Care Home: Mount Tryon Care Home

Similar services:

• Fairfields Country Rest Home
• Queensmount
• Poldhu
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well People who use the service and their relatives have the information they need to decide whether Mount Tryon is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs but also means that they are assessed to ensure they would `fit in` with other people in the home. People receive a good standard of personal and nursing care. One person wrote `This home is well run and comes highly recommended` Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 7Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. The way care is provided to those with dementia type illnesses is based on best practice guidelines and staff are continuing to look at ways of improving the care that is provided. Medicines are also well managed at the home by the nursing staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are good and mean that staff know how to care for some one in a safe and consistent way that meets their individual needs and preferences. People have access to a good programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home. People tell us that the food is good at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. People are safe at the home. Staff have had training to recognise signs of abuse and know how to report any suspicions or poor practice. Mount Tryon is a safe and pleasant place to live and work. The manager and her staff group have suitable qualifications and experience to care for people who require nursing and personal care. Pre employment checks are performed on staff to show they are suitable to work with vulnerable adults. The home is well managed by the manager and Provider. What has improved since the last inspection? People living at the home now have their own lockable storage space for medication. Since the last inspection a specific area of the home has been registered to care for people who suffer from dementia. What the care home could do better: No requirements were made at this inspection. CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Mount Tryon Care Home Higher Warberry Road Torquay Devon TQ1 1RR Lead Inspector Caroline Rowland-Lapwood Unannounced Inspection 10:00 24 February 2009 th X10029.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 Mount Tryon Care Home DS0000069235.V373774.R02.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 and Care Homes for Adults 18 – 65*. 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. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mount Tryon Care Home Address Higher Warberry Road Torquay Devon TQ1 1RR 01803 292077 01803 299416 mounttryon@barchester.com www.barchester.com Barchester Healthcare Homes Ltd 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) Carol Vivien Robins Care Home 59 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (42), Physical disability (10), of places Physical disability over 65 years of age (42) Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2007 Brief Description of the Service: Mount Tryon is a purpose-built care home situated in a quiet residential area of Torquay, and is owned by one of the countries largest providers of residential and nursing home care in the UK. It is registered to provide personal and nursing care for up to 60 physically disabled clients, of either gender. An experienced Registered Nurse who also has professional management qualifications manages the home and Registered Nurses are on duty 24 hours a day. The accommodation is provided on two floors, the first floor being accessible by a passenger lift or internal stairway. A new area of the home has recently been developed into a specialist unit for those people suffering with dementia this is situated on the second floor. It is a pleasantly decorated home throughout offering a homely environment even in the disabled bathing and shower rooms. All of the client’s bedrooms are single occupancy and have en-suite facilities and a nurse call system. The home also has nursing equipment such as hoists and specialist beds and mattresses to meet the individually assessed needs of the clients. The home has a selection of communal accommodation spread over the two floors. There is a lounge on the first floor with its own balcony offering glimpses over Torquay and the bay. The large lounge on the ground floor has direct access to the well-appointed dining room. The home also has its own Pub with the atmosphere of a small bar decorated to provide the character and charm of a small country pub in the 60’s. The home also provides a activities room and employs a two activities coordinators who offer a wide range of activities to individuals and groups of clients including the Gardening Club and the Friday Club that provides a weekly opportunity for clients to air their views about the whole service they experience at the home. There is a bus that is used for trips from the home and also to take clients to appointments if other transport is not available. The exterior of the home has ample parking and level access to the front door. There is also a garden area with sensible wheel chair access. The clients have access to visiting professionals such as the chiropodist, dentist and optician. The Statement of Purpose is displayed in the reception area of the home and is Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 5 easily accessible for residents and visitors. The fees stated on 24/02/09 were residential fees from £465 per week and nursing costs started from £545 and were dependant on the assessed care needs of the residents. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection we performed a random inspection in December 2008 following a complaint that alleged a person had not had the full care he needed. This random inspection found only some evidence to support these allegations and therefore the complaint was only partially substantiated. Three requirements were made as a result of this inspection. At this inspection we found all three requirements had been met and none were outstanding. This key unannounced inspection consisted of a visit to the home on Tuesday 24th February 2009. Two inspectors and an expert by experience performed this inspection. The Commission for Social Care Inspection consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. During this time we spoke to the registered manager who is the person with day to day responsibility for the service, the senior manager and many of the members of care and ancillary staff on duty. We case tracked four people who use the service. Case tracking means we looked in detail at the care four people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at three staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Mount Tryon. What the service does well: People who use the service and their relatives have the information they need to decide whether Mount Tryon is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs but also means that they are assessed to ensure they would fit in with other people in the home. People receive a good standard of personal and nursing care. One person wrote This home is well run and comes highly recommended Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 7 Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. The way care is provided to those with dementia type illnesses is based on best practice guidelines and staff are continuing to look at ways of improving the care that is provided. Medicines are also well managed at the home by the nursing staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are good and mean that staff know how to care for some one in a safe and consistent way that meets their individual needs and preferences. People have access to a good programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home. People tell us that the food is good at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. People are safe at the home. Staff have had training to recognise signs of abuse and know how to report any suspicions or poor practice. Mount Tryon is a safe and pleasant place to live and work. The manager and her staff group have suitable qualifications and experience to care for people who require nursing and personal care. Pre employment checks are performed on staff to show they are suitable to work with vulnerable adults. The home is well managed by the manager and Provider. What has improved since the last inspection? 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. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission procedure is good and means that staff has enough information to decide whether they are able to meet the needs of the person. EVIDENCE: Before moving in to the home all people wanting to live at the home have their needs assessed to ensure that the home can meet their needs. Information is gathered from the person, their family, and health and social care professionals. Staff described how each new admission to the home is made Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 10 welcome and helped to settle in. Staff says they have enough information about each new resident and are prepared for their admission. Each care plan contained a pre admission assessment and detailed admission assessment. This was used alongside assessments made by social services and other health care professionals. Together this information is used to put together a detailed plan care and risk assessments. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care people receive is provided in a respectful and person centred way. The care planning systems at the home are excellent and reflect how health and personal care needs are identified and met in a safe way. The management of medicines is good and helps protect people from risk. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 12 EVIDENCE: During the inspection people looked cared for, with the finer details such as eye care, nail care and appropriate foot wear present. People being nursed in bed appeared warm comfortable and pain free. People had call bells within reach and access to drinks nearby. Care charts for those who required regular checks were present and had been completed to show what care had been provided. People living at Mount Tryon have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine screening programmes including ‘flu immunisation’. Each person has a designated GP who attends when staff request a visit or can be consulted via the telephone. Examples of health care professional input seen included; GP, speech and language therapist, dietician, physiotherapist, chiropodist, community psychiatric nurse and continence specialist nurse. Health care needs are monitored in well-written care plans. The care plans are organised to show different areas of the plans. The plans set out each person’s specific needs. Each plan contains assessments for such issues as falls, nutrition, moving and handling and more general risks. Risk assessments also included skin assessments and mental health assessments. There is also a risk assessment available when the use of bed guards (bed rails) has been considered with monthly bed rail equipment checks. These assessments are reviewed each month or where a change occurs. Systems were in place to check reviews had occurred. Plans of care were well written and explained how care needs for each person will be met. However, a discussion was held about writing care plans from the person’s perspective to prevent staff making life at the home too clinical or institutional. The use of skin maps was used for people who have sustained cuts and injuries and wounds, which were then reviewed until healing had taken, place. Staff consulted with wound care specialist nurses where specialist advice was needed. When specialist health care professionals are sought for advice, treatment and guidance staff record any changes within the persons care plans. The activities staff also has their own sheet to record activities that each person has been involved in and their response to the activity. People who use the service are encouraged to join in with physical exercise programmes provided. The activities coordinator told us chair activities were encouraged and soft balls were used for upper body exercise and coordination. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 13 The use of walking aids was available and encouraged. People had space to wander as they chose or were able. Grab rails were present throughout the home and ramps were available to reduce risk of trips and falls whilst promoting independence. The home cares for people with dementia type illnesses and have just opened a wing of the home called ‘Penny Lane’, which is equipped for caring with people with dementia type illness. Some staff has been trained in the specialist ways of caring for people. We spent a portion of time watching staff interact with people in the lounge. As a team, staff displayed very positive interactions, which caused positive experiences for people in the home. Some people received more interaction and input than others, but collectively all people observed received some positive experiences during the observation period. Staff told us the home is enrolled on a project called Memory Lane. Where training in dementia care, looking at the environment and life stories eventually improve the life for people in the home. Staff told us they had started to attended specialist dementia care training to improve the quality of care from the perspective of the person with dementia. Care of the dying is performed well at the home. Staff use the Liverpool Care Pathway where all health care professionals work together and record together the care that is planned and given to ensure care is continuous and effective. Thank you letters displayed were positive about end of life care received. One card read we knew he received only the best care anyone would want, all the time. This was especially true during the last days of his life. I am truly grateful and thankful for the sensitivity and respect everyone gave to him. He really believed he was in a superb hotel and not a care home. Another quote read Thank you again for looking after her and making her as comfortable as possible. We looked at how medicines are managed and stored. We found that there are good ordering, storage and recording systems in place which staff follow. We looked at the records of some people receiving medicines and found these are up to date and accurate. We looked at whether people living at the home were treated with dignity and respect. In their surveys, all the people who responded told us that they felt listened to by staff, and we were told during the inspection that people felt that their dignity and privacy was respected during bathing and dressing, although some people would prefer more than one bath a week. During the inspection, we heard people being called by their chosen name, and we saw staff being friendly and heard them using appropriate language. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 14 Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 good This judgement has been made using available evidence including a visit to this service. The varied, well organised social and therapeutic activities provided for people is good. People also benefit from a wholesome balanced diet. EVIDENCE: Two activities coordinators are employed for 35 hours and 20 hours a week. They provide a wide and varied programme of events, which are advertised in the Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 16 “Tryon Times” newsletter and throughout the home on posters. Examples of activities seen were gardening, cooking, trips out, picture books, use of memory boxes, exercise sessions, flower arranging, musicians, animal visits and craft events. A large painting done by a group of people in the home is on display in the entrance hall. On the day of inspection a cooking session of pancakes to celebrate Shrove Tuesday was in progress. All those within the lounge area helped prepare or enjoyed eating the final product. Staff also told us that activities staff has introduced more intense person focused activities on a 1:1 basis. One resident said of the musical activity, “ I am not old enough to recall First World War songs they play and sing here, don’t like the modern stuff and would prefer music from the 30s to the 50s”. During the visit, several people were seen enjoying jigsaw puzzles in the dining room and others in the lounge were watching television or reading. The activities room appears well stocked and equipped. It has a couple of computers ready to be brought into use and connected to the Internet. One person has his own personal computer in his bedroom and is said to be very good at computing, “I built it myself” was his comment when he saw our interest in it. People mentioned how much they enjoy trips out in the minibus saying, “trips out have made such a difference”, and “lovely to go out and meet people”. People said that they choose whether or not to join in the activities. When the weather is suitable some sit in the garden. They also exercise the choice of eating in the dining room or their bedroom. Throughout the unit where people have dementia type illnesses there were scarves, bags and tactile items for people to touch, remove and play with. There were rummage drawers where people are able hold touch and look at familiar items. Records of activities are stored within the general care plan of people in the home. One care plan had no entries since August 2008 despite this person being fully involved in the activities of the day. Staff confirmed this person was regularly joining in activities. Another person who was in frail health had no mention of how staff had supported her on a 1:1 basis in recent weeks. Staff told us a religious minister for Church of England comes to the home once every three weeks to perform a service. Staff told us there was no other alternative religions at the home, but gave assurances that staff would be able to approach churches or religious leaders if this was necessary. Further inspection revealed one person who was active in a religion different to the Church of England. Care Plans were not clear on how staff could support this person in the religious aspects of their life or whether it was the person’s decision for this to be left entirely to the family. The new wing for people with dementia type illnesses was decorated to a high standard. However basic orientation for people was lacking. There was no clock or date on display resulting in one person repeatedly asking staff what time it was. Valentine hearts were on display despite Valentines Day being two weeks ago and celebrations taking place for Shrove Tuesday. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 17 Staff ensured there was music playing within the lounge area but the same CD was played repeatedly at the same time as the TV being displayed with no sound. This could be confusing for people in the home. Staff told us that in the summer they make use of the enclosed garden and walkways but that a herb garden was being developed inside the home. We were told that a garden feature had recently been installed at the home. People said their visitors are always made welcome by the staff. The local vicar visits periodically as his time permits. Several have nearby family who take them out. Without exception everyone spoken with said that they choose their time of retiring and rising with or without assistance from carers. On the day of the visit the lunch consisted of mushroom soup, and either salad or home baked gammon with parsley sauce, boiled potatoes, carrots and leeks. In the attractive main dining room there was waiter service, with the meal being plated from a hot servery. The food was hot, tasty and well presented. The dessert was fresh fruit salad with or without cream. People were seen to have alternative meals if none of the set choice was to their liking. The food for the first floor dining room was brought from the kitchen in a mobile hot cupboard with a Bain Marie top thus ensuring the temperature was maintained during transit. In both dining rooms carers were seen to assist diners in a gentle and relaxed manner sitting beside them and engaging with them on a one to one basis. Most service users appreciated the food saying, “you get a choice”, “chef is really good”, “you can eat what you like”, “generally quite good”, “I would prefer to have the main meal in the evening as lunch comes too soon after breakfast”, “breakfast is the best meal of the day as I am hungry by then”, “some days the food is better than others”, “food can be a bit like nursery food – rice pudding and pasta although we do get roast twice a week”, and “food too sweet for me but I don’t grumble”. Several people mentioned that food is one of the topics usually discussed at the “Friday Club” (a weekly meeting of people living at the home and management). Before lunch people were offered (and most accepted) an aperitif of either sherry or red or white wine. Some people retired to the small bar whilst others took their drink in the lounge. The atmosphere in the bar was convivial and relaxed. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. 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. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. The knowledge procedures and training in place for the Protection of Vulnerable Adults help to protect people. EVIDENCE: People told us they felt able to complain to staff and the manager in the home. Surveys also told us that people were able to complain. Comments included Yes I do know how to complain but have not needed to do so. and We have never needed to complain The complaints procedure is contained within the Statement of Purpose and Service Users Guide. The home has a record, which is organised and clearly shows any complaints in along with the outcomes following an investigation. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 19 In the last year the CSCI has received one complaint late last year. It was alleged that one person had not received the appropriate care. A random inspection was undertaken and the home gave the appropriate records to the inspector to look at. The complaint was found to be partially substantiated and three requirements were made. All three requirements have now been met. Bed rails were used at the home after risk assessments had been completed. Bed rail bumpers were used to prevent injury and entrapment. Monthly equipment checks were in place to make sure any risk was reduced. All staff attends regular Protection of Vulnerable adult’s awareness training. Posters were present highlighted which staff were due for this training. Staff has pre employment checks before they are able to work. Staff files all contained an enhanced CRB (police check) and POVA (Protection of vulnerable adult pre employment check) checks. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Mount Tryon is a safe, hygienic and pleasant place to live and work. EVIDENCE: There are many communal areas throughout the home, which, were being used. Large lounges were divided into smaller seating areas which people were seen rearranging freely. Some lounges had TV whilst others had a radio. A Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 21 quiet lounge was located upstairs in the home. Some people chose to sit in their own rooms. There is a large dining area close to the kitchen, which is used by people throughout the home and had a restaurant atmosphere with wine being served with meals. These modern premises are warm, homely and well maintained. All the areas visited were very clean and tidy with suitable decorations and embellishments to assist those with dementia to recall the past. The bedrooms have been personalised to greater or lesser degrees depending on the wishes of the occupants. The Dementia Unit is a real “showpiece” and appears to fulfil all that has been said about it in the brochure. It has been planned with a great deal of thought and consideration for both patients and staff. With the assistance of staff, three residents were using the domestic style kitchen in the corner of the lounge/dining room to cook pancakes. There are many toilet and bathing facilities within the home. Specialist baths are available for people wishing to have a bath and decoration and furnishings have made these rooms appear more homely. Each person has their own room, which are decorated with personal items. Adjustable beds and specialist mattresses were available for the prevention of pressure sores. Each room has a name plaque and in some cases a memory box containing items, which indicate who the person is and what interests they have followed. The home was clean and tidy with a total absence of unpleasant odours. The laundry was clean, tidy and well organised. People told us there were not any major issues with laundry. Washing machines suitable for washing foul laundry were present and industrial dryers were present. The laundry has washable walls and impermeable floors. There are dedicated staff that operate the service that explained that the route for bringing laundry to be washed was done without access through dining or kitchen areas. Staff had access to gloves, aprons and hand soap. