not take into account or cater for this aspect of people’s lives. For example the garden is secure and accessible however there are no raised flower beds which would enable people to undertake or join in with gardening. If raised flower beds were in place people who required the use of wheelchairs or had poor mobility would be more able to smell or touch flowers or plants. There are limited facilities to do domestic tasks such as cooking. At the previous home facilities were available to run a breakfast club. This was were a group of people were supported by the activities organiser to go to a small kitchen area and with the necessary support make their own breakfast items such a toast or a cup of tea. No dedicated space is available in the new home for this to continue. In addition there is no dedicated space for a reminiscence room or area nor for multi sensory equipment. At the previous home there was a small area that was set up as a pub/bar again this facility has been lost in the new build. It is hoped however that as the new home develops that these areas will be instated in one of the existing large lounge areas. Of the fourteen surveys received two people stated that they were not aware of any activities on offer at the home. The majority, nine in total stated that there were usually activities on offer. Signage is available throughout the dementia care floor. This is bright and clear and allows people to locate such facilities as toilets and bathrooms. Memory boxes are situated outside individual bedrooms. These boxes are filled with personal items, old photographs, war medals, knitting needles or other items that have meaning for the individual. This enables people to locate their individual bedrooms more easily. Staff stated that they had enjoyed helping people living at the home and/or their family in filling the boxes. In addition the bedroom doors are decorated, as one would expect to see a front door. The doors have knockers and letter boxes. The home has a dedicated hairdressing salon. This has been decorated and furnished to a good standard. At least two people spoken to during the inspection raised concerns with regard to the lack of televisions in their bedrooms. People stated that Southern Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 19 Cross Healthcare had stated that all the rooms would be furnished with a flat screen TV which would be able to receive a digital signal. To date these have not been provided despite on going assurances from the company that they would be. We viewed the meals in both areas of the home over the two days of the inspection. Everyone we spoke with said the food was very good or excellent. One resident said there is always a choice and if you don’t like that they will do you something else. This was confirmed in the surveys received. One relative visiting during the inspection stated that she felt the standard of food had was good especially the range of fresh vegetables which are available. The food served on both days of the inspection looked and smelt appealing with a range of vegetable available. A choice of meal was evident. A four week rolling menu has been developed including a cooked breakfast and a hot option in the evening. During the inspection it was found that a number of people required staff support at meal times. Staff were observed to sit down when they support people to eat. This allows staff to ensure that they have the time to spend with people during meals and ensures that meal times are a pleasant experience for all. This time also allows staff to monitor dietary intake more effectively which will promote the general health of people living at the home. It should be noted that the lunch time meal was not served until 14:00 hours on one day of the inspection. The meal is advertised as being served between 12:00 until 13:00hrs. The meal was ready and waiting for over an hour and half. The delay in serving the meal was due to a lack of staff being available to help in serving and supporting people with their food. Staff were still supporting people to undertake their personal hygiene until this time. A number of people had arrived at the dining room on time for their meal and so therefore were left sat at the table for excessive periods of time. No explanation was given to people left waiting for their meal. This lead to a number of people becoming concerned and agitated with the delay. Although a choice of meals is available at all times and a written menu is on display it could not be confirmed how all people living at the home make choices in this area. Some people living at the home cannot verbally express their choices. Staff could develop a system were they plate up the choices and show these to people who can then make a choice. Alternatively staff could develop pictures and photographs of the food again enabling people to have a greater understanding on what is being offered. Visitors were seen visiting family and friends throughout both days of the inspection. Interactions between people living at the home and staff were observed to be appropriate and friendly during both days of the inspection. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 20 Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 21 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. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the homes policies and procedures. Staff have received recent training in the prevention and recognition of abuse. EVIDENCE: Feedback from people living at the home when asked do you know who to speak to if you are not happy? All people stated that they would speak to a staff member or the manager if they had any concerns. Comments from relatives included A wonderful home no complaints. The Home has a complaints procedure that is clearly written and contains the contact details for CSCI. The home has received five complaints since opening. These had all been dealt with in line with the homes complaints procedure. The policies and procedures regarding protection of residents are of a good standard, which include complaints, recognising signs of abuse and whistleblowing. The home has copies of the local abuse polices and procedures. Abuse training is included in the staff induction programme. The Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 22 training matrix was viewed as part of the inspection process and this showed that staff had received abuse training. Staff spoken to during the inspection all now have a increased knowledge of the action to be taken should issues be identified. Staff recruitment files were viewed during the inspection. These contained all necessary checks. