CARE HOMES FOR OLDER PEOPLE
Tracey Vale Residential Home Brimley Vale Bovey Tracey Newton Abbot TQ13 9DA Lead Inspector
Judy Hill Announced 20 July 2005
th 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 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. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Tracey Vale Residential Home Address Brimley Vale, Bovey Tracey, Newton Abbot, Devon, TQ13 9DA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01392 382000 info@devon.gov.uk Devon County Council Anthony James Rooke Care Home 35 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (35), Physical disability (6), Physical disability over 65 years of age (6) Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users who require adaptations or equipment such as hoists or wheelchairs, or who require care from more than one care assistant, shall be accommodated in rooms 7, 10, 19, 21 & 22 only. 2. Only Service Users in the MD(E) and DE(E) categories with less intrusive behavious, specifically assessed by Tracey Vale staff to be able to meet their needs, shall be accommodated. 3. Only those Service Users in the PD (aged 55 ) abd PD(E) categories, specifically assesed by Tracey Vale staff to be able to meet their needs, shall be accommodated. 4. Numbers of residents in specific categories to be restricted as within brackets as above. Date of last inspection 8th February 2005 Brief Description of the Service: Tracey Vale is registered to provide care and accommodation for a maximum of thirty five people who are elderly and who may have a mental disorder or dementia and people over fifty five years of age with physical disabilities. The home offers long stay, short stay and respite care and has a re-enabling unit that provides intermediate care and support for six people. The registered service provider is Devon County Council and the registered manager is Tony Rooke. The home is sitated in a quiet residential area in Brimley, which is on the outskirts of of Bovey Tracey. The house was purpose built in the 1970s and requires some refurbishment to bring it up to current standards, but high standards of cleanliness are maintained and the provision of communal space is good. Staff and managerial support is provided on a twenty-four hour basis. The staffing levels are good and most of the care staff hold National Vocational Qualifications at Level 2 in Care. Meals are prepared on the premises and a choice of set meals and alternative is always available.
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This is an overview of what the inspector found during the inspection. This inspection was announced and was carried out by one inspector from 10am to 5.10pm on Wednesday 20th July 2005. The information found in this report was gained from in conversation with the registered manager, three assistant managers, one care worker and ten residents. Additional information was gained from a partial inspection of the premises and documentary evidence, including completed feedback forms from five residents and four visitors to the home, a completed pre-inspection questionnaire, the Statement of Purpose and Service Users’ Guides, menu plans, staff rotas and medication administration record sheets. What the service does well:
In addition to accommodating residents on a long term, short term and respite basis, the home has a well supported re-enabling unit to provide intermediate care for people who have been discharged from hospital and need help to remain the confidence and skills needed to enable them to return home. The staff who are responsible for assisting the residents with their medication have been trained to do so competently. A choice of at least two set meals is offered at all mealtimes and is neither is to the residents liking, alternative meals will be made available. The standards of cleanliness maintained at the home are good. The communal areas are spacious and comfortably furnished and the residents have the use of kitchenettes to enable them to make themselves and their visitors hot drinks and snacks if they choose to do so. A handyman is employed for thirty hours a week to carry out routine repairs and safety checks. The laundry facilities are well appointed and include modern appliances and three sluicing facilities. The registered manager is suitably qualified and very experienced in the provision of residential care. He is supported by four deputy manager’s, which enables a member of the management team to be on duty at the home at all times. The care staffing levels and ancillary staffing levels are high enough to
Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 6 meet the needs of the residents. Good training opportunities are available for the staff and over sixty percent of the care staff hold a National Vocational Qualification in Care at Level 2. A quality assurance/quality monitoring system has recently been introduced to enable the residents and other stakeholders to comment on the quality of the service provided. What has improved since the last inspection? What they could do better:
The Statement of Purpose and Service Users’ Guides and well-written and informative but need updating. Some in-house activities are provided but they are poorly attended. The home could consult the residents’ about the social, recreational and occupational activities that they would like the home to provide. Staff escorts could be provided to enable the residents to go out individually and in groups in they choose to do so. Some of the residents are helped by their families to handle their financial affairs but in most cases the service has taken on this responsibility on without exploring all possible alternatives or carrying out risk assessments to identify if the individual residents actually need the level of help provided. In some instances the only help needed may be an escort to the Bank or Post Office, which the staff could be provide. The most of the bedrooms are too small to enable them to accommodate the amount of furniture recommended, insufficient electrical sockets are provided and the radiators are not individually thermostatically controlled. It is however
Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 7 acknowledged that plans have been drawn up to improve the standards of the bedrooms. The bathrooms are very institutional in appearance and uninviting. 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. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 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 standard(s) 1 & 6 Current and prospective residents have the information they need to make an informed decision about where to live. The intermediate care unit provides a very good service, which benefits people who need help to regain their independence. EVIDENCE: The copies of the homes Statement of Purpose and Service Users’ Guides that are held on the Commissions files were inspected. Both documents are very informative but require a little updating to reflect changes that have occurred since they were drafted in February 2003. Copies of the Service Users’ Guide were seen in the residents’ bedrooms. In addition to offering short-term and respite care, Tracey Vale offers residential intermediate care for up to six people. This service is provided in a self-contained wing of the home and has dedicated care staff. Additional support is provided by Social Service care managers, an occupational therapist and a physiotherapist. The length of stay is usually six weeks but can be reduced or extended, depending on the needs of the resident.
