Care Home: Torpoint Nursing Centre

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What the care home does well Torpoint Nursing Centre provides nursing, personal care and support for a maximum of 57 people. On the day of the inspection people looked well cared for and those spoken to said they were happy living in the home. Staff were observed working with people in a positive manner which resulted in individualised care and support. The staff seemed to work well as a team. Pre admission assessments are always carried out to ensure that the home can manage the needs of the person. Emergency admissions under the RATS scheme (people being admitted to a care home for a short stay whilst they recover from a period of illness) are assessed by a healthcare professional who makes sure the home get information and a care plan detailing their needs prior to admission or very soon afterward. Prior to admission people (and/or their relatives) are encouraged to look around the home and spend some time there, they can ask any questions they may have and discuss any ongoing concerns. Ongoing training, done by the in house trainer and via outside agencies means that staff are up to date and have the skills to look after the residents. Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time and we were told that a range of activities are regularly offered to people. Entertainers are bought into the home regularly and the variety of communal space means that people can spend time where and with whom they like. The expert by experience reported the following `There is a team of three occupational therapists at the Centre, two of whom also work as carers. There appears to be a wide variety of exercises and activities to choose from both within the Centre and outside`. Feedback has told us that the level of activities and individual attention is appreciated. The ethos of the home is to let people spend time doing what they want to so mealtimes and activity times are not rigid in order to accommodate peoples different needs. The care plans are designed so that information about people`s interests, hobbies and important life and work history is recorded and is used as part of the homes `person centred care` approach. We were told that each person is also having a personal social history book developed that will be kept in their rooms. The home also provide palliative and end of life care and a number of staff have ongoing training in this area. They use the Liverpool Care Pathway end of life care programme when appropriate. This is considered good practice. People commented on the good quality of the meals the expert by experience reported that `Without exception people were very complimentary about the food`. What has improved since the last inspection? There were no requirements or recommendations following the last inspection. Ongoing redecoration and refurbishment means that people have a safe, homely and comfortable home to live in. What the care home could do better: The manager should ensure there is s system in place for verbal medication orders from the surgery to be followed up in writing either by letter or fax, as confirmation of the dose required. This will make sure that the dose written down is the correct dose required by the GP. The manager should review the night staffing levels to ensure that people`s needs can be met in a timely fashion at all times. The manager should ensure that the Health Protection Agency are consulted on the appropriate use of hoist slings and any actions required are implemented. Key inspection report Care homes for older people Name: Address: Torpoint Nursing Centre Vicarage Road Torpoint Cornwall PL11 2BW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Torpoint Nursing Centre Vicarage Road Torpoint Cornwall PL11 2BW 01752813677 01752816323 torpoint@torcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Torcare Limited care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Service users to include up to 27 adults with a physical disability (PD). Service users to include up to 27 adults with a terminal illness (TI) some of whom may have nursing needs. Service users to include up to 30 adults aged over 65 years with dementia (DE(E)). Service users to include up to 30 adults aged over 65 years with a mental illness (MD(E)). Service users to include up to 57 adults of old age (OP) Total number of service users not to exceed a maximum of 57. Date of last inspection Care Homes for Older People Page 4 of 27 Over 65 30 30 57 0 0 0 0 0 27 27 Brief description of the care home Torpoint Nursing Centre is one of three establishments owned by Torcare Limited. It provides nursing care for up to 57 people needing care and accommodation by reason of old age, some of who may be terminally ill, have a physical disability or be suffering from dementia or other mental disorder. In their Information Pack the home state that they have developed our care philosophy from the special method (specialized early care for alzheimers) by the Psychologist Oliver James. We have studied and used other methods but have found that our patients well being and contentment is far greater following Oliver James principles. Accommodation is provided mainly in single rooms, most of which are en suite. Although the home is divided in four areas these interlink and people can spend time in different parts of the home if this is to their advantage. There are however key pads at strategic points to safeguard people who might wander into an unsafe zone. The home is situated in the centre of Torpoint, close to shops and other local services. Outings are organised to take advantage of these as often as possible. People are encouraged to use the garden and patio areas, where seating is provided, when the weather is suitable. The home organises regular functions during the year to which family & friends are invited. The home involves relatives of both past and present service users in discussing and reviewing the homes performance to measure how well it attains the standards & criteria that it has set for itself, this is known as the Care Standards Committee and meets at least 4 times a year. Fees currently range from £530 to £650 per week. There are extra charges for hairdressing, chiropody and newspapers fro example. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key Inspection took place from 11.20 am until 5.20 pm on 14th December 2009. It was conducted with the general manager and the matron, the provider was available throughout the day if needed. A tour of the home was carried out and residents and staff were observed and spoken to informally during this time. A variety of records were seen during the course of the day. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission),the report done by the expert by experience* following the inspection and completed surveys from both care staff and residents was also used to help form the judgements made in the report. *An expert by experience is a person who, because of their shared experience of Care Homes for Older People Page 6 of 27 using services or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The three tasks that an expert by experience can do are to talk to people who use services, staff and management, observe daily life in the service and the interaction between staff and people who use services and look around the premises. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? There were no requirements or recommendations following the last inspection. Ongoing redecoration and refurbishment means that people have a safe, homely and Care Homes for Older People Page 8 of 27 comfortable home to live in. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The general manager said that people are always assessed prior to moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible invited to look around (without making an appointment) and spend some time at the home and ask any questions they may have. The AQAA states that We provide comprehensive written information about our service in our Statement of Purpose Information Pack, Financial Contract, brochures and website. The website (torcare .co.uk) says The Centre is dedicated to creating a flexible, caring, homely Care Homes for Older People Page 11 of 27 Evidence: environment for the medically and chronic sick. The AQAA told us that we offer an appropriate unit within the home where the service users needs can best be met. We are able to move the clients within the home to a unit appropriate to their needs with the minimum disruption and stress. The general manager said the decision to move people within the home is done with the person themselves or their representatives understanding and consent. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be met. Evidence: The 4 care plans examined set out peoples nursing and personal care needs and contained information about visits made by or to health care professionals such as GPs, opticians and dentists. Individual risk assessments seen were up to date and relevant, they included manual handling, nutrition and skin condition. The general manager said that the format of the care plans in changing in the near future to reflect the changes ongoing in care of the elderly and dementia care services, this will done by a working party that will include the Chairman of the Committee. A tour of the home showed that equipment to help skin stay in a good condition and for prevention of pressure sores is available and meets peoples current needs. The general manager said that they have enough equipment and can buy or rent more as required following assessment. The expert by experience was told by more than one person that , especially at night, not all hoists are charged and available leading to longer waiting times than they would like to have the attention they need. The general manager told Care Homes for Older People Page 13 of 27 Evidence: us that this issue has since been discussed at a general meeting that included staff and residents and that nothing could be substantiated. The manager is keeping an eye on the situation and will take any action if required. The medicines are stored in locked trolleys on each floor, the one seen was clean and well organised. The drugs fridge has its temperature taken and recorded daily. The records of administration were clear and a photograph of each resident is kept with the record to aid identification. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. It was advised that any verbal messages about medicine doses such as warfarin are followed up in writing (either by letter or fax) by the surgery as confirmation of the dose required. The ethos of the home is that they dont like to use sedative or antipsychotic medicines unless really necessary. The general manager said if it is being considered then she and/or the provider (who is a registered mental health nurse) have to be informed and a meeting is held to ensure all other avenues have been explored first. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. The expert by experience reported that everyone able to express an opinion said that they chose the time of their retiring and rising with some preferring to retire early to watch favourite television programmes from their bed. the home also provide palliative and end of life care and a number of staff have ongoing training in this area. They use the Liverpool Care Pathway end of life care programme when appropriate. The Marie Curie Caner care website (mariecurie.org.uk) states that this programme is recognised nationally and internationally as leading practice in care of the dying to enable patients to die a dignified death and provide support to their relatives / carers. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: We saw that people are encouraged to exercise choice in how they spend their time and activities are regularly offered individually or in groups. The care plans are designed so that information about peoples interests, hobbies and important life and work history is recorded and is used as part of the homes person centred care approach. We were told that each person is also having a personal social history book developed that will be kept in their rooms. The expert by experience reported the following There is a team of three occupational therapists at the Centre, two of whom also work as carers. There appears to be a wide variety of exercises and activities to choose from both within the Centre and outside. On the day of the visit, children from a local junior school entertained with a very varied selection of Christmas Carols and songs that many of the residents joined in Care Homes for Older People Page 15 of 27 Evidence: with. Various entertainers visit on a regular basis. The Centre has a small minibus used from time to time to take residents on trips. Carers accompany wheelchair users into the nearby shopping street. One person said he is able to go out to the shops unaccompanied. A party of residents has been invited to a nearby Naval establishment for drinks and entertainment and shortly lunch is to be taken by some at the local Community College. Holy Communion is available to all once a month. Visitors are welcomed at anytime and were seen coming