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are kept safe and well cared for by a stable well trained staff group. EVIDENCE: Off duty records are maintained and show that staffing levels are stable and supplied in sufficient numbers to meet the complex needs of people who use the service. In addition to the nursing and care staff, additional ancillary staff are employed to clean, cook, attend to the laundry and maintain the home. There are additional reception staff, administrators and activities staff to complement the nursing staff team. Some staff at the home has come from overseas and subsequently English is not their first language. In these cases people said there were no problems in Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 23 people and staff understanding one another and if there is a problem staff will get other staff to make themselves understand or understood. The care staff have received training in both general care duties such as manual handling, food hygiene, fire safety, health and safety and infection control. Some care staff has had additional training to understand the more complex needs of mental health problems including dementia. Staff told us that many care staff has an NVQ in care at level 2 or above. Staff posters encourage staff to take NVQ training. There are assessors within the home and within the organisation to help with this. Recruitment is well managed at the home. Staff recruitment folders showed that the recruitment process is consistent with all staff being interviewed following completion of an application form. Applicants are asked to complete a criminal declaration and health questionnaire. Staff files also contained a photograph, CRB and POVA recording information two written references and proof of identity including photograph from the driving licence or passport. All registered nurse files contained up to date Nursing and Midwifery Council and work permit checks where appropriate. All staff files showed evidence that staff had completed an induction programme and had had a recent supervision session. Induction programmes are performed within the home for orientation purposes and emergency procedures and then supported on computer systems for back up theory and information. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The competent Manager and staff at the home manage the home in an effective and efficient way. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 25 EVIDENCE: The home is owned by a corporate organisation that provides the manager and staff with support and guidance. There are many company policies and procedures in place, which are tailor made to ensure they are suitable for Mount Tryon. The manager is supported by a skilled staff group. The manager told us she would be returning to her role as clinical lead in the near future after the recruitment of another experienced manager within the organisation. There is an administrator at the home whose role is to support the manager in administration and finances including the management of people’s personal accounts. These systems were inspected and show that the process of managing other people’s money is safe, appropriate and auditable. Records and receipts kept were clear and well organised. Records also showed that whilst the monies of people are stored within one bank account, unpaid bills are not supported by other people in the home. Other records were well maintained at the home. Confidential information is appropriately stored and records are safely stored. Financial systems were not closely inspected on this visit. However, Insurance certificates were displayed in the home and show sufficient cover. Quality assurance processes are robust at the home. The inspector receives regular updates (regulation 26 reports), which are completed by a senior person within the organisation. These provide information about how the home is meeting the needs of the residents it cares for. The inspectors saw the minutes of the Friday club where residents are able to express their concerns and wishes. The residents spoken to confirmed that they enjoyed the meeting and being part of the home. The organisation completes anonymous resident satisfaction questionnaires. Maintenance records were seen to show that electrical, fire, emergency lighting, heating, gas systems, lifts, alarms, call bells and specialist equipment have had recent servicing checks. Maintenance records were extremely well organised and professional. In house checks were present for the prevention of legionella and routine maintenance. Pest control contracts were also in place. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 26 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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 ENVIRONMENT Standard No Score 19 4 20 X 21 X 22 X 23 X 24 4 25 X 26 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 27 NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations Systems should be introduced to make care plans more person centred. Staff should ensure TVs are only left on when people are sleeping if that is the person’s choice. Care Plans should be clear at how spiritual needs will be met and how staff can support this. Staff should be aware not to confuse people with visual aids to remind them what season or celebration is current. Staff should consider providing a clock and calendar to provide orientation for people in the home. Staff should be encouraged to ensure all people receive stimulation and interactions. Systems should be in place to make sure people are not confused or frustrated by having the same music playing DS0000069235.V373774.R02.S.doc Version 5.2 Page 28 3 4 5 6 7 OP7 OP12 OP12 OP12 OP12 Mount Tryon Care Home unless it is their choice and should make sure the TV and radio are played separately to prevent confusion or over stimulation. 8 OP12 Activities diaries should be accurate and up to date. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 29 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. Mount Tryon Care Home DS0000069235.V373774.R02.S.doc Version 5.2 Page 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!