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 23 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, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, tidy fit for purpose and provides a good level of accommodation. As the home is new it has yet to develop it’s own identity and atmosphere. Additional developments are needed to ensure that the environment supports social and recreational opportunities for people living at the home. EVIDENCE: Torrwood is a purpose built newly opened care home. All bedrooms have ensuite facilities some with toilet and wash hand basin. Others have en-suite shower facilities. The bedrooms vary in size dependant of the fees paid Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 24 however all meet the national minimum size. In addition to the en-suite facilities there are a range of accessible bathrooms, shower rooms and toilets throughout the home. Each bedroom has been fitted with an adjustable bed and the home has a range of up to date hoists and equipment. The home is fitted with a nurse call bell system in all areas. We sampled a few bedrooms and it was evident that people are encouraged to personalise their private space. The home has a range of communal living spaces including lounges, dining rooms. Corridors are wide and well lit. There is a good range of signage particularly in the area that supports people with dementia. Ancillary services such as kitchens and laundry are all found on the lower ground floor. As these are new they are clean, tidy and well equipped. The fixtures and fittings at the home are of a good standard however as with all new builds some issues have become apparent over the last few months. For example a number of the floorings in some areas particularly the dining rooms have bubbled and raised. The company who installed the flooring had returned to address the issue. There is a relatively high list of other snagging and issues which have been raised. These issues are also being addressed. As the home is newly opened it was described by many, both staff and people living at the home as being “like a hotel”. This was perceived by some as positive and by others as a negative aspect. A number of people had found the transition from the two smaller homes to a large home difficult. In addition a number of the bedrooms remain vacant adding to the general sparseness in some areas. It is hoped that as the home continues to develop that it will develop it own identity and atmosphere and that people will begin to feel comfortable in the new surroundings. As previously stated some areas of the environment require additional development especially for those people living with dementia. Consideration should be given to increasing the environmental facilities to include opportunities for completion of domestic type of tasks such as cooking and reminiscences. There are sufficient communal spaces for these areas to be developed. Some people stated that it “was a shame that the activity equipment has to be packed away when the activities organiser has gone home”. This may contribute to the feeling by some that the home is hotel like. There is an accessible garden to one floor of the home. Again this needs further development to include things such as raised flowerbeds and increased planting to include fragrant and tactile plants. The current garden is somewhat over looked by neighbouring properties although it is hoped that once the planting along the fencing has grown that this will be reduced. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 25 Again as previously stated earlier in the report some people living at the home and relatives were very disappointed that Southern Cross had told them that bedrooms would be supplied with televisions that would allow access to a digital signal. Southern Cross have made repeated assurances that these will be provided however they have yet to fitted to any room. Although it is not within the National Minimum Standards that TV’s are fitted in bedrooms Southern Cross should not have made these assurances if they do to intend to provide this facility. It should be noted however that there are wide screen televisions in a number of the communal spaces. The home takes appropriate steps to reduce the risk of the spread of infection. Liquid soap and paper hand towels are appropriately sited throughout the home. Staff have access to a good supply of protective clothing. All people in both the surveys received and spoken to during the inspection stated that they were happy with the level of cleanliness of the home. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 26 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are not adequate and may compromise the health and well being of people living at the home. Additional developments in staff training are required. Staff recruitment procedures are good and ensure the safety of people living at the home. EVIDENCE: During the inspection it could not be confirmed that the current level of staffing are adequate. Comments from the majority of the surveys raised issues with the current levels of staffing. Comments included “It takes too long for the bells to be answered” “when short staffed not enough personal care and contact” “I think there should be more staff. I feel staff are expected to do to much.” “Staff at Torrwood are excellent but my relative does seem to well kept because of lack of staff” “bells seem to go on for too long before they are answered” “more staff would be an advantage”. This was confirmed during the Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 27 inspection via discussion with people living at