and going freely during the inspection. They are also offered refreshments which is appreciated. One comment on a completed relatives survey was as a relative visiting we are made very welcome and their open door policy means we feel that the level of care and expertise shown is genuine. People can eat their meals in one of the dining rooms available or in their room if they wish. The expert by experience reported that Without exception people were very complimentary about the food saying The food is quite good, Theres a lot of good food, Its so good I have to be careful I do not eat too much so I quite often have salad instead of sandwiches, The food is of good quality and so much of it, The food is surprisingly nice compared with my last Care Home and The food is very nice and we can have wine with it sometimes. People have the choice of eating in a dining room, their bedroom or in a lounge. Cooked breakfast is available, followed by a choice of two main cooked items for lunch with tea being a choice of either cooked or cold food. If a resident is out for the day a hot meal is available on their return. Feedback on relatives and Service Users surveys was generally positive about the meals, 2 people commented that variety in the diabetic desserts could be improved. Special diets are catered for and the chef said that he has regular communication with the nursing and care staff about peoples dietary needs. The ethos of the home is to let people spend time doing what they want to so mealtimes and activity times are not rigid in order to accommodate peoples different needs. The provider said that this sometimes looks like the home is in organised chaos but that is how they prefer it as it means people are not been expected top conform to rigid regimes. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Staff undertake regular safeguarding training. This means that people who live at the home can be sure that any concerns they have will be taken seriously and that they are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the Service Users Guide. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been 2 complaints made to the Commission in the last 12 months, these were passed to the home to deal with and they did so effectively, using their own robust complaints procedure The AQAA states that the home received 2 complaints in the last 12 months both of which were upheld. The general manager said that people are seen by senior staff daily and hopes that any issues or concerns could be bought up then. She added that they have regular contact with a number of relatives and feels they would be able to approach them with any concerns that would then be dealt with quickly. All but 1 of the 15 completed Service Users and relatives surveys indicated they know how to make both formal and informal complaints. Records show that staff have attended safeguarding training, they also have information about safeguarding when doing National Vocational Qualification (NVQ) Care Homes for Older People Page 17 of 27 Evidence: training and during induction training. The senior staff are familiar with the local safeguarding procedures and the general manager or provider are on call at all times if any staff have any safeguarding issues to report. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment, redecoration and maintenance means that people have a comfortable, homely and safe environment in which to live. Evidence: The home is close to public transport, local shops and other facilities of Torpoint. The home is divided into 4 units (each designed to meet the different needs of the residents), but as people mix between the units a homely atmosphere is created. There are bedroom and communal facilities on the ground and first floors. On the day of the inspection 51 people were resident at the home. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. People spoken to by the inspector and the expert by experience indicated that they were happy with their current accommodation. The provider has an ongoing programme of routine maintenance and redecoration. The general manager said that in the dementia units toilet and bathroom doors are often left open so that the residents can identify what they can see and where they are. They also get to know individuals ability to recognise things and will mark their room doors or other areas as appropriate to help them navigate around their area of the home, as they have identified that one approach does not fit all residents needs and abilities. The expert by experience commented as follows There is a variety of dining areas and lounges with comfortable chairs thus providing choice for people. The home is tidy Care Homes for Older People Page 19 of 27 Evidence: without giving an institutional feeling. The temperature was good and there were no unpleasant odours. He added that One Unit has a glass panelled dining room/sitting area surrounded by a corridor on all four sides, without the benefit of external views apart from the glass roof through which the sky and upper floors of the building can be seen. Sitting in this space is akin to being in a goldfish bowl but without the advantage of viewing the outside world. This was pointed out to the general manager during the inspection who said that she had never thought of the room in that way would would be mindful of who uses the room and that staff or visitors are always present if people are in there and that nobody had ever commented on the room or that they dont like it. The home complies with the local fire service and environmental health department requirements. There are enough assisted bathrooms, shower rooms and toilets for the people who currently live at the home and some rooms have en-suite facilities. People access the first floor via one of 2 shaft lifts. On the day of the inspection the home was clean, tidy and hygienic. Six of the seven completed residents surveys indicated that the home is always fresh and clean with the seventh indicating that it usually is. Policies and procedures around infection control are up to date and available to staff at all times. In house training on the importance of infection control is routinely offered to staff. There is a maintenance man who deals with ongoing and routine maintenance and servicing. Outside contractors are used as necessary for bigger jobs. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are adequate meaning peoples needs are being met most of the time. The recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: On the day of the inspection there were appropriate staff numbers and skills mix available to provide the required nursing personal care and support for people. There are always 2 trained nurses on duty, with each unit having a senior carer and group of care staff on duty during the day. The general manager said that the staff rotate around the units so that all staff are able to look after all of the current residents needs. The expert by experience reported that Call bell response time was said to usually be within 5 minutes but some said that frequently at night the carer would arrive and announce they would have to return with a colleague and this would cause a delay which one person said could be of up to two hours which was a long time when waiting for a commode or bedpan. There were allegedly night time delays in carers arriving with a hoist needed to effect a transfer with claims that a hoist was not available due to a flat battery or the slings were missing or the wrong ones (see explanation under the health and Personal care section). Several people said they felt that there were insufficient staff on duty at night. When this was discussed with the Care Homes for Older People Page 21 of 27 Evidence: general manager during the inspection she said that they would review the night staffing arrangements, the number of hoists being used and charging of the batteries. Three of the 7 completed staff surveys indicated that there are always enough staff on duty and remaining 4 that there are usually enough staff to meet he individual needs of the residents. There is a stable staff group and a variety of training opportunities are provided, by the in- house trainer, that includes first aid, moving and handling and food hygiene. The expert by experience was told that With one exception everyone said that generally they got on well with the staff and the manager commenting, No problems with the staff, All the carers are so friendly, The staff are very helpful, The staff are well trained and know what they are doing, The staff may be untrained when they arrive but they are soon put on courses for their NVQs, The staff are lovely and we get on well, and They are looking after me very well. The 5 staff files we looked at all had completed application forms, 2 written references, CRB and POVA clearances, statements of terms and conditions of employment and job descriptions. They were well organised and stored securely. The AQAA states that 31 staff have completed an induction process and all of the completed staff surveys indicated that their induction covered everything they needed to know to do the job when they started very well. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The attitude to health and safety shown by the provider, nursing, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The new manager has worked as a nurse at Torpoint Nursing centre for a number of years. This is her first managers post and she has the full support of the general manager and the provider. The in house trainer ensures that all statutory training is up to date that includes manual handling, fire safety, first aid and infection control. The slings used with hoists were discussed with the general manager as it could not be identified if people had their own slings in the right size and how often they are laundered. It was recommended that each person who uses a hoist has their own sling measured to fit them which should reduce the risk of cross infection from using Care Homes for Older People Page 23 of 27 Evidence: communal slings. The home has agreed to ask the health Protection Agency for advice on this matter and if any changes are required these will be implemented. The registered provider was able to demonstrate that there are appropriate checks in place for various health and safety procedures including portable appliance tests, insurances, environmental health and the maintenance of fire safety. The registered provider conduct regular quality assurance surveys seeking the views of the people who use the service, their relatives and a number of health care professionals. They also have a Care Standards Committee (made up of people who have had or currently have relatives living in one of Torcares services) who meet regularly throughout the year to review inspection reports and discuss any other intended changes and upgrades to the service. Minutes from their meetings are sent to CQC for information.This is noted as good practice. The results completed surveys are analysed and evidence that action is taken to improve the service is made available in the home and to the Commission. A number of thank you cards and letters were seen during the inspection. The homes policies and procedures are up to date and available to staff at all times. We saw the written records kept of all financial transactions on behalf of the residents, they included income and outgoings and receipts. Secure facilities are used for storage of money and any valuables. The registered provider maintains the health, safety and welfare of the residents through implementation of their policies and procedures. Appropriate records were seen to demonstrate this. The maintenance man carries out ongoing routine house and garden maintenance. The expert by experience noted that The chrome framework in one toilet was heavily corroded and long overdue for replacement. This was pointed out to the manager who said that it would be replaced. She added that she would ensure all equipment is regularly checked to ensure it is in good condition. There appeared to be a good rapport between management, staff and residents throughout the inspection and also from comments made in completed staff surveys such as the management seems to have a genuine interest in the well being of the residents and will listen to our concerns. Regular supervision of staff is undertaken and appropriately recorded. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The manager should ensure there is s system in place for verbal medication orders from the surgery to be followed up in writing either by letter or fax, as confirmation of the dose required. The manager should review the night staffing levels to ensure that peoples needs can be met in a timely fashion at all times. The results of the review should be sent to the Commission. The manager should ensure that individual slings are provided for people who need to use a hoist, this will make sure that each person has one that is the right size for them and it will decrease the risk from cross infection if a sling is used for more than one person. 2 27 3 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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