Care Home: Toray Pines

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What the care home does well The management take time and care to ensure that each person`s needs are assessed before entering the home. The assessment fully involves the resident and their family. People living in this home told us they were well cared for by a committed and competent care team. They were very satisfied with the care, approach of staff and the overall service provided by the home. There is a weekly activity programme available that people can choose to join in with and that they said they enjoy. The home provides comfortable, bright, safe accommodation which people told us was clean and well maintained. People said they enjoy their food, which is fresh, varied, well presented and nutritious using fresh ingredients. There was a system to show regular reviews of care are carried out, which fully involved individuals and their family carers when it was right to do so and wherever possible. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. What has improved since the last inspection? A major programme of redecoration and refurbishment has taken place with new carpets, furniture and fabrics throughout to provide an updated, bright, attractive environment for the people who live there. Staffing levels have been increased to take into account the changing needs of the people living in the home. Staff training has been made more detailed and training in dementia has prepared staff for this new service. The home has employed a registered nurse as a training coordinator to address the training needs of staff. The training is focused on providing a more person centred approach to care. The home has appointed a manager and deputy manager who have knowledge and skills about dementia in order to ensure that the service provided uses up to date practice. They have established an entertainment committee involving people living in the home, relatives and staff to look at the range of activities provided in the home. The home was awarded 3 stars "excellent" food hygiene award by East Lindsey District Council in recognition of its catering standards. What the care home could do better: There were no requirements or recommendations from this inspection. There is an enthusiastic care and management team who are committed to providing an improved service and promote a person centred approach to care. They are auditing their service and where improvements have been identified are keen to introduce them. CARE HOMES FOR OLDER PEOPLE Toray Pines School Lane Coningsby Lincs LN4 4SJ Lead Inspector Tobias Payne Unannounced Inspection 8th July 2008 08:20 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 Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Toray Pines Address School Lane Coningsby Lincs LN4 4SJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) 01526 344361 01526 344695 shirley.woods@twhealthcare.co.uk www.tanglewoodcarehomes.co.uk Tanglewood (Lincolnshire) Ltd The acting manager is not registered with the commission at the moment but her application is being processed by the commission. Care Home 52 Type of registration No. of places registered (if applicable) Category(ies) of Dementia (52), Old age, not falling within any registration, with number other category (52), Physical disability (52) of places Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Older persons, not falling within any other category - Code OP Physical disability - Code PD Dementia - Code DE The maximum number of service users who can be accommodated is 52. 10th July 2006 2. Date of last inspection Brief Description of the Service: Toray Pines is a purpose built and situated in the village of Coningsby, which has a range of local services and facilities. It is one of a group of homes operated by Tanglewood (Lincolnshire) Limited. The home is registered as a care home to provide personal, nursing care and accommodation for up to fiftytwo people. It is set in its own well-maintained gardens with a central patio area. Gardens are accessible for those service users with mobility difficulties or who need wheelchairs. Accommodation is provided on two floors, which can be accessed by a shaft lift or stairs. The majority of rooms are single occupancy. There are also 6 double bedrooms, which are en-suite with separate toilet and bath. Lounge and dining areas are located on both floors. There is car parking available to the side of the property. The fees at the inspection visit on the 8/7/2008 ranged from £351 to £553 each week. Additional charges were for hairdressing, which ranged from £7.50 to £28.50 and chiropody £11. Information about the home including the statement of purpose, service user’s guide and a copy of the last inspection report can be obtained from the manager of the home. A copy is also Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 5 available in a folder at the entrance to the home. Toray Pines DS0000002558.V367948.R01.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 stars. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and started at 8.20 a.m. It was done using a review of all the information available to us about the Toray Pines Care Home. The inspection visit took place over 7 hours. We spoke with 9 people living in the home and 4 visitors to the home. We spoke with 7 staff members the acting manager, deputy manager and compliance manager for the company who was in the home during our visit. The main method of inspection used on our visit was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also examined records and walked around the home. What the service does well: What has improved since the last inspection? A major programme of redecoration and refurbishment has taken place with new carpets, furniture and fabrics throughout to provide an updated, bright, attractive environment for the people who live there. Staffing levels have been increased to take into account the changing needs of the people living in the home. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 7 Staff training has been made more detailed and training in dementia has prepared staff for this new service. The home has employed a registered nurse as a training coordinator to address the training needs of staff. The training is focused on providing a more person centred approach to care. The home has appointed a manager and deputy manager who have knowledge and skills about dementia in order to ensure that the service provided uses up to date practice. They have established an entertainment committee involving people living in the home, relatives and staff to look at the range of activities provided in the home. The home was awarded 3 stars “excellent” food hygiene award by East Lindsey District Council in recognition of its catering standards. 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. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People coming to this home receive detailed information about the home to enable them to make a decision about whether or not to come into the home. People coming into the home receive an assessment and know their needs can be met. They are also involved in this process. EVIDENCE: There was a clear and detailed statement of purpose and service user’s guide available at the entrance to the home. The information contained details of the philosophy, aims and objectives, residents’ rights, complaints procedure as well as frequently asked questions. In addition there was a copy of the last inspection report. This information could be produced in large print at request. People coming into the home were assessed by the acting manager before they came to the home. During this assessment lots of information was obtained from them and or their family/advocate to ensure the home could meet their needs. Once this was done they sent written confirmation that based on this assessment the home was able to meet their needs. Each Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 10 person also received a contract with details of cost of their stay. We spoke with a new person who had been admitted to the home who confirmed this had taken place and had received a warm welcome to the home. The home does not provide intermediate care. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being fully involved in identifying their own needs and choices. Clear care plans, created from assessments of need help to ensure that people’s health and welfare needs are fully met. Medication is safely given by staff who know what they are doing. EVIDENCE: Since the last inspection considerable effort has been made in making the care records and care plans more person focused and staff have received training to ensure this is taking place. Further developments continue to take place. We examined in depth 3 care plans. Each person had a care record describing their care and support. We saw that wherever possible they had been involved in identifying their needs and this was shown by their signatures. Records showed an admission sheet, contract, agreements for bed rails, access to medical records, activity of daily living assessments, nutritional assessments, night routine, risk assessment, moving and handling assessments, life history/personal information, printed care plan with specific hand written details. The care plan described each person’s needs, aims, possible Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 12 approaches and outcomes/updates. All entries had dates and signatures of staff and the people receiving care and support. There was evidence of choice and preferences in the care plans. Care plans were regularly reviewed, again, with involvement of the person. We also saw where required there were clear records for wound management with body maps and references to referrals to speech, language and tissue viability specialist advice. Each person was registered with a GP and there were good links with community nurses and specialist support. We spoke with a visiting GP who was satisfied with the professional approach of staff. Throughout the inspection we saw staff responding to call bells promptly, with little fuss in a calm and friendly manner. Comments were, “the staff are very good” and “they are there if we need them”. We noted that those people who needed to be cared for in bed were comfortable with newspapers, magazines, drinks and the call bell placed near to them. People ho live at the home need support to take their medicines safely. During our visit we saw residents receiving the support they needed. All staff who administer medication are assessed before they do this. All registered nurses and senior care assistants give medication. A specific trolley was used and the member of staff identified the person, checked the medication against the chart, made sure the person had taken it and signed for it. The acting manager had a detailed medication policy, which staff said they use to make sure they provide support in the right way. The last pharmacy inspection was on the 20/5/2008. The report gave excellent for storage. There were no concerns. In addition there are regular medication audits the last being on the 7/6/2008. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged and supported to make choices to take part in a variety of social activities, which ensures that individual, social and cultural needs are met at the home. People choose from and enjoy a wellbalanced nutritious diet. EVIDENCE: At the entrance to the home there was a very clear, well-maintained notice board displaying all information about activities in the home. This included the activities programme for the week, summer fete and magic show for the 12/7/2008, details of the hairdressing service on Tuesday and Thursday and church service for the 24/7/2008. The acting manager employs a dedicated activities coordinator employed 20 hours a week. We saw meals being served in the 2 newly decorated dining rooms with new furniture from a hot trolley by catering staff. Tables were attractively laid with cruet and flower decorations for each table. Those people who needed assistance were helped by staff in a discreet and sensitive manner with staff sitting with them. Each person when admitted to the home had a nutritional assessment and information about this together with their likes and dislikes Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 14 was sent to the kitchen. The menu was displayed for the day. Breakfast included where requested a cooked breakfast. The main meal was a set menu with an alternative and dietary needs were being met. Where a person had specific needs arrangements could be made to be referred for dietary or swallowing advice and support. Staff had received food hygiene training. The Environmental Health officer for East Lindsey District council had made an inspection on the 7/6/2008 and as a result of this had awarded the home 3 stars “excellent” food hygiene award. We spoke with 3 visitors who told us they could visit whenever they wished to do so and always received a “warm and friendly welcome”. People living in the home told us “the food is the way I like it” and “I have had an enjoyable lunch”. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. People are protected from abuse by the correct recruitment procedures. EVIDENCE: There was a detailed complaints procedure in the statement of purpose and service user’s guide, displayed on the wall at the entrance to the home and on the back of each person’s bedroom door. A number of complaints had been received directly by the acting manager and we could see they had all been investigated using their complaints procedure and all of them were in a complaints register. We had received no complaints. At the time of our visit none of the people or staff had any complaints about the home. Each member of staff was correctly recruited with a check by the Criminal Records Bureau. All staff had formal training on abuse prevention both at their induction with updates. We spoke to 3 members of staff who knew clearly knew what abuse was and what they would do if abuse was suspected. The home had a copy of Lincolnshire’s Adult Protection Procedures. People felt they could approach staff if they had any concerns or worries. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People continue to live in well-maintained, comfortable, clean and safe accommodation. EVIDENCE: People have continued to live in comfortable and clean accommodation. Since the last key inspection there had been an extensive redecoration and refurbishment programme throughout the home. This continues with the development of a dementia unit on the first floor. Following the full refurbishment of the home, the provider and manager continue to ensure the home and grounds are maintained to a very high standard. There was a maintenance programme for all repairs and renewals. The home had up to date guidance about dementia, which also included design and signage. The new management team had extensive knowledge about this speciality and were keen to ensure that the service including the design and lay out met the Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 17 needs of the people. People we spoke with were complimentary about the standard of décor and cleanliness throughout the home. We saw staff cleaning the home and showing evident pride in their work. There were sufficient moving and handling and pressure relieving equipment in the home. There were infection control policies and procedures. The home had separate laundry and sluice facilities. Staff had gloves and aprons. Comments we received included “my clothes are looked after well”, “I find my room very comfortable” and “the home is always clean and comfortable”. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a safely recruited, well-trained staff team available who have the skills to meet the needs of the people living in the home. EVIDENCE: The levels of staff have increased since the last key inspection and the manager showed us that staffing is monitored to meet the changing dependency of the people living in the home. There were separate staff for activities, domestic, catering, administration, laundry and maintenance. The home also had a link nurse for tissue viability who had regular meetings with Lincolnshire Teaching Primary NHS Trust and met other nurses to promote best practice. They wish to extend this and develop other specialist nurses for other practices. All staff were recruited correctly with an application form, 2 references obtained, a check by the Criminal Records Bureau and a supported 2 day mentored induction. We spoke with 3 staff who confirmed this. Comments included “I had a very well thought out induction which prepared me for my work” and “I have learnt a lot”. The company had recruited a training coordinator since October 2007. Training had included safe guarding adults, privacy and dignity, resuscitation and choking, Makaton (specialist sign language), palliative care, safe handling of medicines and infection control, moving and handling, food hygiene, fire prevention, first aid and risk Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 19 assessment. In addition in preparation for the dementia unit all staff had received dementia awareness training. There were separate dementia guidance folders with guidance and information from the Alzheimer’s Society and the University of Bradford. In addition to this 60 of care staff either had achieved or were studying for a nationally recognised qualification. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and staff benefit from the positive leadership of the management team. Management record systems show that residents’ health, welfare, safety and choices are promoted. The management team ensures that that residents, relatives and professional visitors have the opportunity to voice their views and opinions. The management uses feedback from questionnaires to make improvements. EVIDENCE: A new manager was appointed to the home in July 2008 and was undergoing a supported induction from the compliance manager for the company. She was aware that she would need to obtain a management qualification. She was in the process of applying to us to be the registered manager for the home. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 21 She was supported by a deputy manager. Both were registered nurses with extensive care and management experience as well as knowledge about new approaches in dementia care. The manager holds regular staff meetings and told us how she uses these to further develop a person centred approach to care. Every member of care and nursing staff received regular formal supervision. People we spoke with had no concerns about the home and felt they could approach the staff or management if there were any concerns. Comments from staff were “everyone has been helpful and supportive”, “I like working here” and “I receive regular supervision”. Records were well maintained including regular audits for any money held on behalf of any people living in the home. Each person had a separate page detailing the amount date, signature and running total. Receipts for expenditure were also kept. The company had well established quality assurance systems in place, which were outlined in the statement of purpose. This included a quarterly meeting with people in the home. The last was held on the 23/5/2008 and minutes were available. Survey forms were to be sent out to obtain views about the home. The acting manager told us this would be done in the near future. In addition there were “how are we doing” questionnaires. The compliance manager made monthly monitoring visits and reports were available of the visits. Internal audits have been introduced to look at medication and care records. These had action plans where deficiencies had been found and improvements made. The home had policies and procedures and the compliance manager was developing up to date clinical procedures. There were comprehensive health and safety, fire and maintenance records. All were up to date, well maintained and available. Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 3 3 Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 23 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. 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. Refer to Standard Good Practice Recommendations Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Toray Pines DS0000002558.V367948.R01.S.doc Version 5.2 Page 25 - 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. 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