the home and visitors. When asked are there enough staff all people stated “no”. Additional comments included “The staff are always too busy to stop and talk” “You have to wait to get help in the mornings. I like to get up after breakfast but there is never anyone to help me. I have to wait until nearly dinnertime some days” All staff spoken to during the inspection (at least five) stated that they did not feel that staffing levels were adequate. Some stated that they thought this influenced the level of care that they were able to provide. Staff stated that although the staffing levels on some occasions were comparable to the “old home” the size of the building now meant that they had to walk further for example to help people move from the lounge to the dinning room. Staff stated that on occasions the staffing levels were not comparable to those found in the old homes. Findings from the inspection confirms these findings with such things as medication and meals delayed due to lack of staff availability. During the inspection duty rotas were viewed. There were 56 people living at the home during the inspection. This equated to 23 people living on the floor providing dementia support and 33 people living on the general nursing floor. The duty rota for the floor providing dementia care had four care staff and one nurse on duty from 08:00Hrs until 20:00hrs and then two care assistants and one nurse on duty over night from 20:00Hrs until 08:00 Hrs. This means that each care assistant was responsible for the care and support of 5.75 people during the daytime hours. The nurse would be completing such tasks as drug rounds, wound dressings, undertaking reviews of people who were poorly or frail, reviewing the appraising the care given by staff, liaising with healthcare professionals such as GP’s and completing the care records. Given that the majority of people in this area would require the help of one staff member if not two staff to complete such things as washing and dressing, eating and drinking it is not unfeasible that staffing levels would be stretched. It should also be noted that Torrwood is registered to provide Dementia care in this area however only one of the qualified nurses is a Registered Mental Nurse (RMN). The manager stated she was aware of this and was actively trying to recruit additional RMN’S. The duty Rotas for the floor providing general nursing were also viewed. A total of six staff, including one Registered nurse (RN) were on duty for day time hours with a total of four staff ( RN included) at night. This equates to the care staff providing care and support to over six people during daytime hours. Again this would include helping each individual to wash, dress, access meals and fluids and provide each with social, recreational or personal contact. On reviewing the staffing numbers it was evident that some staff were working excessive hours. One staff member regularly worked 72 Hours per week. At least an additional two staff were seen to regularly work about 50 hours per week. All staff have however opted out of the working time directive. The hours worked are above the usual full time hours one would expect to see Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 28 (usually the average full time hours is around 37 hours per week.) The management need to ensure that staff working such long hours do not impact on the care and support provided at the home. In addition the management need to consider the health and safety aspect of working excessively long periods with out significant time off to rest. The homes statement of purpose states “ At Torrwood we will strive to create a home where, in comfort, safety and security, the service user can be an individual that he or she has always been. We will offer support to help maximise personal potential in light of individual needs in particular physical, intellectual emotional and social capacity.” Given the current staffing levels at the home this philosophy of care is not being met. It is required that Southern Cross review the staffing levels as a matter of urgency particularly as new people are admitted to the home to fill the current empty beds. These comments are not a reflection on the staff who currently work at the home who were all described as being very caring and kind. The staff training matrix was viewed and copies taken during the inspection. These demonstrated that • 55 of staff have attended fire safety training, with 89 having completed a fire drill. • 83 of staff have completed moving and handling training in the last 12 months • 91 of staff have received training in Abuse awareness. • 80 of staff have received training in infection control. • 27 of staff have received Yesterday, today and tomorrow training. This is Southern Cross’s dementia care training. More training in this area is planned. The manager now needs to ensure that all remaining staff complete all necessary mandatory training. In addition to ensure that all staff have training in order to help them fulfil their job role e.g. dementia training for those staff who work on the dementia care floor. The training matrix showed that the home employs 35 care staff. Of these 35 staff 11 have an NVQ qualification or equivalent. The homes statement of purpose states that they would like 50 of staff to have this qualification. The current level is below the 50 the home hopes to achieve. In addition to care staff and registered nurses the home employs kitchen staff, laundry and domestic staff, activity staff, an administrator and maintenance staff. The home has a robust induction programme which is completed by all staff. Two staff recruitment files were viewed during the inspection and there was evidence that the home was following robust recruitment procedures which Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 29 also included appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA). Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 30 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, 32, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home currently has a manager registered with us. The home is run with the service users best interests safeguarded by policy, practice and procedures. EVIDENCE: The home manager is Margaret Ndanga. Ms Ndanga joined Southern Cross in July 2008 and was initially responsible for the two homes that moved into Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 31 Torrwood. Ms Ndanga has numerous years experience working in the field of care home management and is a registered nurse. In addition she has a bachelors degree in Care Home management and a masters degree in Community health. Ms Ndanga has worked hard over the last few months ensuring that the move from the two old homes to Torrwood went smoothly. Ms Ndanga lives in the grounds of the new home and is available to staff and people living at the home for the majority of time. As such she has been seen to work long and sometimes excessive hours. Ms Ndanga, now that the move has been completed, must ensure that she manages to have some time off to ensure that she has a good work life balance. This will ensure that she is able to fulfil her role to the best of her ability when she is at work. In addition to Ms Ndanga the home has two Registered Nurses who will take the clinical leads for the two areas of the home (dementia and general nursing) Since taking up her position as manager Ms Ndanga has reviewed and made some significant changes. Ms Ndanga has agreed that there is still alot to do until the home would be providing the level of care and support that she would like. The considerable changes at the home have caused some disruption to staff however this would not be unexpected in a home undergoing change. Ms Ndanga has been instrumental in making the improvements from the previous homes. Staff stated to us that they found her very approachable One staff member stated that she felt that staff now worked as a team and that this was due to the home now having robust leadership. The home has systems in place to monitor the quality of the services and care offered. Copies of the homes internal quality audits were seen. Regular meetings are held for relatives, carers and staff where views are encouraged. All people spoken to during the inspection stated that they would feel happy to raise any concerns with the management. All stated that they thought their views would be listened to. As part of the homes quality assurance programme and as required in the Care Homes Regulations, monthly visits are made by a company representative with written reports completed. Reports were examined during this inspection. We were informed that the home does not act as appointee for any people living there but manages small amounts of spending money for people. We looked at the records relating to this and found them to be well maintained. Details of transactions and balances are maintained in computerised format on an individual basis. Statements are forwarded to individuals relatives or representatives as appropriate, on a monthly basis. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 32 A system of staff supervision has been developed and is in place for all staff. Documented evidence was available and staff spoken with confirmed that they were supported. We looked at the homes procedures relating to health and safety. This involved a tour of the premises, observation of practices, discussion with staff and examination of records. All were found to be satisfactory. It should be noted however that in some of the en-suites razors were seen. This may pose a risk to people living at the home particularly for those people with dementia. The home need to ensure that they consider this when completing risk assessments at the home. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? 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 OP27 Standard Regulation 18 (1) A Requirement The management of Southern Cross must ensure that there are sufficient numbers of staff working on each shift to ensure that staffing levels do not compromise the care and support available to people living at the home. The management must ensure that medication is given throughout the day at regular intervals to ensure that this does not compromise the health and well being of people living at the home. Timescale for action 01/06/09 2 OP9 13 (2) 01/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that care plans are completed consistently so that they all provide clear guidance to staff of the care needs of individuals living at the home. All the DS0000072587.V374674.R01.S.doc Version 5.2 Page 35 Torrwood Care Centre 2 OP14 4 5 OP19 OP23 6. 7. 8. OP19 OP30 OP38 care plans should be completed in person centred way clearly detailing the likes, dislikes of the individual and how they would like their care to be delivered. Staff need to continue to develop system which enable people living at the home to make choices. This could include the development of pictures and photographs. This should include choices with regard to fluids and meals. It is recommended that the environment is developed to ensure that it supports social, leisure and recreational opportunities for all people living at the home. It is recommended that Southern Cross provide digital televisions in each bedroom as promised or that they give clear information to people living at the home when and if these are to be provided. People can then make an informed choice as to whether they purchase their own TV’S. It is recommended that Southern Cross continue to keep the environment under review and ensure that any remaining issues or snagging is completed. It is recommended that all staff receive all mandatory training and training which will enable them to fulfil their role such as dementia care training. It is recommended that items such as razors are included in the risk assessments completed for individuals to ensure that the safety of people particularly those with dementia is not compromised. Where people are deemed to be at risk these items should be securely stored. Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Torrwood Care Centre DS0000072587.V374674.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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