CARE HOMES FOR OLDER PEOPLE
Troydale Farm Troydale Lane Pudsey Leeds West Yorkshire LS28 9JT Lead Inspector
Mary Bentley Unannounced Inspection 20th February 2006 10:20 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 Troydale Farm DS0000001517.V283135.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. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Troydale Farm Address Troydale Lane Pudsey Leeds West Yorkshire LS28 9JT 0113 255 5984 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) Mrs Edna Gilbank Mrs Edna Gilbank Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Troydale care home was built as a farmhouse in 1706 and was first registered as a care home in July 1989. The house has been sympathetically converted and many of the original features have been retained. The home now provides personal care to older people with a moderate level of disability. Nursing care is not provided. Troydale is set in farmland in the Tong-Cockersdale conservation area and has extensive views over Troydale valley. It has pleasant gardens and car parking is provided in the grounds. The home is only a short distance from Pudsey town centre and has public transport links with Leeds and Bradford. Accommodation is provided in 9 single and 2 double rooms on two floors. Bedrooms are fitted with washbasins and there is ample provision of communal toilets and bathrooms. The communal rooms, a lounge and dining room, are on the ground floor. There is level access to the home and a stair lift provides access to the first floor. . Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year, from April until March, care homes have a minimum of two inspections; these may be announced or unannounced. This was the second inspection of this home and it was unannounced; the first inspection was also unannounced and took place in November 2005. One inspector carried out the inspection and spent approximately three hours in the home. There have been no additional visits to the home since November 2005. The purpose of the inspection was to look at the key standards that had not been inspected in November 2005. The methods used during the inspection included talking to residents, staff and management. I looked at records and carried out a tour of the home. The home prefers the term “resident” to “service user” therefore that is the term that will be used throughout this report. Comment cards were left at the home for residents and relatives; these cards provide an opportunity for people to share their views of the service with the CSCI. Comments received in this way are discussed with the provider without revealing the identity of those completing them. What the service does well: What has improved since the last inspection?
There were no requirements or recommendations following the last inspection. This was my first visit to the home and it was clear that the home has continued to maintain the high standards reflected in the report of 2 November 2005. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 6 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. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected, for details please see the report dated 2 November 2005. EVIDENCE: Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9. Residents are protected by the homes systems for managing medicines. EVIDENCE: There were no residents in the home who were self-medicating. All the staff who are involved in helping residents with their medicines have received accredited training. Medicines are stored safely and the required records were up to date and accurate. The manager said that medicines are reviewed regularly by the General Practitioners or at the request of the home. This is good practice. None of the residents in the home were insulin dependant diabetics. The manager said that when residents need injections the District Nursing team does them. The District Nurses provide a high level of support to the home. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 10 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): 13 Residents are supported in maintaining contact with their family/friends and with the local community as they wish. EVIDENCE: There are no restrictions on visiting and should they wish to, residents can invite family or friends to join them for meals. In addition to the range of social activities provided within the home, residents are given opportunities to take part in events outside of the home. Over the past couple of months residents have been out to a Fish and Chip restaurant in Pudsey, Tong garden centre and St Georges Hall in Bradford. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 11 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): These standards were not inspected, for details please see the report dated 2 November 2005. EVIDENCE: Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 12 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, 24, 25 and 26 The home is clean, comfortable and well maintained. The absence of radiator guards in some areas creates the opportunity for residents to be placed at risk. EVIDENCE: All parts of the home were clean and free of unpleasant odours. There is a rolling programme of refurbishment and redecoration and the manager keeps a record of the work that has been done. At the time of the inspection the home was reviewing the security measures and looking at ways that they could be improved. The communal rooms on the ground floor are furnished and decorated in a domestic style and are appropriate to the needs of residents. Bedrooms are nicely decorated and residents had their personal belongings around them. Some of the radiators are not fitted with guards and are not Low Surface temperature radiators.
Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 13 The laundry is suitably equipped to meet residents’ needs. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 There are enough staff to meet residents needs. Staff are supported in developing their skills and knowledge. EVIDENCE: The home employs separate staff for housekeeping and cooking duties. Overnight the home has one member of staff on duty and the manager or the deputy is on call if needed. Staffing levels are reviewed and adjusted in response to the changes in residents’ needs. The home has a good training programme. National Vocational Qualification (NVQ) training is ongoing and at the time of the visit 50 of staff were qualified to NVQ level 2 or above. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 38 The home is well managed and overall the health and safety of residents and staff are promoted and protected. EVIDENCE: Mrs Gilbank is the registered provider and registered manager. Mrs Gilbank takes a more administrative role and the deputy manager, Mrs Riley, takes on most of the responsibility for the day-to-day running of the home. Within the home Mrs Riley is generally regarded as the manager and the long-term plan is to formalise this arrangement with Mrs Riley becoming the registered manager. Mrs Riley is currently doing an NVQ level 4 in Care. A selection of maintenance records was checked and was accurate and up to date. The manager has implemented systems for auditing Health and Safety and risk assessments were available. The majority of staff are up to date with mandatory training including fire safety, moving and handling and food hygiene. One of the senior staff is trained to provide moving and handling
Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 16 training to staff and is planning to update this training in the near future. Three members of staff have been training in First Aid; there are plans for more staff to undertake this training. The only concern about health and safety was in relation to the absence of radiator guards in some rooms, further information on this is provided in the environment section of this report. Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 17 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 X X X N/A 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 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 Regulation 13(4) Requirement Radiators must be fitted with guards or replaced with Low Surface Temperature radiators. Timescale for action 30/06/06 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 OP38 Good Practice Recommendations It is recommended that a member of staff attend the fire safety-training course run by West Yorkshire Fire and Rescue Service so that they are qualified to deliver fire safety training in the home. The home should aim to have a trained First Aider on every shift. 2 OP38 Troydale Farm DS0000001517.V283135.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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