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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 standard(s) 9 Appropriate procedures are used to ensure that the residents medication is taken as prescribed. EVIDENCE: The medication administration practices used in the Intermediate Care Unit were inspected. The residents in this unit handle their own medication and have lockable facilities in their rooms in which to store it safely. The staff carry out regular checks to ensure that the residents are taking their medication as prescribed. The registered manager said that all of the staff that handle and administer the resident’s medication have received training to ensure that the drugs are handled safely. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 The residents are encouraged to maintain their independence and to exercise choice within their home environment but the provision of in-house and outdoor activities is poor. EVIDENCE: It was made evident from conversations with a number of residents and the manager and an observation of the residents that they are actively encouraged to exercise choice in their daily routines and to maintain their independence within their home environment. Examples of this are the provision of a choice two set meals for every meal and the availability of alternatives if the residents do not want either of the set meals and the availability of facilities to enable the residents to make their own hot or cold drinks and snacks. Feedback from comment cards completed by the residents and conversations with the manager and one of the assistant managers indicated that although some in-house activities are provided, the residents have not been fully consulted about what activities they would like the home to provide and attendance is poor. The policy on visitors is included in the Service Users’ Guide and the residents are encouraged to maintain contact with their friends and families. Visitors are welcome at any time and facilities are available to enable the residents to offer
Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 12 them hot drinks. Meals will also be provided for visitors on request, although a charge will be made for this. Group and individual outings are not routinely arranged by the home, therefore unless the resident’s are taken out by their friends and families few opportunities exist for them to be active in the community. The completed pre-inspection questionnaire identified that none of the residents manage their own financial affairs or hold their own benefit books. This was discussed with the manager who said that some of the residents received support from their families but that Devon County Council Finance Department dealt with all of the other resident’s finances. Individual risk assessments had not been carried out to identify if and why the residents needed this support or to demonstrate that other options had been exhausted before the service provider took charge. The only justification offered by the registered manager was the resident’s inability to access banks and post offices but this is not an acceptable reason as escorts could be provided. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 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 standard(s) 0 EVIDENCE: These standards were assessed as met at the last inspection and were not inspected on this occasion. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 23, 24, 25 & 26 The residents live in a clean home with good communal areas but some areas, including the bedrooms, toilets and bathrooms do not meet current standards. EVIDENCE: The home is located in a quiet residential area in Brimley, which is less than a mile from the facilities and amenities Bovey Tracey town centre. There is a local shop/post office close by and a regular bus service to and from the town. Several facilities are within easy walking distance, including churches, the towns cricket grounds, a bowling green and a swimming pool. The home backs onto open fields and the rooms to the back of the house have excellent views of Dartmoor. There are gardens to the front, back and side of the house. Several residents were seen sitting outside at the front of the house, which is a favourite place because it enables them to see people coming and going. The gardens are not currently enclosed and as there are plans to use part of the home to provide a specialist service for people with dementia, some fencing will be required to ensure that confused residents have the benefit of a safe outdoor area.
Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 15 The home was purpose built in the 1970’s and was registered in 2002 as a going concern. Consequently the size of some of the bed-sitting room and the provision and the location of toilet facilities does not meet the current standard for registration. However, discussions with the manager identified that major renovations are planned which will reduce the number of bedrooms but provide larger bedrooms improved toilet facilities. Copies of these plans should be sent to the Commission as soon as they are available. The home has been designed as four units, each with its own lounge, dining and kitchen facilities. Although some further redecoration is needed, the communal areas were seen to be clean and comfortably furnished. A handyman is employed for thirty hours a week and carries out routine maintenance. In addition to this he carried out fire safety tests, water temperature tests and, as he is suitably qualified to do so, portable appliance tests. There are in total eleven toilets in the home but because of the design of the home the location of the toilets in relation to some of the bedrooms and communal areas is not ideal. Most of the toilets are not suitable for people who use wheelchairs because there is insufficient space available to enable them to transfer themselves or for the staff to assist them safely. The provision of more accessible toilets must be considered in the planned structural changes to the home. There are four bathrooms and two shower rooms, which is adequate for the needs of the residents. However, the bathrooms are very institutional in appearance and one of the shower rooms is being used inappropriately as a storage area. Most of the resident’s bedrooms are under ten square metres and therefore to small to accommodate the furniture that is recommended. Many of the rooms do not have adequate power points and most of the residents have not been provided with lockable storage facilities. The rooms are all lockable and some of them have been personalised and made very homely by their occupants. Although a modern central heating boiler has been installed, the central heating radiators are old and do not have individual thermostatic controls to enable the residents to adjust the heating in their rooms. The lighting meets LUX standards but could be improved in the hallways. Although the manager said that the residents could have bed-side table lights if they wanted, these are not provided as a matter of course. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 16 The windows can be opened to provide ventilation, but have restraints to prevent accidents. The laundry room is situated in an appropriate location and soiled linens and clothing can be transported to it without having to carry it through areas where food is prepared, stored or eaten. There are two sinks in the laundry and a third is being installed for the staff to use to wash their hands. There are a total of three sluices. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The resident’s benefit from the provision of carefully selected and appropriately trained staff in number that are adequate to meet their needs. EVIDENCE: The staff rotas were inspected and demonstrated that good care staffing levels are maintained. They do, however, need to be redesigned to show the full name of each member of staff and the capacity in which they are employed. The completed pre-inspection questionnaire identified that a total of twentyfive care staff are employed and conversations with the manager identified that fourteen of the staff had completed an NVQ at Level 2. A further three members of staff are working towards gaining this qualification. The information provided in the pre-inspection questionnaire and an interview with one member of staff demonstrated that staff training is given a high priority. The staff recruitment procedures are satisfactory and CRB and POVA First checks are being carried out to ensure that only suitable staff are employed to work at the home. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 33 The resident’s benefit from a well managed service. EVIDENCE: The registered manager is very experienced and well qualified and has a good understanding of the needs of the residents. A quality assurance/quality monitoring system has been introduced and questionnaires have been used to gain feedback from the residents about the quality of the care provided. Posters were displayed in the home to let the residents and visitors know about the forthcoming inspection and completed comment card were received from five of the residents and four visitors to the home, all of which contained positive comments on the service provided. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 3
COMPLAINTS AND PROTECTION 3 3 2 x 2 2 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 3 x x x x x Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 20 Yes 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. Standard 2 Regulation 4, 5 & 6 Requirement Both the Statement of Purpose and Service Users Guide need to be updated. Updated copies of both documents must be sent to the Commission. The residents must be consulted about their social interests, and arragements must be made to enable them to engage in local, social and community activities. The residents should be consulted about the provision of social, occupational and recreational activies, which should be provided to meet their needs and preferences. Previous timescales for compliance 30/11/04 & 30/3/05 not met. Devon County Council must inform the Commission for Social Care Inspection how it is to comply with the requirement that each service user has a toilet within close proximity of his/her bedroom and the communal areas. Previous timescales for compliance 30/11/04 & 30/7/05
Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 21 Timescale for action 20/10/05 2. 12 16 20/10/05 3. 21 16 & 23 20/10/05 not met. 4. 23 16 & 23 Devon County Council must inform the Commission for Social Care Inspection how it intends to meet the mimimum space requirement for bedrooms as defined in this standard. Previous timescale for compliance 30/11/04 & 30/7/05 not met. All residents must be provided with a lockable storage facility in which to store their money and other valuables and adequate power points must be provided in residents bedrooms. Arrangements must either arrange to have individual thermostatic controls fitted to the radiators in the residents bedrooms or replace the existing radiators with radiators that can be individually controlled. Previous timescale for compliance 30/4/05 not met. 7. 20/10/05 5. 24 16 & 23 20/12/05 6. 25 23 20/12/05 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 13 14 21 Good Practice Recommendations Staff support should be provided to enable the residents to go out both in groups and individually if they wish to do so. The residents should be encouraged to handle their own financial affairs for as long as they wish to and as long as they are able and have the capacity to do so. The bathrooms should be refurbished to reduce their institutional appearance and make them more inviting. Alternative storage facilities should be provided for items
D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 22 Tracey Vale Residential Home 4. 27 that are being inappropriately stored in one of the shower rooms. The staff rotas should provide the full names of the staff on duty and their job totles. Tracey Vale Residential Home D54-D07 S32549 Tracey Vale V224677 200705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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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